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Refractive Lens Exchange vs LASIK Surgery

eye doctor explaining refractive lens exchange vs lasik

Are you tired of the constant struggle with glasses or contact lenses? You’re not alone. Many people deal with vision impairments and are seeking effective solutions. This article will delve into two popular vision correction procedures, Refractive Lens Exchange (RLE) and LASIK.

We’ll explore the differences of refractive lens exchange vs LASIK, who they’re best suited for, and how they compare, providing you with the information you need to make an informed decision about your eye health.

What is Refractive Lens Exchange?

Refractive Lens Exchange (RLE), also known as lens replacement surgery or clear lens extraction, is a procedure that involves:

  • Removing the eye’s natural lens
  • Replacing it with an artificial lens implant with advanced lens technology
  • Primarily used to correct vision issues like nearsightedness, farsightedness, and astigmatism
  • Corrects presbyopia (age-related loss of near vision)
  • Most common for patients older than 40 years old

What is LASIK eye surgery?

LASIK (Laser-Assisted In Situ Keratomileusis) is another popular vision correction procedure. It involves:

  • Reshaping the cornea using a laser
  • Primarily used to correct common refractive errors, including nearsightedness, farsightedness, and astigmatism
  • Most common for patients younger than 40 years old
lasik surgery steps

Comparison of Refractive Lens Exchange and LASIK

When comparing RLE and LASIK, it’s important to consider the following aspects:

AspectRefractive Lens ExchangeLASIK
Ideal AgeOlder than 40Younger than 40
Corrective UsesNearsightedness, farsightedness, astigmatismNearsightedness, farsightedness, astigmatism
Procedure DetailsRemoval and replacement of the natural lensReshaping of the cornea using a laser
Recovery TimeVaries, but typically longer than LASIKShorter, usually within a week
ContraindicationsNot recommended for very mild myopia or hyperopia, certain eye diseasesNot recommended for individuals over 40, thin cornea, certain health conditions
Cost$4,500-$5,500 per eye$2,500 per eye
Reading GlassesMay not require reading glasses depending on the type of lens usedReading glasses may be needed after the age of 40

Patient Experience After LASIK Surgery

lasik surgery operating room
standard laser surgery suite

LASIK Surgery Experience:

  • The surgery itself is relatively quick, typically taking less than 30 minutes. During the procedure, a numbing drop is placed in the patient’s eyes, the area around the eyes are cleaned, and an instrument called a lid speculum is used to hold the eyelids open. The patient’s vision may dim during the procedure due to the application of a suction ring to the eye, and they may feel pressure and experience some discomfort during this part of the procedure.
  • After the procedure, patients are advised to rest with their eyes closed for a few minutes, after which a quick eye exam is conducted to ensure the corneal flaps are in place. Anti-inflammatory or steroid eye drops may be administered, and then the patient is released to recover at home. Patients are advised not to drive themselves home after the procedure as their vision may fluctuate from clear to blurry.
  • In the first few days following surgery, patients may experience some discomfort, including general soreness, stinging, and a feeling of grittiness in the eyes. These symptoms usually subside after a couple of days. Patients may also experience temporary visual problems such as glare, light sensitivity, and seeing halos, which usually clear up after a few weeks.

Here is a short animated video from the American Academy of Ophthalmology on LASIK surgery:

Recovery After LASIK:

  • Most patients can see clearly immediately after surgery, and any soreness or redness should be gone in about a week. The cornea does most of its major healing during the first two to four weeks after surgery; however, full recovery takes from three to six months. It’s common for people to experience some vision fluctuations during this time, but overall, vision continues to improve until the eyes are completely healed.
  • Some patients may experience dry eyes after LASIK eye surgery, which is a common side effect. This usually resolves after a few weeks or months. In some cases, patients may also have red spots in the white part of their eyes following surgery, which are simply broken blood vessels often caused by the pressure of the suction ring used during surgery. These should heal in a week or two.
  • LASIK won’t prevent the development of presbyopia. And while the changes to the cornea are permanent, if a patient’s nearsightedness or farsightedness is still progressing, their vision may eventually become worse. This is why one of the criteria for LASIK candidates is having a stable lens prescription for at least one year before surgery.

Now, let’s move on to the patient experience after Refractive Lens Exchange.

Patient Experience After Refractive Lens Exchange Surgery

eye surgery operating room
standard eye surgery operating room

RLE Surgery Experience:

  • The Refractive Lens Exchange (RLE) surgery is performed under drop anesthesia and a dilating drop, and takes about 15-20 minutes from start to finish. The area around the eye is cleaned and a lid speculum is placed to act like an eyelid support. The patient will notice a lot shadows and lights during the procedure. They might also experience some pressure and mild discomfort.
  • Unlike LASIK, RLE surgery is performed one eye at a time.
  • Immediately after the RLE surgery, the patient’s pupil will still be dilated. It may remain that way for 24-48 hours, and they’ll likely experience a degree of blurred vision during this time. They may also have a scratchy sensation inside their eye as the anaesthetizing eye drops wear off and the pupil returns to its standard size, but they must resist the urge to rub their eye. The surgeon will provide anti-inflammatory and antibiotic eye drops to help avoid unnecessary discomfort and infection as the eye heals.

Here is a short animated video from the American Academy of Ophthalmology on RLE surgery:

Recovery After RLE:

  • Full recovery from RLE can take between one to two weeks. Patients may experience discomfort, blurriness, dry eyes, and some visual variation as their eyes and brain adjust to their new way of seeing. Most patients experience a quick and painless recovery with minimal issues. Following the doctor’s advice, patients will likely be able to return to their usual activities within about a week. However, they should wait longer before swimming, immersing their eyes in water, or engaging in contact sports.
  • The visual recovery for RLE patients is somewhat varied; however, the intraocular lens implant works well to correct vision problems for those with various prescriptions. In many cases, patients notice an immediate improvement in their eyesight. The majority report a noticeable improvement by the following day, and some note that it takes a few days before they become accustomed to their new lenses. Typically, patients report a successful transition by their 1-week follow-up appointment with their eye doctor and are happily adapting to their new lenses.
  • As patients return to work or spend time on the computer or outdoors, their eyes might become dry more often than usual. They should use eye drops to keep them lubricated.

Refractive Lens Exchange vs. LASIK: Which is better for me?

Choosing between Refractive Lens Exchange and LASIK is a decision that should be made in consultation with an eye care professional. However, here are some factors to consider:

  • Age and Presbyopia: LASIK is typically not recommended for individuals over 40 due to the onset of presbyopia, a condition that affects your eye’s ability to focus on close objects. On the other hand, RLE can be a good option for this age group as it is a lens replacement surgery and corrects presbyopia. Patients under the age of 40 have LASIK as the primary choice.
  • Prescription: For individuals with a high degree of refractive error, RLE might be a more suitable option. This is because RLE can correct a wider range of vision issues compared to LASIK. If your prescription is very high, LASIK might not be safe or able to fully correct your vision.
  • Eye health: Certain eye conditions can make one procedure more suitable than the other. For instance, if you have thin corneas, LASIK might not be suitable. In such cases, RLE could be a better option.
  • Future Vision Changes: If you’re at a high risk for cataracts, choosing RLE would prevent the need for cataract surgery in the future, as the procedure removes the natural lens where a cataract would form.
  • Cost: RLE is an operating room surgery that includes an anesthesia team and an artificial intraocular lens implant. This increases the cost compared to LASIK. The average cost of LASIK in the US in 2020 was about $2600 per eye. RLE cost ranges between $4500-$5500 per eye.

Remember, these are general guidelines and individual experiences can vary. It’s important to have a detailed discussion with your eye doctor about your specific situation and vision goals. They can provide personalized advice based on your eye health, lifestyle, and expectations.


While we’ve discussed the basics of Refractive Lens Exchange and LASIK here, it’s important to delve deeper into each procedure to fully understand their implications. For instance, if you’re considering Refractive Lens Exchange, you might want to explore its pros and cons in more detail. To help with this, we’ve compiled a comprehensive guide on the advantages and disadvantages of Refractive Lens Exchange surgery. This resource can provide further insights to aid in your decision-making process. We also compiled a list of LASIK FAQs here to provide more detail.

FAQs About Refractive Lens Exchange vs LASIK

  • What is the difference between refractive lens exchange and LASIK?

    Refractive Lens Exchange (RLE) and LASIK are both procedures used to correct refractive errors, but they work in different ways. LASIK works by reshaping the cornea (the clear, front part of the eye) to correct the way light is focused onto the retina. RLE, on the other hand, involves replacing the eye’s natural lens with an artificial one to correct the refractive error. RLE is the same procedure as cataract surgery, but it’s done to improve vision rather than to remove a cataract.

  • Is refractive lens exchange good?

    RLE can be an effective procedure for the right patient. It can correct a wide range of refractive errors and can also eliminate the need for cataract surgery in the future. It’s particularly beneficial for people over the age of 40, those with early cataracts, and those who are not good candidates for LASIK or other laser vision correction procedures.

  • Who is not a candidate for RLE?

    Not everyone is a suitable candidate for RLE. People who might not be suitable include those with active corneal disease, significant medical or eye problems such as previous corneal ulcers, keratoconus, diabetic retinopathy, macular degeneration, or glaucoma. Also, people with significant dry eye, those who are pregnant or nursing, and those whose eyeglass prescription is not within certain limits set by the eye surgeon might not be suitable. RLE is ideal for patients older than forty who can’t get LASIK.

  • How long does refractive lens exchange surgery last?

    Patients that have been screened appropriately for RLE surgery should experience a lifetime benefit from the surgery. The intraocular lens implants used during surgery do not degrade. Exceptions include patients that develop eye disease later in life like macular degeneration or glaucoma.