Clear Lens Exchange (CLE), also called Refractive Lens Exchange (RLE), is a surgical procedure in which the clear natural lens of the eye is removed and replaced with an artificial intraocular lens (IOL).
It is typically performed on individuals who have severe refractive errors, including nearsightedness, farsightedness, astigmatism, or presbyopia, and who are not candidates for traditional refractive surgeries such as LASIK or PRK.
CLE is considered a safe and effective option for correcting vision and can provide patients with a long-term solution for achieving clear and improved vision.
When should I consider CLE for my eye problem?
CLE is a preferred method for individuals experiencing presbyopia, which is a progressive condition requiring reliance on reading glasses as individuals age, or those with severe farsightedness (hyperopia), who do not qualify for LASIK, PRK, or phakic IOL surgery.
Additionally, in certain cases where a patient has both hyperopia and presbyopia, lens exchange may be the sole option for clear vision with reduced dependence on glasses post-surgery. While lens replacement surgery can address myopia (nearsightedness), it is generally not recommended when LASIK, PRK, and phakic IOLs are readily available.
Pros and cons of CLE
Pros:
- Provides a long-term solution for correcting vision, potentially eliminating or reducing dependence on contacts or glasses.
- Can correct a wider range of refractive errors than traditional LASIK or PRK surgery.
- Can improve vision in patients with cataracts, a common age-related condition that causes a clouding of the lens.
- Low risk of postoperative complications or infections.
- Generally provides immediate improvement in vision after surgery.
- Can prevent or delay the need for cataract surgery later in life.
Cons:
- As with any surgical procedure, there may be some risks involved, such as infection, bleeding, and inflammation.
- There is a possibility of developing a condition called posterior capsule opacity, which causes clouding of the posterior lens capsule and can cause some blurriness of vision months or years after the surgery.
- Clear lens exchange surgery is typically more expensive than traditional LASIK or PRK surgery.
- Not all patients are good candidates for clear lens exchange surgery, and some may require alternative vision correction methods.
- Recovery time after surgery can be longer than LASIK or PRK.
It is important to note that this is not an exhaustive list and that the specific advantages and disadvantages of clear lens exchange surgery may vary depending on each individual patient’s unique situation. It is important to discuss any concerns or questions with a qualified ophthalmologist to determine whether this procedure is a good option.
CLE Procedure
- Preoperative evaluation
The patient’s eyes are thoroughly examined by the surgeon or an optometrist to determine the correct power of lens needed for each eye. This includes measuring the curvature of the cornea, the length of the eye, and the patient’s refractive error. - Anesthesia
Before the surgery begins, the surgeon administers local anesthesia to numb the eye being operated on. This usually involves the use of eye drops injected around the eye, as well as oral medications to help the patient relax. - Creating an incision
Using a small surgical instrument, the surgeon creates a small incision in the cornea. This incision is typically less than 3 mm in size and is made in a manner to minimize damage to the surrounding tissues. - Removing the natural lens
The surgeon then uses a process called phacoemulsification to remove the clear natural lens of the eye. This involves using sound waves to break up the lens into small pieces, which are then suctioned out through a small tube. - Inserting the artificial lens
Once the natural lens is removed, the surgeon inserts an artificial intraocular lens (IOL) through the small incision. The IOL is typically made of silicone or acrylic and is designed to replace the natural lens of the eye. - Positioning the IOL
The surgeon then positions the IOL in the correct location where the natural lens used to be, using specialized instruments. The lens is positioned in a way that corrects the patient’s refractive error and provides clear vision. - Closing the incision
The incision is then closed with small sutures or is allowed to heal on its own, depending on the type of incision made. - Repeat for the other eye
Once the procedure is completed for the first eye, the process is typically repeated for the other eye. - Post-operative care
After the surgery, the patient will rest in a recovery area for a brief period and may be given eye drops to use for several weeks to prevent infection and reduce inflammation. It is important to use these eye drops as directed. - Follow-up care
A follow-up visit will be scheduled to monitor healing progress and ensure that the patient’s vision is improving as expected. At this visit, the surgeon will evaluate the patient’s vision and remove any sutures if they were used.
Types of Glaucoma
Glaucoma is a complex condition and has several types. The two most common types, primary open-angle, and angle-closure glaucoma, account for most cases. Primary open-angle glaucoma is caused by the slow drainage of fluid from the trabecular channels of the eye, resulting in increased intraocular pressure.
An astounding 95 percent of people with glaucoma suffer from the primary open-angle form. Conversely, angle-closure glaucoma arises when the trabecular channels become suddenly and completely blocked.
Apart from primary open-angle and angle-closure glaucoma, several rare types of glaucoma exist, such as:
- Low-tension glaucoma: This type of glaucoma occurs even when intraocular pressure remains normal.
- Congenital glaucoma: It is present in infants and young children due to an abnormality in the structural and functional development of the eye drainage channels.
- Secondary glaucoma: It occurs as a result of inflammation, trauma, or other medical conditions.
- Pigmentary glaucoma: It arises when pigments within the iris block the drainage channels of the eye.
- Pseudoexfoliation glaucoma: It occurs when abnormal proteins accumulate in the drainage channel of the eyes, leading to glaucoma.
Awareness of the various types of glaucoma is vital for early identification and prompt treatment to prevent irreversible vision loss.
Frequently Asked Questions about CLE
Who is a good candidate for clear lens exchange surgery?
Clear lens exchange surgery is usually recommended for individuals with severe refractive errors or cataracts who are not candidates for other refractive surgeries such as LASIK or PRK. It is important to undergo a thorough evaluation with an ophthalmologist to determine if you are a good candidate.
Is clear lens exchange surgery painful?
No, clear lens exchange surgery is not typically painful. The surgeon administers local anesthesia to numb the eye before the surgery begins, and in some cases, may also provide a sedative to help the patient relax.
How long does the surgery take?
The procedure itself typically takes around 15-20 minutes per eye. However, patients generally need to spend a few hours at the surgical center on the day of the procedure for pre-operative evaluation and post-operative care.
How soon can I return to normal activities after the surgery?
Most patients can resume normal activities within a few days of the procedure. However, it is important to avoid strenuous activities and minimize exposure to sunlight or other bright light sources for a few weeks after the surgery.
Will I still need glasses after the surgery?
The goal of clear lens exchange surgery is to correct your vision so that you have minimal to no reliance on contact lenses or glasses. However, it is possible that some patients may still require glasses for certain activities.
What is the success rate for clear lens exchange surgery?
Clear lens exchange surgery is considered a very safe and effective procedure, with a high success rate. However, like all surgical procedures, there is a small risk of complications or side effects.
Can both eyes be treated on the same day?
Yes, it is possible to undergo clear lens exchange surgery on both eyes on the same day. However, some surgeons may recommend treating one eye at a time to minimize potential complications.
How often will I need to have my artificial lenses replaced?
In most cases, artificial lenses do not need to be replaced after clear lens exchange surgery. The lenses are designed to provide clear vision for many years or even decades.
What type of anesthesia is used during the surgery?
The surgeon typically uses local anesthesia to numb the eye before the procedure. This involves the use of eye drops or injections around the eye.
Is clear lens exchange surgery covered by insurance?
Clear lens exchange surgery is generally not covered by insurance for patients who do not have cataracts. Patients should check with their insurance provider beforehand to determine if the procedure is covered for their specific situation.
