RLE vs. Cataract Surgery: What’s The Difference

Apr 06, 2022
 – Eduardo Besser, MD
  • Cataracts

Learn the difference between refractive lens exchange and cataract surgery, and which one is recommended for different patients.

Refractive lens exchange (RLE) and cataract surgery are two of the most common eye surgeries for patients over 40. While the technique used in the procedures is essentially the same, saying the surgeries are identical isn’t entirely accurate.

The distinction between RLE vs. cataract surgery lies in the specifics of the vision complaints, and the stage at which the surgical intervention takes place. Learning the similarities and differences between the two can help patients make an informed choice.

What is Refractive Lens Exchange?

Some patients have heard of popular eye surgeries like LASIK, but may not be as familiar with its equally effective counterpart - refractive lens exchange. So what is refractive lens exchange?

Refractive lens exchange is an elective eye surgery for patients who want to fix refractive errors caused by aging, and achieve freedom from glasses and contacts.

This lens replacement surgery corrects presbyopia, nearsightedness, farsightedness, and astigmatism. After a successful surgery, patients can enjoy crisp vision from a range of distances.

During the procedure, an ophthalmologist replaces the eye's natural lens with an artificial intraocular lens (IOL). The implanted lens gives patients stable vision and helps prevent several age-related eye conditions.

The procedure is quick and effective. Eye doctors can do both eyes in around 15 minutes, and patients will see results immediately after the surgery.

Who is a candidate for Refractive Lens Exchange?

Good candidates for refractive lens exchange are people over the age of 40 who are experiencing age-related vision changes — in particular presbyopia, a condition where patients have difficulty focusing on close objects.

Eligible candidates can also include patients who want sharper vision, but don't qualify for other laser vision correction surgeries such as LASIK. Patients with ordinary vision changes who no longer want to wear glasses or contact lenses are also suitable.

RLE candidates should have a healthy and stable vision. Those with certain eye diseases such as Keratoconus are not ideal candidates for the procedure.

What is Cataract Surgery?

Cataract surgery is a lens replacement surgery used to remove visually disruptive cataracts.

A cataract is an ocular condition where the eye’s interior lens gradually becomes hard, cloudy, and yellowed over time with age — causing a patient's vision to dim and blur. Cataracts are a natural part of the aging process, but may require surgery if they affect someone's daily activities.

In serious cases, cataracts can cause lasting eye damage, leading to vision loss if left untreated. They are the leading cause of blindness in people 65-80.

During cataract surgery, the eye doctor removes the patient’s cloudy lens and replaces it with an artificial one. This improves their vision and prevents serious damage to the eyes.

Vision with without Cataract mobile

Who is a candidate for Cataract Surgery?

Patients with severe cataracts are good candidates for the procedure as this condition deters them from performing their job or daily activities. Some signs a patient may have a severe cataract:

  • Blurry vision

  • Double or ghosted vision

  • Sensitivity to light

  • Difficulty seeing at night

  • Sees bright colors as faded or yellow

RLE vs. Cataract Surgery: How are they similar?

The procedures themselves are nearly identical. In both RLE and cataract surgery, an ophthalmologist replaces a patient’s natural lens with a synthetic intraocular lens.

Doctors have refined and improved cataract surgery over many decades. Because of this, both RLE and cataract surgery are two of the safest, quickest, and most effective eye procedures. They both have track records of success and high patient satisfaction.

Eye doctors can perform the surgeries in around 15 minutes. Patients may notice results immediately — while experiencing significant improvements to their vision in the following days.

What synthetic lenses can I choose from?

During RLE and cataract surgery, the eye doctor implants an artificial lens in the eye.

Patients can choose between a number of state-of-the-art lens implants — some of which can solve multiple vision problems simultaneously. These include:

Monofocal lenses: The standard lens type for RLE and cataract surgery.

Presbyopia-correcting IOLs: High-performance upgrades that correct vision at multiple visual ranges.

Toric lenses: Specialty lenses for patients with astigmatism.

No single lens is "the best" for everyone. Choosing a lens should be part of a detailed consultation with your ophthalmologist prior to surgery. Factoring in your lifestyle, vision goals, and ocular health, your ophthalmologist should be a partner in choosing the lens that best suits your unique needs.

RLE vs. Cataract Surgery: How are they different?

While the procedures for cataract surgery and refractive lens exchange are essentially the same, the reason patients seek out the surgeries are different.

Refractive lens exchange is an optional or elective surgery typically performed for patients aged 40+ who want to eliminate the glasses or contacts they wear for refractive problems (eg, near-sightedness or astigmatism) while also eliminating their increasing, age-related need for reading glasses. These patients will also eliminate any chance of getting cataracts in the future.

Cataract surgery is for patients diagnosed with mature cataracts that are affecting activities of daily living. Visual changes can no longer be corrected with glasses or contact lenses as the cataract prevents light from entering the eye clearly. Left untreated, the cataract will continue to worsen and vision will further deteriorate over time.

Does insurance cover Refractive Lens Exchange?

Because of the different reasons why patients receive RLE vs. cataract surgery, insurance and coverage may vary.

Refractive lens exchange is an optional or elective surgery, so neither the procedure nor the artificial lens replacements are covered by insurance or Medicare.

There are financing options available to help make the expense manageable or spread payments out over time, but patients won’t receive assistance from their insurance company or government programs.

Does insurance cover Cataract Surgery?

Unlike RLE, cataract surgery is considered a necessary medical surgery, and the procedure itself is covered by insurance and Medicare. Insurance will also cover the cost of standard Monofocal (single-focus) lens implants.

However, insurance does not cover the cost of alternative high-performance lenses available for the surgery. If a patient wants presbyopia-correcting IOLs or specialty toric lenses for astigmatism, they’ll need to cover the fees for these premium services.

What’s the difference between refractive lens exchange and cataract surgery? Both are essentially the same procedure, but the reason patients receive RLE vs. cataract surgery differs.

RLE is an elective surgery for patients who no longer wish to wear glasses and contacts, and cataract surgery is a medical procedure for people with advanced cataracts that are affecting their ability to see clearly even with glasses or contact lenses.


If you're concerned you have cataracts or simply want to enjoy better vision after 40, then contact Dr. Besser to schedule an appointment and see which surgery is best for you.

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