Refractive lens replacement – qualification for the procedure

RLE (refractive lens exchange) or CLE (clear lens extraction), or refractive lens exchange, involves removing the patient’s own lens and replacing it with a technologically advanced artificial lens to correct the visual impairment. Refractive lens replacement surgery can also be performed on patients who have previously undergone laser vision correction.

Multifocal lenses (trifocal, multifocal, EDOF) allow very good visual acuity for distance, near (35-40 cm) and intermediate distance (60-90 cm). Toric monofocal lenses eliminate astigmatism, provide sharp vision for either distance or near.

Toric multifocal lenses eliminate astigmatism They provide sharp vision for distance, near and intermediate distances, so they give the possibility of complete independence from corrective glasses.

Who qualifies for refractive lens replacement surgery

Refractive lens replacement surgery is recommended for patients with severe farsightedness, presbyopia and astigmatism, and in some cases myopia. CLE (clear lens extraction), as the name implies, is a procedure for replacing a non-corrected lens with an artificial one.

During refractive lens replacement surgery, it is possible to use a lens that is individually matched to the needs of a particular patient.

Contraindications to refractive lens replacement

Refractive lens replacement is an alternative for people who cannot undergo laser vision correction for various reasons. So if you choose to implant an artificial lens due to contraindications to laser defect correction, eye problems such as thin corneas or dry eye syndrome are no longer a contraindication.

Refractive lens replacement does not make any changes to the cornea (other than initial incision marks of 1-2mm), as happens with laser correction, and is recommended for people of all ages.

The following tests and procedures are performed as part of the qualification for refractive lens replacement surgery:

• Patient Interview.
• Computerized eye examination (autorefractometry).
• Keratometry (measurement of the curvature of the cornea).
• Pachymetry (measurement of corneal thickness).
• Corneal topography.

The following tests and procedures are performed as part of the preoperative examination for refractive lens replacement surgery:

• Patient Interview
• Computerized eye examination (autorefractometry)
• Keratometry (measurement of corneal curvature)
• Tonometry (measurement of intraocular pressure)
• Optometric examination
• Visual acuity without correction (vis sc)
• Eye dominance
• Subjective refraction
• In the case of astigmatism – Determining the power and axis of the cylinder
• Visual acuity under correction (vis cc)
• Checking the parameters of binocular vision (fusion, stereopsis, presence of foria/tropia)
• In the case of presbyopia, determination of addition (nearsightedness addition)
• In case of presbyopia, simulation of monovision (monovision tolerance test)
• Pachymetry (measurement of corneal thickness)
• Corneal topography
• Dynamic pupilography
• BUT – tear film interruption test (tear film quality)
• Eye biometry (measurement of eyeball length), anterior chamber depth (Anterion)
• Cycloplegia (paralysis of accommodation and pupil dilation)
• Autorefraction
• Anterior and posterior ocular biomicroscopy
• Tomography (OCT – optical coherence tomography of the eye)
• fundus photography (fundus camera image)

Examination of the anterior segment of the eye is performed at SwissLaser through the platform ANTERION® . The device combines corneal topography and tomography, measurement of the anterior segment of the eye, measurement of axial length, and IOL ( Intraocular lens power calculation) calculation to facilitate the routine surgical procedure. Visual confirmation of all measurements with high-resolution swept source OCT images ensures diagnostic confidence. One of the ANTERION® modules (the Barret module) includes calculation formulas for calculating toric lenses.

OCT examination of the posterior segment of the eye and cornea is performed at SwissLaser with the Retina Scan Duo ™. It’s a high-resolution OCT and funduscamera (imaging the fundus of the eye through the pupil) in one.

NOTE: In addition to the ophthalmological examination, it is advisable to perform laboratory tests, i.e. Blood group determination, morphology, coagulation system.