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Refractive Lens Exchange


RLE procedure is exactly the same as routine cataract surgery. ... procedure A phoropter is used to measure refractive errors A small incision is made close to ... – PowerPoint PPT presentation

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Title: Refractive Lens Exchange

Refractive Lens Exchange
How the eye works
  • Light rays enter the eye through the clear
    cornea, pupil and lens.
  • These light rays are focused directly onto the
    retina, the light-sensitive tissue lining the
    back of the eye.
  • The retina converts light rays into impulses,
    sent through the optic nerve to your brain, where
    they are recognized as images.
  • 70 of the eye's focusing power comes from the
    cornea and 30 from the lens.

Refractive errors
  • Inability to see clearly is often caused by
    refractive error.
  • Four types of refractive error
  • Myopia (nearsightedness)
  • Hyperopia (farsightedness)
  • Astigmatism
  • Presbyopia

Refractive errors myopia
  • In myopia (nearsightedness), there is too much
    optical power in the eye
  • The distance between the cornea and the retina
    may be too long or the power of the cornea and
    the lens may be too strong.
  • Light rays focus in front of the retina instead
    of on it.
  • Close objects will look clear, but distant
    objects will appear blurred.

Myopia, or nearsightedness
Refractive errors hyperopia
  • In hyperopia (farsightedness), there is too
    little optical power.
  • The distance between the cornea and the retina
    may be too short.
  • Light rays are focused behind the retina instead
    of on it.
  • In adults (but not children), distant objects
    will look clear, but close objects will appear

Hyperopia, or farsightedness
Refractive errors astigmatism
  • In astigmatism, the cornea is curved
    unevenlyshaped more like a football than a
  • Light passing through the uneven cornea is
    focused in two or more locations.
  • Distant and close objects may appear blurry.

Astigmatism occurs when light passes through
football-shaped cornea and/or lens
Refractive errors presbyopia
  • Presbyopia is an age-related condition in which
    your eyes gradually lose the ability to see
    things up close, because the lens of the aging
    eye can no longer change shape.
  • When we are young, the lens in our eyes is
    flexible and is able to change focus easily
    between near and far objects, like an autofocus
    on a camera.
  • At around age 40, this flexibility begins to
    gradually decrease, making it more difficult to
    see objects up close, unless the eye has

What is refractive surgery?
  • A group of outpatient surgical procedures used to
    alter how your eye focuses light rays on the
    retina, thereby improving vision and reducing
    dependence on glasses and contact lenses.
  • In most cases, refractive surgery affects the
    shape of your cornea to redirect how light is
    focused onto the retina. Popular procedures
    include LASIK, LASEK, PRK and CK.

Refractive surgery procedure on the cornea
What is refractive surgery?
  • Most refractive surgery is performed on the
    cornea and affects only the front of your eye,
    while the rest of your eye will change naturally
    as you age.
  • In some cases, refractive surgery procedures
    dont reshape the cornea instead, the eyes
    natural lens is either replaced or enhanced by an
    implantable lens that helps correct vision.

What is Refractive Lens Exchange (RLE)?
  • A non-laser procedure where the natural,
    non-cataractous, lens of the eye is removed and
    replaced with an artificial, intraocular lens
  • The cornea is not reshaped.
  • Used to treat moderate to high degrees of
    nearsightedness (myopia), farsightedness
    (hyperopia) and patients who are not LASIK

Typical intraocular lenses (IOLs) used in the
refractive lens exchange (RLE) procedure
How is the RLE procedure performed?
  • The IOL is implanted in a surgical procedure and
    performed on an outpatient basis under local or
    topical anesthesia.
  • Procedure takes approximately 15-20 minutes.
  • RLE procedure is exactly the same as routine
    cataract surgery.

How is the RLE procedure performed?
  • In addition to a complete pre-operative eye exam,
    these measurements are performed to give the
    surgeon the necessary information to calculate
    the necessary power of the IOL
  • Keratometry measurement of the form and
    curvature of the cornea.
  • Retinal exam.
  • The axial length of the eye from the cornea to
    the retina (A-scan).
  • The depth of the anterior chamber.

A phoropter is used to measure refractive errors
How is the RLE procedure performed?
  • After the eye is numbed with topical or local
    anesthesia, one to three small incisions are made
    close to the edge of the cornea.
  • After the procedure, these incisions are usually
    self-sealing, requiring no stitches.

A small incision is made close to the edge of the
cornea, prior to removing the natural lens and
inserting the IOL
How is the RLE procedure performed?
  • A tiny, high-frequency ultrasound instrument is
    inserted into the eye to break up center of the
    eyes natural, crystalline lens.
  • The lens is then gently vacuumed out through this
    same instrument.

The eyes natural lens is suctioned out through
an incision
How is the RLE procedure performed?
  • An IOL is folded and inserted through the same
    incision that was made to extract the natural
  • The IOL is then unfolded and placed into the
    "capsular bag" that originally surrounded the
    natural lens.

IOL in the eye
Considerations for the RLE procedure
  • May be recommended for patients who have
    cataracts starting to form.
  • May be recommended for patients with thin corneas
    who are otherwise not candidates for the LASIK
  • May be recommended for patients with unusually
    high refractive error.

Considerations against the RLE procedure
  • Patients with significant ocular disease of any
  • Patients with a history of retinal detachment.
  • Patients with any reason for increased risk of

Risks and possible side effects of RLE surgery
  • Over-correction or under-correction (with a
    possible need for a re-treatment).
  • Infection.
  • Increased floaters or retinal detachment.
  • Dislocation of implant.

Is refractive surgery right for you?
  • Advanced surgical procedures, including
    refractive lens exchange, are creating more
    opportunities for people who want to be less
    dependent on glasses or contacts.
  • Surgery may not entirely eliminate your need for
    corrective lenses. Glasses/contacts may still be
    needed for activities such as fine or detailed
    work, reading and perhaps night driving.

Is refractive surgery right for you?
  • A large part of the success of any refractive
    surgery depends on your understanding of the
    procedure and your expectations.
  • Since refractive surgery is an elective
    procedure, you have the opportunity and
    responsibility to become fully informed about its
    risks and benefits.
  • Your ophthalmologist will explain the specific
    technique, its benefits, as well as possible
    risks and side effects associated with your case.

Discuss options and questions with your
  • With the help of your ophthalmologist, its
    ultimately your responsibility to weigh the risks
    and side effects of a procedure with the benefits
    it has to offer.
  • If you decide refractive surgery is right for
    you, you may join millions of people who have
    reduced their dependence on glasses or contacts.
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