Refractive lens exchange is a surgery that is typically carried out using a local anaesthetic (injection) and can be completed in as little as 15 minutes. It is only ever performed on one eye at a time and most surgeons like to wait at least 2 weeks until they will consider treating the other eye. The refractive lens exchange procedure is basically the same operation as removing a cataract in that your own natural lens is replaced with a new artificial lens (lens implant). The only difference with cataract surgery is that during this operation your own natural lens that is being removed is cloudy. A cataract is simply a clouding of your normally transparent natural lens.
There are a few different ways of carrying out this operation but by far the most commonly used is phacoemulsification. Breaking down this word helps explain exactly what it means:
Phaco simply means lens.
Emulsification means to turn from a solid into a liquid.
Phacoemulsification refers to the breaking down of your hard natural lens into a liquid substance which can be easily sucked out.
What To Expect During Refractive Lens Exchange:
- The power of the lens implant is calculated using ultrasound. The 2 main measurements that are required are the curvature of your cornea and the length of your eye (axial length). This process is called biometry and results in a lens being made that will eliminate the prescription in your glasses.
- Once your lens has arrived from the lab (few weeks) and you have undergone all the other suitability checks, you are ready for surgery:
- Dilation drops (make your pupil bigger) and anaesthetic drops are instilled into your eye.
- A small incision is made in your cornea. This incision can be as small as 2-3 mm. Through this incision, the handheld phacoemulsification instrument (size of a fountain pen) is inserted to access the lens. Ultrasound is then used to break up your natural lens so that it can be sucked out easily. Your natural lens sits inside a capsule (bag) and care is taken when removing your lens not to damage this capsule.
- Once all the old lens has been removed the artificial lens (intraocular lens) is placed through the incision and placed into the lens capsule. The best place for the new lens is exactly where the old lens came from e.g. the lens capsule. The lens implant is soft and pliable and hence can be folded up and fitted through the tiny incision. Once inside the lens capsule, it unfolds into the correct position, thus correcting your vision.
- Normally if the incision is small no stitches are required.
You can read more information about refractive lens exchange by reading this guide.