Refractive Lens Exchange

What is Refractive Lens Exchange?

Refractive Lens Exchange is a surgical technique that combines cataract surgery (phacoemulsification) with the correction of refractive errors (nearsightedness, farsightedness, astigmatism, or presbyopia) through the implantation of a premium intraocular lens (IOL).

Essentially, not only is the cataract removed, but dependence on glasses or contact lenses is also reduced or eliminated.

How Does It Work?

Phacoemulsification:

The cloudy lens (cataract) is removed using ultrasound.

Premium IOL Implantation:

A special intraocular lens is placed that corrects:

Myopia/farsightedness:

Monofocal or toric IOLs.

Astigmatism:

Toric IOLs.

Presbyopia ("farsightedness"):

Multifocal or extended-range (EDOF) IOLs.

Advantages vs. Traditional Cataract Surgery

Permanent correction of prescription (not just cataract removal).

Glasses independence in 80–90% of cases (with multifocal IOLs).

Outpatient procedure (15–20 minutes per eye).

Who Are Candidates?

Patients with cataracts and myopia/hyperopia/astigmatism.

People over 50 years of age who also want to correct presbyopia.

Excludes: Severe retinal diseases or very irregular corneas.

Cost vs. Benefit

More expensive than standard phacoemulsification (due to the price of premium IOLs).

Worthwhile if you're looking to avoid glasses after surgery.

70% of patients with multifocal IOLs no longer need glasses for reading or driving (ASCRS Study, 2023).

Recommended Minimum Age for Refractive Lens Exchange

Refractive Lens Exchange (cataract surgery + correction of refractive errors with premium intraocular lenses) does not have a fixed minimum age, but its application depends on key factors:

Ideal Candidates

Patients with cataracts + refractive errors:

The typical age is ≥50 years (when age-related cataracts appear).

In exceptional cases (congenital or traumatic cataracts), it can be performed in young adults (20–40 years old).

Patients without cataracts but with high prescriptions:

Instead of Refractive PHACO, conventional refractive surgery (LASIK/PRK/ICL) is preferred in patients under 50 years of age.

Reasons to Wait (in young patients without cataracts)

The natural lens is better than an IOL:

It provides dynamic focusing (accommodation).

Risk of premature presbyopia:

If the young lens is removed, the ability to focus near is lost.

Better alternatives:

LASIK, PRK, or ICL are safer for those under 50 years of age.

Exceptions:

Congenital or traumatic cataracts:

Children or young adults can undergo surgery, but with special IOLs.

Very high myopia (>-15D):

In some cases, Refractive PHACO is considered before the age of 50.

The natural lens begins to lose flexibility at 40–45 years of age (presbyopia), so Refractive Lens Exchange is ideal at this stage.