Refractive lens exchange found safe, effective for treatment of hyperopia
June 26, 2009
Refractive lens exchange (RLE) is a lens-based refractive procedure in which the clear natural lens is removed from the eye and replaced with an intraocular lens (IOL) of appropriate power to correct moderate and high refractive errors.
The procedure is essentially the same as cataract surgery. The only difference is that the lens being removed is clear, not clouded by cataracts.
Many surgeons are reluctant to perform RLE for purely refractive reasons due to the potential for serious complications, such as glaucoma and retinal detachment.
RLE safety and effectiveness: Study design
To investigate the safety and effectiveness of refractive lens exchange for the treatment of moderate and high hyperopia, researchers in Indonesia treated 153 eyes with the procedure.
The mean refraction of the eyes prior to surgery was +5.29 D and the mean age of the patients was 52 years.
Three different IOLs were investigated, including multifocal IOLs for the treatment of presbyopia. Mean follow-up after surgery was more than five years.
RLE safety and effectiveness: Study results
Amit Tarafdar, MD reported the results of the study at he joint meeting of the Asia-Pacific Academy of Ophthalmology and the American Academy of Ophthalmology held recently in Bali.
Findings of the study included:
- Mean refraction after surgery improved to 0.04 D, compared to +5.29 prior to the procedure.
- Uncorrected visual acuity (UCVA) at near was 20/20 in more than 90 percent of the subjects.
- There were no occurrences of intra-operative or post-operative complications and no instances of detached retina folowing surgery.
- Clear lensectomy (and RLE) for hyperopia is predictable and extremely safe," Dr. Tarafdar said. "Results are acceptable for monofocal lenses and extremely good for multifocal lenses."
Surgeons prefer RLE for treatment of hyperopia, but not myopia
In related news, a recent survey of refractive surgeons in the American Society of Cataract and Refractive Surgery (ASCRS) found that a majority of surgeons prefer RLE for the surgical treatment of high (+5.00 D) hyperopia, compared to only 9 percent preferring LASIK for these patients.
(Thirty percent of those surveyed said they prefer not to perform either type of surgery on these patients.)
But it is a different story for the correction of high myopia. For patients with -10.00 D of nearsightedness, 40 percent of surgeons surveyed say they prefer phakic IOL implantation, 20 percent prefer LASIK and only two percent prefer RLE.
The difference is due to the higher risk of retinal detachment and other RLE complications among eyes with high myopia compared to eyes with high hyperopia.