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Refractive Lens Exchange: Understanding Dysfunctional Lens Syndrome

Posted on April 8, 2021
Close-up Brown Eye.

Once someone reaches their 40s, they’re likely to experience changes in their vision. 

Presbyopia occurs when the lens in the eye naturally becomes less elastic. The lens is a clear, curved tissue that flattens or bulges out to focus on objects. From the moment you’re born, the lens begins to lose its flexibility, but it’s typically middle age before you notice the difference.

Between 25% and 35% of the eye’s ability to focus comes from the lens. People have the option of correcting a hardened lens or dysfunctional lens syndrome with refractive lens exchange, also known as RLE.

Continue reading to learn about the stages of DLS and the RLE procedure.

The Stages of Dysfunctional Lens Syndrome

DLS occurs in three gradual stages. They begin in your 40s and should stop in your 60s.

Stage 1 of Dysfunctional Lens Syndrome

The first stage of DLS is the onset of presbyopia. As mentioned before, this stage commonly starts in your 40s. The lens is hardened to the point where the change in eyesight is noticeable.

You’ll find it difficult to read something that’s 14 to 16 inches away.

Because the lens is more rigid, you will have trouble focusing on things that are close to you. People with presbyopia have to get bifocals or reading glasses to correct this vision problem.

These same people may not have any issues focusing on objects that are far away. The lens’ curvature doesn’t have to move as dramatically when focusing on things in the distance. The lens has to flatten rather than become rounded.

Treatment Options

The lens is still healthy at this point. It’s not as flexible, but it’s clear. Refractive lens exchange is just one of the possible treatment options for this stage of DLS.

People may choose LASIK in one eye (if they qualify for LASIK) for distance vision and LASIK or RLE in the other eye for near vision. Sometimes, depending on the amount of nearsightedness a patient has they may not even need to treat the near eye.  It may sound odd to get LASIK in one eye instead of both. However, your brain will correct the imbalance between your eyes by choosing the appropriate eye to see. One eye with nearsightedness eye is enough to read without reading glasses for most patients after surgery.

Stage 2 of Dysfunctional Lens Syndrome

The second stage of DLS occurs in people between their late 40s and mid-50s. The natural lens inside the eye not only becomes rigid but also loses its optical quality as we age.  This is most notable trying to read in low light environments like a dim restaurant. The deterioration of the lens results in light scatter. 

A healthy lens is totally clear and allows light to cleanly pass through. As you age, the proteins that make up the lens denature or alter molecularly. This causes the lens to turn yellow and disrupt the passing of light.

You’ll experience worse night vision and mild glaring, and find that you are constantly needing more and more light to read well.  

Treatment Options

This is the stage where an eye doctor would suggest getting RLE over LASIK for most patients. The specific process of RLE will be explained later in the article. Basically, the dysfunctional lens is replaced with an intraocular lens or IOL.

Stage 3 of Dysfunctional Lens Syndrome

The lens continues to yellow and harden, further worsening the ability to focus and see things clearly. Overall, vision is poor at this point because even less light passes through to the retina. During the final stage of DLS, the lens becomes cloudy is called a cataract.

Cataracts affect the perception of color as well as the quality of vision. Glaring is significantly worse.

Untreated cataracts can turn white or even dark brown. People who let their cataracts become too advanced can lose all vision in that eye. Worldwide, untreated cataracts are the leading cause of blindness.

Treatment Options

Opaque lens or cataracts are treated with cataract surgery. In this kind of surgery, the cataract lens is removed and replaced with an artificial lens known as an IOL.

What is Refractive Lens Exchange?

Essentially, RLE is the exact same procedure as cataract surgery but is done on a lens that has not yet become cloudy.  RLE is also known as clear lens extraction or lens replacement surgery. Someone with presbyopia or severe farsightedness (hyperopia) can choose to get RLE. An artificial lens called an IOL replaces the natural, but dysfunctional lens inside the eye.

There are three types of IOLs. Monofocal fixed-focus IOLs correct only one kind of refractive error. You’d have clear vision at either a close range, intermediate range, or far range.

Accommodating IOLs are monofocal lenses that allow the eye to focus at different ranges. When changing the focus power, the IOLs literally shift within the eye.

People can see at various distances with multifocal IOLs, too. However, these IOLs remain stationary.

The Refractive Lens Exchange Procedure

The whole procedure only takes about 7-8 minutes per eye. Patients get one eye treated at a time. Numbing drops are used as is a local anesthetic so pain or discomfort are uncommon.

Recovery takes about a week and although many see immediate improvements, it takes a few weeks for the improvement to reach its peak.

Side effects of RLE you may experience during recovery include glaring, halos, blurring, and itchy eyes.

You shouldn’t feel the IOLs and no one will be able to see them because they’re behind your pupil and iris. The corrective effects of IOLs are permanent and regression is unlikely.

The Risks of Refractive Lens Exchange

Clear lens extraction is more invasive than LASIK so there are more risks. Most of these risks can be minimized with surgery or medication. Severe complications are rare.

Risks include a dislocated IOL, eye pressure, retinal detachment (more likely with extreme nearsightedness), droopy eyelids, and bleeding or infection in the eye. Multifocal IOLs can cause blurring, glare, and halos.

Is Refractive Lens Exchange Right For You?

You may want to consider refractive lens exchange if you’re over the age of 40 and notice your vision gradually worsening, especially when you look at things up close.

You might have relatives that are already experiencing the benefits of cataract surgery and are seeing even better than you are up close now.  Why wait until the lenses become cloudy to have them removed when you can enjoy those same benefits now and never need cataract surgery as a result?

RLE is quite often successful treatment for presbyopia and severe refractive errors despite the risks.

Don’t hesitate to contact us with any questions. You can also call us at 512.346.3937.

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