When natural crystalline lens of the eye is still clear, cataract surgery is called Refractive lens exchange.
Refractive lens exchange (RLE) is performed to treat the following two conditions:
- Short-sightedness and/or long-sightedness
Treatment is tailored to the individual to facilitate the best possible vision that will suit their lifestyle requirements. It is important to bear in mind that there is no perfect solution to match all lifestyle needs. During the consultation, the surgeon will help you pick an option that is most suitable for you.
Frequent asked questions (FAQs):
AI has an important and evolving role to play in improving outcomes of refractive lens exchange and refractive lens exchange surgery.
- At the AI Vision clinic, we utilise an artificial intelligence (AI) based system to determine the visual distances most commonly used by patients. This helps the patient and surgeon determine which lens to use for refractive lens exchange surgery.
- Artificial intelligence (AI) is also used to increase the accuracy of lens selection at the AI Vision Clinic. Accurate lens selection is a key determinant of clarity of vision following refractive lens exchange. We believe that the surgeon’s experience combined with AI maximises the chance of achieving your desired visual outcome.
In the hands of an experienced surgeon, the operation takes 10-15 min. The patient can go home immediately after routine surgery, and vision usually improves significantly within a few days.
NICE guidelines (adopted by Royal College of Ophthalmologists) state: ‘having a PCR rate of approximately 2% or less is widely regarded as an indicator of surgical competence’. (NICE cataract surgery guidelines 2017).
Mukhtar Bizrah has extensive experience in refractive lens exchange and cataract surgery. Despite managing complex cases, his posterior capsule rupture (PCR) rate is 0.8%, which is one of the lowest nationally.
Refractive lens exchange enjoys a good safety profile. Risk of needing another operation is 1 in 100, and risk of permanent loss of vision (due to severe infection or bleeding) is approximately 1 in 1000. Patients who are short-sighted (condition known as myopia) have an increased risk of retinal detachment. About 20% of patients may develop clouding behind the implanted lens, which may require treatment with laser. The laser treatment usually takes a few minutes and recurrence of the problem is extremely rare.
You vision will depend on the type of artificial lens that you choose to be implanted inside the eye during the surgery. Options include:
- Monofocal lens: Many individuals prefer to have excellent vision in the distance, and are happy with the option of wearing spectacles (glasses) for near (reading) vision. A monofocal lens enables excellent clarity and contrast for a chosen distance (distance, intermediate or near vision). It does not allow one to see well for both distance, intermediate and near without spectacles. A monofocal lens is the least likely to result in haloes.
- Toric lens: This enables treatment of astigmatism, as well as the cataract. A toric lens is highly recommended for suitable individuals who have a significant degree of astigmatism
- Enhanced depth of focus lenses: These enable patients to see well for both distance (4 or more metres) and intermediate (about 1 metre) vision. For fine near vision, spectacles correction is often needed. They are less likely to result in haloes and glare than trifocal lenses.
- Trifocal lenses: These enable individuals to see well for distance, intermediate and near visual activities. The overall contrast of vision is for each distance is not as good as a monofocal lens set for a certain distance. However, these have the major advantage of allowing spectacle independence.
- Blended vision (also known as monovision): This means implanting a monofocal lens to enable distance vision in one eye, and a monofocal lens for near or intermediate vision in the other eye. While the idea sounds complex, a surprising number of patients opt for this and are pleased with the outcomes.
Choice of the lens is based around your preference and lifestyle, as well as the presence of other eye conditions. The above provides a blueprint, and more detailed discussion with an experienced surgeon will help you make the decision that is right for you. An artificial intelligence (AI) based device can also be used by the AI clinic to help you determine your lifestyle needs.
At the AI vision clinic, we utilise 3 key elements in our management of patients:
- Patient choice
- Clinical and surgical expertise
- Evidence-based treatments and artificial intelligence (AI)
Large clinical trials have not shown laser-assisted cataract/RLE surgery to improve patient outcomes nor safety of surgery. At the AI vision clinic, we therefore do not perform this procedure, as we cannot ethically justify the increased cost to the patient.
Previous laser eye surgery does not affect your ability to have refractive lens exchange. The main challenge in such cases is choosing the correct lens to be implanted inside the eye. Previous laser eye surgery affects accuracy of eye measurements, which in turn affects choice of lens to be implanted inside the eye.
Mukhtar Bizrah trained in one of the highest volume cataract surgery clinics in North America for patients with previous laser eye surgery (e.g. LASIK or PRK). Using his vast experience in this field, he is able to optimise visual outcomes and minimise risks of unexpected surgical results following cataract surgery and refractive lens exchange.
Yes, at the AI Vision Clinic, refractive lens exchange surgery can be performed on both eyes on the same day.