Lens replacement surgery is normally used to refer to one of three similar types of treatments: Refractive Lens Exchange (RLE), Implantable Contact Lenses (ICL) and Cataract Surgery, with each having alternative names and acronyms so it can be a little confusing.
Hopefully this article will untangle some of the terminology and give some clarity on the type of lens replacement surgery that may be suitable for you as well as the costs involved.
Types Of Lens Replacement Surgery
1. Refractive Lens Exchange (RLE)
In general, when people talk about lens replacement surgery they are referring to some type of Refractive Lens Exchange (RLE), which is also known as Refractive Lens Replacement, Clear Lens Exchange (CLE) or Clear Lens Surgery. This is a treatment for patients suffering from presbyopia (long-sightedness normally occurring in middle and old age), hyperopia (farsightedness where objects nearby are not seen as clearly as objects in the distance) or those with a considerably thin cornea.
It is commonly used for patients over 40 who don’t qualify for either LASIK or PRK laser eye surgery but are not willing to continue using glasses or use contact lenses. It can also can correct myopia (nearsightedness) but it is not normally recommended when LASIK surgery or Phakic intraocular lens (IOL) can be used.
The procedure involves removing the eye’s natural lens and replacing it with an artificial intraocular lens. As well as removing the need to continue wearing glasses or use contact lenses, the new artificial intraocular lens will also mean that the patient will not suffer from cataracts in the future as a cataract cannot form on an artificial lens.
2. Cataract Surgery
Cataract surgery involves the same procedure as the refractive lens surgery described above, except that the lens that is removed is not clear but cloudy due to existence of cataracts. Patients have the same choice of monofocal, multifocal or trifocal lenses (see lens types below) giving them the option to also remove the need for reading glasses as well as correcting their cataracts.
3. Implantable Contact Lenses (ICL)
This type of lens surgery involves implanting contact lenses rather than removing and replacing the natural lens which occurs in lens replacement surgery. This new phakic intraocular lens is placed on top of the natural lens and behind the iris (the exact positioning will depend on the lens chosen). As the natural lens is not removed this procedure can be reversed at a later date.
Implantable Lens Types
When lens replacement surgery is performed you will either receive intraocular lenses (IOLs) or phakic intraocular lenses (Phakic IOLs) depending on your prescription and visual requirements. IOLs replace the eye’s natural lens and are used in RLE surgery and cataract surgery.
1. Intraocular Lens (IOL) Types
There are three types of intraocular lenses which can be can be used as replacements for your eye’s natural lens. The choice you are offered will depend on your eye condition and what is available at the clinic you select:
- Monofocal Lenses: Monofocal lenses will normally only fix issues with distance vision and are used for patients who don’t mind continuing to use glasses for specific tasks such as reading.
- Multifocal Lenses: The more advanced (and normally more expensive) multifocal lenses can correct long- and short-sightedness at the same time and, therefore, eliminate the need for glasses altogether.
- Toric Lenses: A toric lens is designed to correct moderate to high corneal astigmatism. It should remove the need for glasses for distance vision but you will still need reading glasses.
- Trifocal Lenses. Your chosen clinic may also have trifocal lenses which are designed to give very high resolution images and exceptional contrast sensitivity at all light conditions and distances.
2. Phakik Intraocular Lens (IOL) Types
Unlike Intraocular lenses, Phakic IOLs do not replace the eye’s natural lens but are positioned between the lens and the iris, or just behind the iris, whilst the natural lens remains in place. There are two main types of phakic IOLs and neither require glasses to be worn once inserted:
- Verisyse: this lens is used to treat moderate to severe myopia and is placed in front of the iris.
- Visian: this lens corrects moderate to severe myopia and is placed in front of your natural lens and behind the iris.
All the options should be discussed in your consultation before you decide whether to proceed or not and costs can depend on the amount of correction required. However, several of the larger national clinics now offer fixed prices for all lens types for all patients.
Cost of Lens Replacement Surgery
Depending on the clinic and specific lens replacement technique used you can expect to pay around £3,000 – £4,000 per eye for multifocal or trifocal lenses. Some clinics offer a free initial consultation but some charge between £200 – £300.
The table below is the price range of the different surgery types based on using multifocal or trifocal lenses and not monofocal lenses which are normally cheaper. The more expensive prices are due to better lenses being used (i.e. Trifocal Toric Lens) on more complex cases. Complete our form on the right to get prices for clinics near you.
|Treatment Type (Prices are per eye)||Consultation||From||To|
|Refractive Lens Exchange (RLE / CLE)||Free – £295||£1,995||£4,300|
|Implantable Contact Lenses (ICL / IOL)||Free – £295||£2,495||£3,950|
|Cataract Surgery||Free – £295||£2,495||£4,300|
All clinics will offer a variety of financing options for their refractive lens replacement (RLE) and implantable contact lens (IOL) treatments. Many will offer 0% finance over 10-12 months and if you would like to pay off the balance over a longer period in order to reduce the monthly payments you should expect to pay about 9.5%-11.5% APR.
Always check the total amount you are repaying if you are getting finance – the low monthly repayments are attractive but you can end up paying more than a third more than the original price due to the interest rate. Below are an example of the monthly payments you can expect to pay for for the different treatment types over 2 durations. The exact terms offered by clinics near you are available if you fill in our short form on the right.
|Treatment Type (Prices are per eye per month)||Deposit*||10 Months||36 Months|
|Refractive Lens Exchange (RLE / CLE)||£0 – £1,250||£250 (0% APR)||£64 (11.5% APR)|
|Implantable Contact Lenses (ICL / IOL)||£0 – £1,250||£200 (0% APR)||£51 (11.5% APR)|
|Cataract Surgery||£0 – £1,250||£250 (0% APR)||£64 (11.5% APR)|
* A deposit of 10% or £500 is normally payable to qualify for 0% interest (the highest deposit we have seen is £1,250). Finance for 12-72 months will normally not require a deposit but the interest rate will be between 9.5%-11.5%.
Lens Replacement Surgery Procedure & Recovery
Lens replacement surgery lasts for approximately 15 minutes and is carried out independently for each eye, with a wait of almost a week between the two eyes. During lens replacement, numbing aesthetic drops are applied so no discomfort is experienced in the eyes. Most people will report immediate visual improvement a few days after surgery.
The procedure you undergo will depend on whether you’re having PIOL or RLE surgery. With PIOL, the natural lens isn’t removed and it’s almost like a permanent contact lens is built into your eye. However, because this lens is located inside your eye, it isn’t as restrictive as a contact lens.
Alternatively, RLE often follows much the same procedure as cataract surgery. This means the natural lens of the eye is removed before a replacement lens (a multifocal or monofocal one) is put in its place. The natural lens is often removed using phacoemulsification, which liquefies the lens so it’s easy to extract.
On the path to full recovery patients may experience a few episodes of discomfort such as blurred vision, halos and glare. Most patients can go back to work within a week of the surgery, although you may need to wait 2 weeks before driving again – your surgeon will guide you on this.
You will not be able to see an artificial lens within your eye as it is placed on your eye, unlike a contact lens. The lenses are meant to last a lifetime as there is a negligible risk of regression (deteriorating of corrective vision) due to factors related to ageing. If problems do arise, the lens can be replaced easily without any permanent damage being done.
Am I Eligible for Lens Replacement Surgery?
As well as having one of the aforementioned conditions, there are a number of criteria you must meet in order to be deemed suitable for lens replacement surgery. Below, you’ll see a list of things that demonstrate whether you are or are not eligible:
You’re Suitable for Lens Replacement Surgery If:
- You’re 21 to 80 years old.
- You’re not suitable for laser eye surgery due to your corneas being too thin.
- You’re healthy.
- You don’t have any existing infections in your eye(s).
- Your glasses prescription hasn’t altered for at least six months.
- You’re not allergic to anaesthetics.
You’re Not Suitable for Lens Replacement Surgery If:
- You’re HIV positive.
- You’re taking immunosuppressant drugs.
- You have an autoimmune disease.
- You have a pacemaker.
- You’ve got retinal detachment or have experienced a severe eye trauma in the past.
- You’re pregnant or breastfeeding.
- You have other eye-related problems, e.g. glaucoma or uveitis (for PIOL patients).
- You have a certain medical condition, including the herpes virus, hepatitis C or diabetes.
Can I Get Lens Replacement Surgery on the NHS?
If you have a vision problem that can be corrected by wearing contact lenses or glasses, you won’t be entitled to lens replacement surgery on the NHS and will have to seek private treatment from a clinic of your choice. This also means you’ll have to pay for the entire procedure.
However, if your vision is severely impacted by cataracts, you will be entitled to cataract surgery on the NHS. For example, you may be eligible if your vision is hampering your ability to drive, read or look after someone you’re caring for. Previously, patients had to wait until they could barely see before they were deemed suitable for cataract operations but, thankfully, these guidelines have been relaxed to accommodate people whose sight has been affected during the earlier stages of cataracts, too.
Now, there are no specific guidelines in place for how your sight should be before you can have cataract surgery, but you may need to check with your local hospital as to what their criteria are.
Sometimes, you may also be recommended for cataract surgery on the NHS if you’re suffering from another eye-related condition, e.g. diabetic retinopathy, as this can’t be treated or monitored effectively if cataracts develop.
Is There Anything I Should Avoid After Surgery?
To help make sure your recovery period is a successful one, there are a number of things you’ll need to avoid post-surgery to ensure this, including:
- Avoid swimming for a week after your surgery
- Refrain from contact sports for a month – non-contact sports (e.g. jogging or going to the gym) can be resumed the day after your surgery, but you should try not to overexert yourself as high blood pressure can hamper your recovery
- Avoid touching your eyes or letting any smoke, dust or sweat get into them for at least a month to help prevent any infections
- To reduce your risk of eye fatigue try not to watch television for too long and refrain from extended periods of computer work
- Avoid driving for a few days after your surgery (your surgeon will be able to advise when it’s safe for you to resume this)
Finally, to promote a healthy healing environment within your eyes, always use the anti-inflammatory drops that have been prescribed to you by your surgeon.
Lens Replacement Surgery Side Effects and Risks
There are some side effects that you may experience after your surgery, with some being more common than others. Being aware of what these are and when they could indicate that something’s wrong is important so you can seek the advice of your surgeon straight away if there’s a problem. These side effects include:
- Changes to your vision. After surgery, the majority of patients will experience some side effects to their vision, e.g. ghost images, halos, glare and starbursts. Some also find driving at night difficult. Although common, these side effects shouldn’t last long and you may wish to refrain from night driving until they pass.
- Often a mild side effect, you may feel a slight scratchy, irritable sensation in your eye for a few months after your surgery. To help ease these symptoms, you can use the eye drops prescribed by your surgeon.
- Posterior capsule opacification (PCO). This is a complication that causes the back of your lens capsule (which is holding your new artificial lens in position) to thicken, which can cloud your vision. This is still quite a common side effect that appears within months or years of your surgery, but can be easily treated with a YAG laser. As can residual defocus which sometimes occurs, too.
- Red blotches on your eyes. Even though these may look unsightly these small haemorrhages aren’t dangerous and won’t impact the overall health of your eyes. They’ll often disappear on their own after around six to eight weeks.
- Eye infection. This is a rarer side effect but is easily resolved with a course of antibiotics.
- Retinal detachment. In rare cases, your retina may become detached from the layer underneath it. If this occurs, you may experience floaters in your vision, which is when you should seek advice. If retinal detachment is diagnosed, you will require another operation to correct it.
- Cystoid macular oedema (CMO). Affecting the macula or central retina, this is a painless condition whereby retinal swelling occurs and areas of fluid form. In mild cases, eye drops can resolve the issue.
- Loss of vision. Although rare, some patients can lose their vision following lens replacement surgery. This is more common in RLE than PIOL or laser eye surgery, with approximately 1 in 500 people suffering from this side effect. This can mean full loss of vision or partial loss that prevents them from driving (because their eyesight no longer meets the standard requirements).
Although 99% of patients are pleased with the effects of this surgery, there is a small minority (1%) that cannot adapt to the changes in their vision. If this happens, you can opt for an exchange of lenses, swapping your multifocal lens for a monofocal one, for example.