Clear Lensectomy (RELEX)

Do Glasses or Contacts prevent you from doing the things you love?
 

Clear Lensectomy also known as RELEX

People over the age of about 45 years old have different refractive needs from those who are younger. The condition known as presbyopia comes with having a lot of birthdays. This means the loss of ability to focus your eyes at closer range, such as for reading. The natural lens, as it ages, gets harder and stiffer and loses its ability to change shape. Since the eye normally focuses by changing the shape of the lens (it shifts its position in the eye as well) the stiffer lens cannot focus as well. Focusing ability is slowly lost throughout a person’s life, but it is not normally a noticeable problem until around age 45. This means that if we perform laser vision correction on anyone older than 45, give or take a few years, we can only solve part of the problem of eliminating the need for glasses or contact lenses. Even if we get a perfect 20/20 (or better) result and glasses are not required for clear distance vision, reading vision will still be blurred without reading glasses. For some, this is perfectly acceptable. Many people are happy if their distance vision is clear without glasses and they are not bothered by having to use reading glasses. We have many happy patients like this.

For others, this is not what they desire or expect from refractive surgery. They expect to be free from glasses or contact lenses most of the time, even when reading, using the computer or doing other close work. We have at least two good solutions for this.

First, we can program the laser to correct one eye (usually the dominant eye) for distance and the other eye for near. If the person is moderately nearsighted with no astigmatism, it may only be necessary to perform the laser procedure on one eye and let the other, still nearsighted eye do the reading. This approach is called MONOVISION. Many are happy with this, but others cannot adjust to one eye or the other always being out of focus. In fact, we do not recommend monovision laser correction, which after all is permanent, unless the patient has worn monovision contact lens correction and has been happy with this.

For those who do not like monovision (this includes most people) we have another solution. We can get both eyes in focus at distance together and also get both eyes in focus together at near. How can this be done? At present, this is only possible by implanting a multifocal lens inside both eyes. This is called refractive lens exchange or sometimes clear Lensectomy. It is also known as RELEX. The technique involves surgery inside the eye unlike laser vision correction. In fact, the procedure is performed exactly like cataract extraction, except there is no cataract to remove. The natural lens is removed even though it is clear, hence the term "Clear Lensectomy." We exchange the natural lens you were born with (which has lost its ability to focus) and replace it with an artificial lens, which is able to focus at both distance and near. Since this changes the refraction of the eye, we call it Refractive Lens Exchange, or RELEX.

There are some important differences between laser vision correction and refractive lens exchange:

RELEX
  • procedure is performed inside the eye; this requires two trips to the operating room, one for each eye
  • best for people 45 years old or older
  • more expensive than laser vision correction
  • risk of complications slightly higher, but still very low risk for vision complications
  • may require additional laser vision correction after surgery, especially if there is significan astigmatism (no extra charge for this if performed within one of RELEX)
  • eliminates the need for cataract surgery later since the lens, which can form a cataract, has already been removed
  • corrests presbyopia (loss of focusing ability with age)
       
    • In general, RELEX is a more permanent solution since the eye’s refraction is usually very stable once healed. A small amount of touch-up with laser may sometimes be required later on.

 LASER VISION CORRECTION
  • usually best for ages under 45 but often possible for older patients especially after intraocular lens implantation
  • both eyes can be treated at the same time
  • less expensive than RELEX since operating room is not needed
  • does not correct presbyopia