RLE (Refractive Lens Exchange) vs. LASIK: What's the Difference?

RLE (Refractive Lens Exchange) vs. LASIK: What's the Difference?

April 19, 2023

Table of Content

Blurry vision is frustrating, and using glasses or contact lenses can be aggravating. Thanks to surgical advances in the field of eye care, you don’t have to live with inadequate vision. Several procedures have been developed and fine-tuned over many decades to help treat refractive errors. A refractive error is a term used to describe a problem with the shape of the eye that prevents light from focusing properly on the retina. Myopia (nearsightedness), hyperopia (farsightedness), and astigmatism are all refractive errors that can be treated with RLE eye surgery. Now, all you and your surgeon have to do is decide which procedure is right for you. Refractive lens exchange vs. LASIK? What’s the difference?

What Is LASIK?

What Is LASIK?

LASIK stands for Laser-Assisted In Situ Keratomileusis and is a procedure that will permanently change the shape of the cornea, eliminating or reducing an individual's need for contact lenses or glasses. Using a laser, your doctor will create a flap on the front surface of the eye, the flap is lifted and the underlying tissue is reshaped. Once completed, the flap is replaced and aligned into its former position.

Are You a Good Candidate for LASIK?

Candidates for LASIK must meet certain requirements to ensure their safety and success during and after the vision improvement procedure. Candidates must be:

  • Over 18 years of age
  • Free of certain health conditions, including autoimmune diseases or uncontrolled diabetes
  • Free of certain eye conditions like cataracts, keratoconus, and optic nerve diseases
  • Free of eye infections or other issues at the time of surgery
  • Meet requirements for corneal thickness as evaluated by a doctor
  • Cannot be pregnant or nursing

What Is RLE Eye Surgery?

So what is RLE eye surgery exactly? A refractive lens exchange is a safe and effective procedure for many patients who have been told that they are not a good candidate for LASIK or PRK. With LASER eye surgery, a microscopic amount of tissue is removed from the cornea to help the light focus properly on a patient’s retina. With an RLE procedure, a patient’s cornea remains intact. Instead of removing tissue from the cornea, a patient’s natural crystalline lens, which sits behind the colored part of the eye known as the iris, is removed and replaced with a biocompatible manmade lens. This lens will have an exact prescription unique to the patient’s refractive error. Eye surgery for lens replacement is very similar to cataract surgery, which many people will need later on in life.

Are You a Good Candidate for RLE?

Are You a Good Candidate for RLE?

RLE is often a good option for patients with high refractive errors. Since LASER eye surgery requires the removal of tissue from the cornea, these people may not be eligible for traditional laser eye surgery. However, those with very high levels of nearsightedness may not be the best candidates for RLE due to the increased risk of complications. It is important to discuss the pros and cons with your surgeon and to help establish a realistic expectation of post-surgery results.

LASIK Pros and Cons

LASIK Advantages

Both eyes are done on the same day in LASIK, which is convenient. Healing is very quick and usually painless. If you’re young, one advantage of LASIK vs. RLE is that you’ll maintain your ability to see up close, that is, until you reach an age where you start to develop presbyopia.

LASIK Disadvantages

When choosing between a lens implant vs LASIK, bear in mind that LASIK requires the removal of corneal tissue. There are limits to how much can be removed safely. People with high amounts of refractive error, or thin corneas may not be candidates for LASIK, in which case refractive lens exchange may be a better option.

In addition, LASIK can sometimes, although exceedingly rare, diminish in efficacy over time, requiring retreatments. LASIK also carries the risk of over-correction, under-correction, dry eye, flap problems, and vision loss.

Refractive Lens Exchange Pros and Cons

Refractive Lens Exchange Pros and Cons

RLE Advantages

RLE is an option for those with high refractive errors who may not be candidates for LASIK. 

The outcome of RLE tends to be very stable. It doesn’t carry the risk of regression over time.

RLE Disadvantages

The refractive lens procedure involves going inside the eye, whereas LASIK does not. Therefore, there is more healing time involved in RLE vs. LASIK. Visual recovery takes a few more days in lens replacement vs. laser eye surgery. Also, with an RLE procedure, one eye is treated and the patient must return a couple of weeks later to have the 2nd eye treated.  

When the natural lens is removed, the ability to focus on near objects is lost. Therefore, reading glasses may be needed after RLE if the goal was to give a patient their best distance potential. There exists the option to have a multifocal lens implanted instead in an attempt to minimize the need for reading glasses.

There are also refractive lens exchange risks to keep in mind. These include a malpositioned lens, infection, bleeding, increased intraocular pressure (glaucoma), retinal detachment, and vision loss, among others.

LASIK vs. Lens Replacement Cost

One difference between laser eye surgery, or LASIK, vs lens replacement, is cost. LASIK surgery can range from $2200 to $3200 per eye. The cost of an RLE procedure,  is often higher than LASIK, depending on the type of implant lens that is chosen. The average RLE eye surgery cost for one standard implant is about $3,800, though implants for astigmatism or farsightedness may cost more. The cost of RLE eye surgery also depends on the anesthesiologist and the facility fee for the outpatient surgery center where the procedure will be performed. To find out how much does RLE surgery cost, it would be beneficial to contact your specific eye surgeon, and check with your primary and secondary insurance companies.

Is Lens Replacement Surgery or LASIK Covered by My Health Insurance?

Is Lens Replacement Surgery or LASIK Covered by My Health Insurance?

Is lens replacement or laser eye surgery covered by insurance? Because RLE and LASIK are considered to be elective surgeries, health insurance is unlikely to  cover the cost of eye lens replacement or vision correction procedures. Vision plans might cover some of the payment for laser surgery, depending on the conditions, but they primarily cover corrective lens expenses. However, because these surgeries are elective, it is unlikely insurance providers will include eye lens replacement surgery in their plans.

There are financing options available to those interested in RLE surgery and LASIK. It is also important to consider the lifetime savings on future costs of glasses, contacts, and eye doctor visits. These can be significant factors in deciding on eye surgery for lens replacement.

Laser Eye Surgery vs. Lens Replacement

If you’re weighing the costs and benefits of lens replacement surgery vs LASIK, ask your eye doctor which vision improvement procedure they think will be the safest and most successful. See the table below for a clearer comparison of RLE eye surgery and LASIK.


Contact the Kraff Eye Institute for an eye exam and consultation, and find out  whether laser eye surgery or lens replacement is appropriate for you. To choose between refractive surgery vs LASIK, your doctor will look at your eyes, vision, goals, and lifestyle to make the best recommendation for you. Whether you get LASIK or lens replacement, your dependence on glasses and contact lenses will be diminished if not eliminated. Doesn’t that sound amazing?

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Dr. Colman R. Kraff

Committed to advancing new technologies in the field of ophthalmology, Dr. Colman Kraff helped to pioneer laser vision correction. In February of 1991, as part of a five-site, U.S., FDA clinical trial team, Dr. Kraff successfully performed the first excimer laser procedures in the Chicagoland area using the VISX Excimer Laser.

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