Refractive intraocular lens surgery is suitable for people with presbyopia and high farsightedness.

Refractive lens exchange (RLE) replaces the eye’s clear natural lens with an artificial intraocular lens to correct refractive error and achieve sharper focus, reducing the need for reading glasses or bifocals. It is usually suitable for people with presbyopia or extreme farsightedness.

It can also correct myopia but is generally not recommended if other methods can be applied.

The procedure for replacing refractive lenses is practically identical to cataract surgery. The difference is that with RLE, the lens being replaced is apparent rather than cloudy due to cataracts.

As with cataract surgery, three types of intraocular lenses are available to replace the natural lens, depending on vision needs and eye health:

  • Monofocal intraocular lenses with a fixed focus
     Monofocal lenses provide clear vision at distance, intermediate or near distances – but not all three at once. Toric intraocular lenses for treating astigmatism are also classified as mono-focal intraocular lenses.
  • Multifocal lenses
     They provide clear vision at multiple distances.
  • Accommodation of intraocular lens
     It is a mono-focal lens that allows focusing at multiple distances by shifting its position in the eye.


There is no “one size fits all” with intraocular lenses, and the eye surgeon will recommend the lens that best suits individual needs.

How the operation works

 Lens replacement surgery usually takes about 15 minutes and is performed, outpatient. Each eye is done separately, usually one week apart.

Numbing anesthetic drops are used during RLE, so there is usually no discomfort, and most people report immediate improvement in vision after surgery.

The initial recovery after refractive lens replacement – when normal daily activities can be resumed – usually takes about a week.

The results of refractive lens replacement may take several weeks to become fully apparent, and visual disturbances such as blurred vision, glare, or a “scratchy” sensation may be noticed while the eyes are healing.

Driving or returning to work approximately one week after the operation will be possible.

Under normal circumstances, the intraocular lens in the eye cannot be felt, just as a person cannot handle a dental cavity filling. And because the lens implant is inside the eye and not on the surface like a contact lens, others can’t see it.

An artificial intraocular lens is a permanent replacement for the natural lens and is designed to last a lifetime. Therefore, there is also minimal risk of regression (loss of curative effect or deterioration of vision) over time.

Refractive lens replacement as a solution for presbyopia?

Presbyopia affects almost everyone; in most cases, it appears sometime after age 40. It is a naturally occurring age-related condition in which the eye’s lens becomes more complex and rigid and loses the ability to focus on near objects.

Non-surgical options for correcting presbyopia include reading glasses, bifocal or progressive lenses, and multifocal contact lenses. Another option is to wear monovision contact lenses.

Refractive surgery such as LASIK, PRK, and phakic IOLs cannot directly address near vision loss caused by presbyopia. Therefore, RLE is often the most appropriate surgical option for people with presbyopia and moderate to severe farsightedness.

Replacing refractive lenses vs. LASIK

LASIK remains the most popular option for correcting nearsightedness and farsightedness. If you have a severe refractive error or an abnormal cornea, refractive lens surgery, such as precise lens extraction or phakic IOL implantation, may be a better alternative.

Unlike LASIK or PRK, refractive lens exchange can correct almost any degree of hypermetropia, and visual acuity after RLE surgery is often better than LASIK results.

If you are nearsighted, RLE is usually only performed if you are not a good candidate for other vision correction surgery. People with myopia have a higher risk of retinal detachment during precise lens extraction, and other refractive surgery options should be explored first.

Vision after refractive lens replacement

It depends on the type of intraocular lens used and whether you need glasses or contact lenses after refractive lens replacement.

Monofocal intraocular lenses are widely used in cataract surgery and straightforward lens replacement. They offer excellent vision and contrast sensitivity and have a low incidence of visual disturbances such as halos and glare.

However, because mono-focals are designed to focus at only one distance, you’ll probably need glasses for close-up tasks like reading small print and working on the computer (but monovision can help with near vision).

If you need glasses after RLE, you will see more clearly and comfortably if an anti-reflective coating is added to the lenses to eliminate distracting reflections. It applies to reading and computer glasses, as well as glasses worn continuously due to residual refractive errors.

Also, if glare from bright light bothers you after replacing refractive lenses, consider photochromic lenses that automatically adjust to changing light conditions outside.

Risks and side effects

Refractive lens exchange is performed in much the same way as cataract surgery, so the complications of RLE are similar.

Lens replacement surgery is more invasive than laser refractive surgery, such as LASIK and PRK, and carries slightly higher risks.

However, sight-threatening complications are rare, and most complications can be successfully treated with medication or additional surgery.

Although refractive lens replacement is safe and effective, every surgery carries some risk.

Refractive lens replacement is a more invasive surgery with a higher complication risk than other vision correction procedures.

Important information:

We will be happy to help you and offer a solution to your problem or your dream idea!

Each client is unique and has an individual situation in the field of health or aesthetics (appearance). For this reason, after consulting about his problems and needs, our specialists will propose the most suitable solution – the type of procedure or treatment and the time schedule, in case it is necessary to undergo the procedure or treatment more than once.

If you are interested in learning more, please contact us on phone number 00421 905 928 302, via the contact form or at the email address info@aladiva.sk.