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

March 15, 2022

Blurry vision is frustrating, and using glasses or contact lenses can be cumbersome. Thanks to surgical advances in the field of eye care, you don’t have to live with compromised 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 surgically. 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. It’s a laser-based procedure that reshapes the clear dome on the front of the eye known as the cornea. LASIK starts with the creation of a flap on the surface of the cornea This flap is then lifted, and a laser removes a microscopic amount of tissue from the cornea. The laser is programmed with pre-operative measurements which are unique to each individual patient. Therefore the amount of tissue removed from each patient is specific to their level of myopia, hyperopia, and/or astigmatism. The flap is then realigned over the treated area to facilitate healing. The treatment is painless and over in a matter of minutes. The patient can also treat both eyes on the same day minimizing downtime and recovery.

What Is Refractive Lens Exchange?

What Is Refractive Lens Exchange

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. This procedure is very similar to cataract surgery, which many people will need later on in life.

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

LASIK requires the removal of corneal tissue. There are limits to how much can be removed safely. People with high amounts of refractive error 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, necessitating retreatments. LASIK also carries the risk of over-correction, under-correction, dry eye, flap problems, and vision loss.

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

Are You a Good Candidate For RLE?

One difference between laser eye surgery and lens replacement is cost. LASIK surgery can range from $2200 to $3200 per eye. With an RLE procedure, the cost can be more depending on the type of implant lens that is chosen and factoring in the cost for an anesthesiologist and the facility fee for the outpatient surgery center where the procedure will be performed.

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.

Laser Eye Surgery vs. Lens Replacement

Best For· Mild/moderate myopia
· Hyperopia
· Astigmatism in the cornea
· High myopia and hyperopia
· Presbyopia
· Early cataracts
· Astigmatism in the lens
Procedure· 10 minutes per eye
· Both eyes done on the same day
· 15 minutes per eye
· Each eye is done 7-10 days apart
Recovery· Patients can resume most of their
  normal day to day activities within 24 hours
· 7-10 days initially
· 3-12 weeks for adaptation, depending on lens type
Not For· High lenticular astigmatism
· Thin corneas
· Cataracts
· High corneal astigmatism
· Retinal issues
· Autoimmune conditions


Talk to your doctor about whether laser eye surgery or lens replacement is most appropriate for you. Your doctor will look at your eyes, vision, goals, and lifestyle to make the best decision for you. Whether you get LASIK or lens replacement, your dependence on glasses and contact lenses will be diminished if not eliminated. How does that sound?

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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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