Refractive Lens Exchange is a procedure becoming more popular in recent years. For individuals whose prescription exceeds the range of the laser (which is usually considered to be between -10.00D of short sight to +5.00D of long sight), it is safer to perform surgery within the eye. Instead of using a laser to re-shape the cornea, the natural human lens can be replaced completely with an artificial lens of the right power to correct the vision (known as refractive lens exchange).

How does Refractive Lens Exchange surgery work?

The technique is very similar to cataract surgery. The natural lens is removed through a very small (2.4mm) incision using a sophisticated ultrasonic probe and the acrylic implant is inserted through the same incision. This can be done with the femtosecond laser. In most cases, no stitches are required and visual recovery is rapid. The surgeon positions the lens to focus light clearly on to the retina.

The procedure is comfortable for patients as very little is felt during surgery. David Gartry will explain what is happening as he performs the surgery and the nursing staff will be there at all times to reassure you throughout. After the artificial lens is inserted the procedure is complete. The highest spectacle prescription that David Gartry has treated with this technique was -37.00D! The patient, an elderly lady who also had cataracts, was left with just -1D of short sight.

One of the disadvantages of refractive lens exchange is the need to wear reading glasses after treatment, unless multifocal implants are used (which also have their limitations). The procedure, therefore, tends to be reserved for patients (over the age of 40) who already need additional glasses for reading. A more recent procedure using phakic lens implants, can overcome the problem of reading glasses. Here, a secondary lens is inserted in front of the natural lens. The natural lens remains in place and can continue to adjust its focus for reading. Phakic implants are a relatively recent development and still the subject of evaluation.

Your RLE Consultation

Your consultation with David Gartry for RLE surgery involves a thorough eye examination, starting with state-of-the-art diagnostic scanners.

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Your RLE Treatment Day

You can expect to be with us for approximately 4-5 hours. When you arrive, the nursing team will make you feel comfortable and reassured.

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After your RLE Surgery

We will be here to support you all the way as you gain your independence back with the transformation in your sight.

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  • Your Intraocular Lens (IOL) Choicearrow

    Monofocal IOLs

    There are a number of intraocular lenses (IOLs) available that can be tailored to suit a range of visual requirements.

    The most frequently implanted lens is a monofocal IOL (standard IOL). This lens offers excellent image quality (especially in aspheric form) and is primarily used to achieve good distance vision. Monofocal lenses of different powers can be implanted so that one eye is corrected for distance and the other for close vision, helping the patient to minimise reliance on spectacles for reading and other close work. This is known as monovision. Some patients acclimatise to monovision more easily than others; in some cases reading glasses may still be preferred for fine print, and a distance prescription may help with some activities, particularly in poor light conditions.

    Multifocal IOLs

    Multifocal IOLs have grown in popularity in recent years allowing for an element of close work vision not present with standard monofocal lenses. The more modern designs have now overcome some of the limitations of earlier examples. These lenses can be well tolerated and can give reasonably good distance and close vision, with a greater depth of focus than monofocal IOLs. However, this is sometimes at the expense of image quality, and glare and haloes may be troublesome. We would not recommend multifocal IOLs for those who drive frequently at night, for example, or those with very exacting visual requirements. These lenses can also be used in the treatment of presbyopia (the loss of near vision as we move into our mid-40s).

    Toric IOLs

    Toric lens implants are for patients with moderate amounts of corneal astigmatism (more than 1 or 1.5 dioptres). Reducing your astigmatism will reduce your dependence upon glasses as compared to a non-toric IOL. A standard IOL can be set to make you either far sighted or near sighted but if you have astigmatism your vision without glasses will still be blurred to some degree because this astigmatism has not been corrected by the standard IOL. You could wear glasses in order to correct the astigmatism or undergo laser eye surgery at a later date (Bioptics). However, if it is desirable for you to have better vision when not wearing your glasses, you may want to consider a toric lens implant.

    Multifocal TORIC IOLs

    These lens implants are the same as the above Toric IOLs but have a +1.5 dioptre reading addition built in to aid near vision.

    Phakic IOLs

    With cataract and refractive lens exchange surgery the eye’s natural lens is removed and replaced with an artificial implant. Some ophthalmic surgeons perform an alternative procedure – phakic implant surgery – where the natural lens remains in place while the phakic IOL is positioned immediately in front of it.
    The combined focusing power of the two lenses can be effective at treating severe short and long-sight, and the artificial lens can also reduce or eliminate astigmatism. David Gartry does not perform phakic implant surgery, as it is a relatively new procedure and he is unconvinced as to its long-term effectiveness and safety. These lenses tend to be used more for younger patients who can still accommodate (focus for close work) who are contact lens intolerant and have high prescriptions. Beyond mid-40s a better option is refractive lens exchange using the new femtosecond laser technology. Phakic implants have been known to cause cataract and glaucoma and, since the technique is intraocular (placing a lens inside the eye), rarely serious problems such as infection or retinal detachment can follow. If at all possible David Gartry encourages these younger patients, who are well beyond the normal laser range, to persevere with contact lenses – perhaps seeking the advice of an experienced contact lens specialist.

  • YAG Laser Capsulotomyarrow

    Around 20% of patients who have cataract surgery will start to experience PCO (Posterior Capsular Opacification), a gradual clouding of their vision that can develop weeks, months or even several years after surgery.

    This condition is treated with a procedure known as a YAG laser capsulotomy, where a laser is used to remove the clouded-over part of the lens capsule to allow a pathway for the light rays to focus on the retina, restoring visual clarity.

  • Testimonialsarrow

    Here are just some of the many stories we have from our thousands of happy patients.

    Stuart A

    “David was great and reassured me as I was concerned that as I suffer from Uveitis that the procedure may trigger this. David confirmed he has dealt with many of these cases and advised he caters for possibilities in the aftercare by increasing the steroid drops for my case. In short, I had no issues and was pleased with pre and post care.”

    Noreen F

    “I thought I would let you know that I recently had my first eye sight check with my Optician following my lens replacement surgery this time last year and “passed with flying colours”!!! She was very impressed with Mr. Gartry’s work. Would you please convey my thanks to Mr. Gartry for a wonderful year of spectacles free vision and I hope to have many more to look forward to.”

    Sue C

    “An excellent result and I would highly recommend Professor Gartry and his team. Thank you so much. Before, I needed glasses for distance and reading and now I’m glasses free. A very straightforward procedure with no discomfort. Professor Gartry was very reassuring throughout the who process.”

    You can read all of our testimonials here – you’ll be able to see the delight in each and every one of their words.

  • Refractive Lens Exchange Feesarrow
    Refractive Lens Exchange at Moorfields Eye Hospital (per eye)
    Initial Consultation Fee £195
    Follow-up Consultations* £175
    Standard treatment £3980
    Laser assisted treatment £4742
    Premium monofocal lens fee £150
    Special order/custom made lens From £575.00

    *Follow-up appointments are not included in the surgery fee and will be charged per visit.  There are usually two and the fee is £175.00 per visit.

    For more details please call us today on 020 7490 7222  or use the form to get in touch.