Lens Replacement Surgery
Lens replacement surgery, aslo known as refractive lens exchange (RLR/RLE), is an alternative procedure for patients who have either presbyopia (where the eye cannot focus), high hyperopia (farsightedness) or for those patients with a very thin cornea.
What Is Lens Replacement Surgery?
|Cost||£2000 to £4,000 per eye|
|Surgery Time||15 minutes|
|Discharge Time||After a few hours|
If you suffer from near-sightedness (myopia) or far-sightedness (hyperopia), you may be able to undergo refractive lens exchange to correct your vision impairmen, if you are not suitable for LASIK, LASEK or PRK surgery.
With this procedure, vision is corrected through the removal of your natural eye lens, and the fitting of a replacement known as an intraocular lens. This lens will enable you to see clearly and to focus, which negates the need for glasses or contact lenses. Ahead of the treatment, your nurse will administer anaesthetic drops to numb the eye so that you don’t experience any pain or discomfort. The procedure lasts about 15 minutes, and is similar in nature to cataract surgery (you will need to leave about a week in between treatments for each eye). For most patients, vision will be improved and the difference will become noticeable in the following days, although it may take up to a week for you to be able to resume your normal routine.
If you have conditions such as presbyopia or hyperopia for example, or if your cornea is considered to thin to withstand corrective laser eye surgery, lens replacement surgery could be a very viable option.
However, with near-sightedness, images that enter the eye are focused in front of the retina instead of entering it, which results in the images appearing blurry. Surgery changes the shape of the lens so that images can enter. For far-sightedness, images are positioned behind your retina rather than on it. Surey can correct this by replacing the lens.
Am I Eligible For Surgery?
Lens replacement surgery isn't for everyone. If you have myopia (short-sighted) or a mild form of hyperopria (long-sighted) the drawback and limitations mean that some other form of laser surgery is usually a better option. Instead lens replacement is more suited to three specific situations:
- You have severe hyperopia (long-sighted)
- You have presbyopia (a natural, age-related change to your lens that makes it harder to focus on objects close to your eye)
- You have a combination of both presbyopia and moderate hyperopia
How Much Does Lens Replacement Cost?
Lens replacement/refractive lens exchange surgery costs between from £2000 to £4,000 per eye depending on the technique used to correct the patient’s vision as well as the amount of correction required.
Watch Mr Romesh Angunawela, Consultant Eye Surgeon at Moorfields Eye Hospital, explain the available alternatives to laser eye surgery and lens replacement surgery costs:
"Patients often ask me what the options are if they can’t have laser surgery and that is something that I can offer patients because I don’t just do laser surgery, I do lens surgery and other types of surgery and some patients just aren’t safe to have surgery done. Either their prescription are too high or they’ve got some underlying condition where you think by doing laser surgery you might make it worse.
Options really that are feasible for these patients are things like Visian ICL lens. The ICL lens is an implantable contact lens that is inserted into the eye and that’s great for patients who have very high prescriptions, or who have conditions like dry eye where doing the laser surgery would make their dry eye worse. The ICL lens doesn’t do that, and the quality of vision you get with an ICL lens is fantastic.
Patients with very high prescriptions or very thin corneas who can’t have laser surgery are suitable for that.
Other alternatives are patients who want to be free of reading glasses, older patients who may have some early cataract or early lens change for whom laser surgery isn’t the best option. For those patients I tend to do lens exchange surgery and use multifocal lenses, and multifocal lenses are great for giving those patients greater independence from needing glasses for distance vision and reading vision. It means they can have a more independent free life from needing to walk around with reading glasses.
There are lots of other options other than laser surgery and it’s using the right one for the right patient that’s really part of the decision making process."
Mr Romesh Angunawela, Consultant Eye Surgeon at Moorfields Eye Hospital
What Are My Finance Options?
Many of the clinics offer patients a range of payment options including payment plans and 0% interest deals for RLE / IOL surgery. The repayment conditions will vary from clinic to clinic and most will require a deposit and patients to undergo credit checks before they are offered.
For example, Optical Express offer the following repayment terms which can help break down the cost of surgery into manageable monthly repayments allowing the patient to repay the cost of surgery over 10-72 months:
|Treatment||Deposit||APR||Price Per Month Over 10 Months|
|Monofocal RLE / Cataract||£500||0%||£149.50 per month|
|Multifocal RLE / Cataract||£500||0%||£249.50 per month|
|Phakic IOL||£500||0%||£249.50 per month|
Prices taken in July 2016
The Different Types Of IOL's Available
In RLR surgery the surgeon will remove the patient's natural lens and replace it with a synthetic lens.
The treatments can differ slightly and include:
- Monofocal fixed-focus lens implant - This type of lens will help correct distant vision, mid-range and close ranges however not all at the same time. It is recommended to patients over 40 or those with cataracts. A fixed focus lens implant is also used when patients suffer from a specific type of refractive disorder, including high myopia.
- Accommodating IOLs - This lens implant enables the patient to see both close up and far away without the need for an additional aid by shifting its position in the patient's eye.
- Multifocal lens implants - Multifocal lens implants correct for both short and long sightedness. This technique is not recommended for patients with small pupils or those who do a lot of night driving due to the possibility of ‘halos’ obscuring their vision.
What's The Difference Between Lens Replacement Surgery & Cataract Surgery?
The only difference between lens replacements surgery and cataract surgery is whether the patient's natural lens is cloudy or not due to cataracts.
Cataracts surgery involves the removal of an individual's natural lens which has become opaque (a cataract) and implanting a synthetic lens. Cataracts surgery differs from RLE, as the lens removed in RLE does not necessarily suffer from cataracts.
As one of the most commonly performed medical procedures in the world, common candidates for cataracts surgery are typically the elderly.
What Are The Benefits Of Lens Replacement Surgery?
This form of surgery can present a permanent solution to people with refractive errors and cataracts sufferers. As the natural lens is replaced with an IOL patients who receive surgery will never require further surgery later in life as the artificial lens won't be affected by degenerative diseases or age-related deterioration.The artificial implant itself isn't visible to the naked eye and the patient won't notice a difference or any discomfort after a few weeks.
Lens Replacement Surgery Procedure
Refractive lens replacement surgery is generally performed on an out-patient basis, patients will not normally spend more than a few hours in the clinic and the procedure itself will take no longer than 15 minutes. The procedure is performed under a local anaesthetic, where drops are used to numb the eyes during the procedure. Incisions are then made in the eye after which the old lens will be extracted and the new artificial lens fitted. The natural lens will be removed with the assistance of ultrasound before the replacement synthetic lens is inserted.
Lens replacement is a common procedure that millions of patients undergo each year to both help patients overcome refractive conditions such as hyperopia and presbyopia as well as treating cataracts. It is considered to be one of the safest and most effective optical procedures available.
Following surgery patients will be able to resume 'normal' activity within a week, in this time patients will be able to return to work and start to drive again.
The final results of lens replacement surgery can take up several weeks to reveal themselves and over the recovery course patients may experience one or many of the following short term side effects:
- Blurred vision
- Mild discomfort
Risks & Complications
This particular type of surgery is believed to be very safe, perhaps even safer than laser surgeries which have become somewhat trivialised as a 'lunchtime' procedure thanks to their ease and high success rates. Many of the risks of clear lens replacement surgery are minor complaints such as sticky eyes from pus and bruising around the surgical area, but more serious complications can occur, although they are very rare.
The most likely serious complication of this surgery is posterior capsule opacification (PCO) which is when the surgeon fails to remove all the fragments of the original lens. The natural response is for the lens particles to regrow around the artificial lens, which can cause severe vision problems. However, this condition can be rectified using laser surgery to fully remove the natural cells.
Vision After Lens Replacement Surgery
Once you have fully recovered from surgery, the effect should be similar to having contact lenses, albeit ones you never need to replace. As the implanted lens is tailored to your specific eyes, the surgery should mean your vision is clear at all distances.
If you've had lens replacement treatment designed to treat presbyopia (or a combination of presbyopia and hyperopia), you'll usually have been given a multifocal lens. The effect will be similar to wearing bifocal spectacles that work for both long-distance and close-up vision.
Remember that if you have lens replacement surgery earlier in life, designed to treat hyperopia, you will likely still develop presbyopia naturally later in life. You may therefore still need special spectacles ("reading glasses") for close-up vision.