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Lens Replacement Surgery Treatments
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What Is Lens Replacement Surgery?
When people are refer to lens replacement surgery they are usually referring to either refractive lens exchange (RLE), Phakic intraocular lens implantation (PIOL), implantable contact lens surgery (ICL) or 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.
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 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.
Phakic Intraocular Lens Implantation
A Phakic Intraocular Lens (IOL) is an artificial lens made from synthetic plastic implanted into the eye in addition to the eye’s natural lens which remains in place. These lenses are positioned either just in front of, or just behind, the pupil.
It should be noted that an Implantable Collamer Lens (ICL) is a type of Phakic Intraocular Lens and both ICL and PIOL can be used interchangeably. Just to confuse things, when discussing lens surgery ICL is also referred to as an Implantable Contact Lens but in this context it should be collamer.
So the main difference between the two types of lens surgery are that one removes the natural lens, whilst the other is an additive procedure which leaves your natural lens unaltered.
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.
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.
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.
Lens Types
Intraocular Lens Types
There are three types of intraocular lenses which 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.
Phakic Intraocular LensTypes
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:
- EVO Visian ICL: this is the most popular implantable contact lens and has now been used used in over 1 million treatments in 75 countries. It is a refractive synthetic lens made from a collagen co-polymer lens that is placed in front of your natural lens and behind the iris.
- Verisyse: this lens is used to treat moderate to severe myopia and is placed in front of 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.
Eye Conditions Treated By Lens Surgery
All the eye conditions below can be treated with lens surgery although as stated above, there may be better alternatives depending upon your prescription and age.
Presbyopia is an age related condition which effects us all after the age of 40 – even those of us who have never had issues with their eyesight before.
It is the slow decline in our ability to focus on objects close-up and it can lead to eyestrain and headaches.
Presbyopia surgery is a variation on standard lens exchange.
Hyperopia (long-sightedness) is a very common genetic eye condition that normally starts to effect people from age 45 as they begin to notice objects in the distance are seen more clearly than those that are closer.
Those born with the condition tend to have shorter eyeballs that the rest of the population or the cornea is too flat.
Glasses or contact lenses can be used to overcome the condition but laser or lens surgery offers a long term solution.
Myopia, also known as short-sightedness or nearsightedness, is a common eye condition with around a 1/3 of the UK population suffering from i. It is estimated that up to 50% of the world’s population will have some form of the condition by 2050.[1]Holden BA, Fricke TR, Wilson DA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016; 123:1036-42
If you are short-sighted, objects in the distance will seem blurry whilst you will be able see close-up objects clearly. The severity of myopia can vary with mild cases requiring no treatment and more acute cases having a severe impact on vision.
Astigmatism effects about 24% of the population[2]Prevalence of refractive error in Europe (2015) , European Journal of Epidemiology. Astigmatism occurs when the cornea is misshapen and can be detected in a routine eye test. Most astigmatism patients are born with the condition and it is caused when the transparent tissue layer at the front of the eye is not as spherical as it should be causing images to become blurry and distorted.
Astigmatism also tends to occur alongside other refractive problems such as longsightedness and shortsightedness. It can be corrected with glasses, contact lenses, laser eye surgery or lens surgery.
A cataract occurs when the naturally clear lens located behind the pupil and iris becomes cloudy. Patients will often complain of blurred vision and if left untreated the crystalline lens will start to turn cloudy and opaque. Normally, both eyes will be affected by cataracts simultaneously although the disease can develop rapidly in one eye rather than the other.
It is estimated that 30% of people 65 years or older have a visually impairing cataract in one or both eyes and 10% in this age group have already had cataract surgery.
Lens Types
There are four types of intraocular lenses which 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 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.
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.
Between 5-10% of patients who opt for multifocal lenses suffer from some kind of halo or glare when looking at lights at night, but most claim that this is something that they adapt to relatively quickly.
This type of lens is not able to correct astigmatism which normally requires a toric lens.
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.
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.
Cost of Lens Replacement Surgery
The cost of your lens replacement surgery will depend on the type of treatment you are having and the clinic performing the surgery.
As a general guide you can expect to pay around £2,000 – £3,200 for standard monofocal refractive lens exchange (RLE) per eye. For a multifocal or Toric lens you can expect to pay £3,200 – £4,100 per eye with the higher prices in that range being charged in the London clinics.
Visit our page on lens replacement surgery costs for more information on lens surgery prices.
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 are suitable 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 are not suitable 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 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.
What To Avoid After Lens 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.
- A slight scratchy, irritable sensation in your eye. This milder side effect may be experienced 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) / fading vision. 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 common side effect of refractive lens exchange is experienced by approximately 20% of patients and is caused by the lens capsule in which the new lens sits thickening leading to hazy vision. YAG laser capsulotomy is a non-invasive surgery that is used to fix this problem so your eye sight returns to the level it was just after your initial lens replacement procedure.
- 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.
- Phakic Intraocular Lens Implantation Patient Guide, Royal College of Ophthalmologists (Reviewed May 2018)
- Refractive Lens Exchange Patient Guide, Royal College of Ophthalmologists (Reviewed May 2018)
- Prices published on UK laser eye surgery clinics in July 2020.
- Small-Incision Lenticule Extraction (ReLEx SMILE). Medscape. emedicine.medscape.com (updated 27 June 2017)
- LASIK – laser eye surgery. American Academy of Ophthalmology. www.aao.org (published 12 December 2015)
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