RLE: The Best LASIK Alternative After 40

Mar 29, 2022
 – Eduardo Besser, MD

What is Refractive Lens Exchange and is it a viable alternative to LASIK? Learn more about this procedure and if it’s right for you.

With over 700,000 procedures a year, LASIK (laser vision correction) remains one of the most popular treatments for those looking to improve their vision and eye health. While LASIK gets most of the attention, many patients are in fact better candidates for alternative refractive surgeries that also have reliable, long-proven track records of highly successful results. One such procedure that combines well-established surgical technique with powerful advances in lens technology is refractive lens exchange.

Refractive lens exchange (also called "lens replacement surgery" and "clear lens extraction") is a popular vision corrective alternative for patients over 40 seeking freedom from glasses and contact lenses.

What is refractive lens exchange?

Refractive lens exchange (RLE) is an elective eye surgery that corrects vision problems such as myopia, hyperopia, and astigmatism, with the added benefit of correcting presbyopia (age-related inability to see up close). It is the same surgical procedure used to remove cataracts. Cataract surgery ranks among the most successful of all ocular and non-ocular surgical procedures.

During RLE, an ophthalmologist removes a patient’s natural lens and replaces it with an artificial intraocular lens (IOL) that improves poor vision. Think of it as implanting a contact lens in your eye.

Clear lens vs cloudy lens

With the new lens implant, patients can enjoy stable vision and eliminate the risk of visually significant cataracts in future.

Refractive Lens Exchange vs. LASIK

LASIK and RLE are both reliable vision correction surgeries with high success rates, strong patient satisfaction, and quick recovery times.

While patients can rely on both options, when comparing refractive lens exchange vs. LASIK it’s important to understand that the procedures utilize different techniques to achieve refractive correction, and take place in different parts of the eye.

RLE is a lens replacement surgery where a patient’s natural lens is removed, and a clear artificial lens is inserted. It corrects vision by operating on the dysfunctional lens in the back of the eye.

LASIK surgery is a laser-assisted procedure where an ophthalmologist reshapes a patient’s cornea. It corrects vision by operating on the eye's surface, removing microscopic layers in the corneal tissue, and smoothing irregularities.

Lasik surgery procedure

Limitations of LASIK surgery

While LASIK remains a safe and reliable vision corrective surgery, when comparing refractive lens exchange vs. LASIK for patients over 40, RLE comes out as a clear winner.

As we age, our eyesight deteriorates because of presbyopia, a condition where the lens hardens over time, making it difficult to focus on objects at a close range. This is why many people have difficulty seeing small print and need reading glasses later in life.

Because LASIK works on the eye's surface rather than the lens, it cannot correct presbyopia. Patients who get LASIK before 40 are as susceptible to this age-related eye condition as those who have never needed any vision correction in the past.

LASIK can compensate for presbyopia through an option called monovision, but as some patients have adverse effects to the procedure, it's not recommended for everyone.

Dahlia closeup

Refractive Lens Exchange for patients over 40

Refractive Lens Exchange is the best vision-correcting surgery for patients over 40 because it combines the proven track record of cataract surgery with the most up-to-date lens implant technology. It offers relief for patients with a variety of eye conditions.

By replacing the natural lens of the eye with a high-quality artificial lens, RLE can correct myopia, hyperopia, and astigmatism — allowing patients to enjoy lasting and stable vision at all distances.

The surgery is particularly beneficial to patients over age 40 because it bypasses age-related vision changes such as presbyopia and early cataracts. The durable artificial lenses implanted in the surgery don't age, so patients can enjoy clear lasting vision while avoiding the risk of developing cataracts.

Who is a candidate for Refractive Lens Exchange?

When comparing refractive lens exchange vs. LASIK, age is the most important criterion. Patients over 40 will enjoy the most benefits from RLE, especially those concerned with age-related lens changes like presbyopia and cataracts.

Refractive lens exchange surgery is also an option for patients with a high intolerance for glasses. Most RLE patients achieve freedom from glasses for both near and distant vision.

RLE is generally not recommended for patients with only very mild myopia or hyperopia. Additionally, patients with certain eye diseases such as keratoconus should avoid the surgery.

Refractive Lens Exchange: Pre-procedure

Before the procedure, patients will receive a comprehensive eye exam to ensure they’re a good candidate.

At our office, this exam includes a detailed medical history and careful screening of the following:

  • Visual acuity

  • Pupils

  • Side Vision

  • Eye Movement

  • Eye pressure

  • Retina/optic nerve

  • Cataracts

Suitable candidates can then schedule the surgery, including a pre-op appointment to determine lens calculations.

Refractive Lens Exchange: The procedure

During surgery, patients will have natural lenses replaced with a synthetic intraocular lens (IOL).

The most current intraocular lens technologies include:

  • Monofocal Fixed-Focus IOL: Provides clear vision at one range – distance, intermediate, or near. May be the best option for patients with certain eye conditions. Visual range can sometimes be extended using monovision.

  • Multifocal IOL: Provides clear vision in multiple vision ranges.

  • Toric IOL: Corrects the different refractive errors associated with astigmatism.

  • Accommodative IOL: A monofocal lens that corrects vision at different distances by changing its position or shape inside the eye.

Refractive Lens Exchange: Recovery

Patients shouldn't drive home following the surgery. While eyes may start to heal quickly after surgery, blurred vision and dilated pupils might remain for 24 to 48 hours.

Recovery will vary from patient to patient. In general, patients will see improvements to their vision several days after the procedure.

Once vision clears, a patient may resume work and light physical activity. It's usually best to wait two weeks to restart a full range of activities. Be sure to discuss individual timelines with your ophthalmologist.

Does insurance cover Refractive Lens Exchange?

Unfortunately, most insurance companies don’t cover refractive lens exchange. Unlike traditional cataract surgery with standard lens implants,, RLE is considered elective surgery, and it's not covered by insurance or Medicare.

However, there are good financing options available to make the procedure accessible, either by spreading it into monthly payments with reasonable terms, or taking advantage of pre-tax dollars through HSA and flex accounts.

When considering the cost, patients should factor in the alternate expenses that will be eliminated – glasses, monthly contact lenses, and potential future cataract surgeries.

Ultimately, both LASIK and Refractive Lens Exchange are reliable, highly effective vision correction procedures. However, as we approach our forties and fifties, RLE is the most effective approach to correct eye changes that evolve over time.


If you’re in the greater Los Angeles area and think you’re a good candidate for either LASIK or Refractive Lens Exchange, contact Dr. Besser’s office to schedule a consultation.

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