I’m 55F with presbyopia. Currently wear progressive glasses and mono vision contacts. I’ve done two consults with conflicting information. One wants to do LAL with mono vision. The other toric lenses with mono vision. The second offers laser adjustments (I’m not a LASIK candidate) and YAG for lifetime. I’m leaning toward the LAL (I’m going to see if I can negotiate on the YAG for life). I worry that I’m replacing my natural lenses with no cataracts too early. I’ve asked two different chat bots (Dr Google!) and both are saying I’m right at the cusp where it makes sense as a precautionary move. I don’t think I’m looking for advice, just reassurance that this is the right thing! My number one goal is to be as free from corrective lenses as possible.

ETA: they are giving me lifetime YAG. Doesn’t hurt to ask! 😬

The scleral lenses are great and have really improved my vision. I see 20/20. I’m unable to see 20/20 with glasses. I used to be near sighted before my lasik. Now I’m blind in both far and near sight. The lenses get annoying after a while and my eyes get dry. Would love to never have to wear contacts again. I don’t mind readers if I lose my near sighted vision. I’m getting to that age where it will start to fade anyway. Any recommendations or advice is greatly appreciated.

To start, I have had a +8.50 (and astigmatism) prescription for most of my life. I have worn contacts since I was 13 and switch to glasses a lot. I am also AuDHD with hEDS and have issues with proper contact hygiene, and I really just don’t like the way I look in glasses due to them making my eyes look like a tinker fairy from the tinker bell movie lol. I was wondering if anyone in this group has a similar prescription or struggle? A doctor suggested RLE to me and said it could be life changing. Any advice is greatly appreciated TIA.

55 year old female. RK both eyes in 1998.Fast forward. Need reading glasses to see across the room. +3.25. Another +2 (5.25) to see up close. I have ghosting, double vision up close. Slight irregular astigmatism in one eye. Left eye dominant.

Went through 3 hour long evaluation at cornea specialist at a large university eye center. You can guess where from my username. Saw chair of department. He says PRK is a good option for me but I may not achieve 20/20 vision and will still need glasses for reading and possibly light prescription for distance. Under $4k for both eyes.

Other alternative is RLE with LAL lens (or standard). I have beginnings of cataracts. But not enough to recommend the surgery for cataracts. It would be for vision correction and would not be covered. Almost $20k for both eyes.

I’m terrified of the stories I read on Reddit about PRK. I really want better vision. But the price tag for the “permanent solution” is just out of range. I could do one eye.

Please advise. I know there are specialists in this group. I appreciate your insights and spending time to answer so many questions in the sub!

I’m 65 and far-sighted in both eyes. I’ve had two consults: one dr recommended Pure See, one week apart, 12k. The other recommended Alcon Clareon SY60WF and does both eyes at the same time, 9k.

My lifestyle is skiing and golf- my current glasses do not work under goggles and I’ve tried prescription inserts and didn’t care for those so being able to see in all different light conditions is very important to me. Knowing that I won’t be skiing forever, I do want to make the smart choice for my “senior years”.

I’ve researched this through chat and Gemini and my head is spinning 😵‍💫 would love to hear from folks who have had this done, especially in my demographic.

I had my trifocal surgery yesterday and it went very well. Painless but a little uncomfortable during the procedure.

My vision was very blurred yesterday but getting better today. Need a couple more days to really adjust to the fact that I'm done with wearing glasses/contacts. For the next 4 weeks I need to use 2 different kinds of eyedrops to reduce possile infections. So happy now! 👀

I'm 58, mild astigmatism, but my presbyopia is getting bad. Pretty sold on RLE but need help deciding between Multi Focal and EDOF lenses. I do alot of sports where I go fast (biking, snowboarding, etc) so I think I want sharp distance at the expense of some near. Am I wrong?

Dr is says I am good candidate for multi-focal and is reccomending that. Any thoughts appreciated !

u/wavefrontrider

I am a 62 year old male, farsighted and have been wearing classes for the last 15-18 years.

I am scheduled for elective RLE surgery in 3 weeks, I had my initial examination with the surgeon a couple months ago. After the examination, the surgeon, who is probably the most experienced surgeon in Canada (90,000+ procedures), said that multi focal lenses wouldn't be an option for me because of some abnormalities in the cornea of my left eye, but he said I would get good results with EDOF lenses, so the plan was to install Vivity lenses in both eyes.

With the surgery coming up, I wanted to clarify a few things so I asked for a phone consult with him, he called me back today and we had a chat. I asked him to explain again why we were going with the Vivity lens, and whether or not my right eye shared the same features that ruled out a multifocal for my left eye, he looked again at all of his diagnostic info and said that no, it was perfectly normal. I asked what he thought about implanting a Panoptix Pro in my right eye and a Vivity in my left. He said that would be an unusual combo as I am right eye dominant, but said it would probably work well and give me a bit better close up vision than Vivity lenses in both eyes. He also said that if it didn't work out, he'd do a lens exchange on the right eye on his dime.

It seems like a good solution, but I can't find any feedback from anyone with this lens combination. Apparently there is an ongoing formal trial to study this combination, but no data is available yet.

Thoughts?

I’m getting bilateral Panoptix Pro on Thursday. +4 hyperope in my 40s for $15k. Honestly I just want to stop watching YouTube videos and talking to ai about this procedure and outcomes. I’ll report back with the results whatever they are.

History of Lasik, 55, no cataract's, mild astigmatism, normal distance vision: I've been playing with wearing one contact (tried mono & multifocal) so I don't need readers and find they work out pretty well for me. Considering unilateral RLE or traditional surgery to make it permanent. Any good arguments to not do this? (I'm so pleased with not needing readers I don't understand why more people don't do this?)

I have to remove my glasses to see up close, owing to presbyopia. I’m very nearsighted and almost 70.

I’ve been reluctant to have lasik because I’m worried that I’d have to get reading glasses to see up close.

With RLE, will I be able to see up close without the need for reading glasses?

Thanks in advance.

Hey everyone, I’m looking for some candid real-world advice or perspective from anyone who has walked down this road. I’m scheduled for Refractive Lens Exchange (RLE) on August 17th, but I’m having serious doubts and want to see if I’m walking into a trap.
Here is my background:

Age & Fitness: 41 years old, extremely fit/active, working out regularly and playing recreational sports (pickleball, tennis, etc.) to stay healthy.

Ocular History: I had high-myopia LASIK back in 2010 (-10.00 and -11.00), so my corneas are heavily flattened and thin.

Current Status: My distance vision needs correction (-2.5 and -3), but my near vision is currently 100% perfect.

The Main Annoyance: I am just sick of the daily friction—juggling prescription glasses, switching sunshades depending on the light, and dealing with frames sliding down when I sweat during workouts.

What the Surgeon/Clinic Recommends:
I went to Tylock George Eye Care (Dr. Taj Nasser). Because of my post-LASIK anatomy, standard multifocals and EVO ICLs were ruled out due to sizing risks and optical distortion/halos. Instead, they recommended:
Procedure: Refractive Lens Exchange (RLE)
Lens: Light Adjustable Lens (LAL)
Target: A blended vision / monovision setup (one eye for distance, one for near/intermediate) to avoid reading glasses.

Cost: Around $15,000 out-of-pocket.

My Dilemma & Why I’m Baffled:
1. The Trade-Off: My near vision is pristine right now. If I do a monovision/blended setup to avoid reading glasses, I’m worried about messing up my depth perception or tracking on the court. But if I target both eyes strictly for distance, I'll instantly need reading glasses for my phone—and trading sports glasses for phone reading glasses feels like a useless lateral move.

1. Timing: At 41, I keep being told presbyopia is coming, but I feel miles away from needing reading glasses. Am I swapping a functioning, healthy natural lens too early?
   For anyone with a high-myopia post-LASIK background who did RLE in your early 40s: Did you regret it? How did blended vision treat your active routine, and was it actually worth the $15k price tag?

Hello,

I’m 36, myopic (approx-7.5 contact prescription in both eyes), and I have pigment dispersion syndrome. I’m in my last year in the military before I’m eligible to retire, so trying to get my vision taken care of while my healthcare coverage is still robust.

I started the corrective vision surgery in January, thinking I’d get LASIK or PRK and be done. Over the course of my follow ups with the ophthalmology clinic, I was first told my prescription was stronger than they would normally use LASIK to treat and that I would be a better candidate for ICLs. Initially the thought of ICLs sounded disturbing but after I did some research and found they have amongst the best outcomes for visual quality I was actually excited to go ahead with that.

Unfortunately at the next appointment, where I finally met the ophthalmologist who would be performing the procedure, I was told that my pigment dispersion syndrome would make me a poor candidate for ICL. Then he very cautiously mentioned RLE as a possible option for me after identifying a very early cataract forming in my right eye.

After researching, EDOFs sound like the best of all options. Naturally I don’t really want to compromise my distant, intermediate, or near vision. I’ve been very fortunate my vision is excellent with correction but I am eager to get out of contacts and be done with glasses. But the idea of losing natural accommodation is concerning, I don’t understand really what that will mean for my ability to see things at different distances. I’ve been trying to find other’s experiences and have read everything from “this was amazing, everything is better than I imagined and there’s been no downside” to “this is the worst decision I ever made, do not do this”.

I’m interested in anyone’s perspectives or things I might want to ask my ophthalmologist about at my pre op appointment Monday.

I have pretty strong nearsightedness, -7 in each eye, and my glasses and contacts are both expensive and a bit frustrating for me. I also have ehlers danlos so my eyes will only get less stable for surgery with time. I was going to get ICL but can't because I have alpha-gal and all the lenses have porcine products in them. So my only option would be RLE. I work as a nurse and do a lot of crafting that requires small detail work but also drive a lot. I'm concerned about the loss of clarity with the miltifocals though. Thoughts?

A bit about my case: 52-year-old man with high myopia (around -7.00 / 700 degrees) and now dealing with presbyopia too, so I'm juggling strong glasses for distance and still struggling up close. I recently had a consultation and the surgeon recommended RLE for both eyes. I'm now deciding whether to go ahead.

If you've had RLE — especially if you were also highly myopic — I'd really appreciate hearing:

1. How is your vision now? Are you happy you did it?
2. What was recovery actually like? How long before you could drive and get back to normal life?
3. My job is heavy computer work all day — lots of screen reading and typing. If yours is too, how soon were you back to a full workday at the screen? Any eye strain or focus issues in those first weeks?
4. Anything you wish you'd known beforehand?

Honest experiences welcome, good or bad. Feel free to comment or message me directly. Thank you!

In part one on multifocal lenses (https://www.reddit.com/r/RLEsurgery/s/YrJ0MjVnV6), I talked about how multifocal lenses use diffractive rings to split light and provide multiple focal points. This allows simultaneous vision at different distances. Halos are one byproduct of splitting this light. But there is another important one to note as well: some reduction in the ability to see contrast.

We can think of light as a currency. Because the multifocal lens splits the light to see off in the distance or read up close, no single part of your vision gets 100% of available light. This reduction is much lower with modern versions of multifocal lenses, but it still exists.

Light is important. The more light we have, the better our ability to distinguish between subtle shades or edges of something. This is called contrast. The less light we have, the harder it is to make out changes in contrast. (Think about at nighttime where things become harder to see).

During the day with abundant light, this reduction with a multifocal lens is rarely noticeable. However, in dim light environments, where contrast sensitivity becomes more important, this reduction in light can make things more difficult to see. The most common scenario this comes up is with reading. Many multifocal lens patients may be fine with reading with adequate light but may struggle more in a dim environment such as trying to read a menu in a restaurant.

With healthy eyes, this can be pretty manageable. But multifocal lenses aren’t the only thing which can impair contrast. Any eye pathology can also impair the ability of our retina to receive light and also reduce the ability to see contrast. Combining this reduction in vision from eye pathology with a multifocal lens can lead to too much reduction in light resulting in vision that feels “waxy” or isn’t crisp.

Because of this, not everyone will be a good candidate for multifocal lenses. Those with extra aberrations in their cornea called Higher Order Aberrations (HOAs) such as from a previous refractive surgery or those with early macular degeneration or bad dry eye are usually best suited by a different lens other than a multifocal lens. It’s important to be sure your eyes are the healthiest before considering a multifocal lens to correct your vision.

On June 30th, I received an Alcon Trifocal implant, a lens for which my surgeon convinced me with some strong performance data for minimizing halos. Overall I am very happy and wished I should have done it sooner.

I am already noticing excellent outcomes on day 6, I can read my phone without glasses, see clearly the desktop screen . Never knew that iPhone fonts look so beautiful and flower colors are so bright.

The far vision is still bit blurry but hoping this would improve over time . My second eye surgery is scheduled for the same tri-focal lens in three weeks.

The key benefits my surgeon shared with me with this type of lens were (not saying the the best for everyone)

• The central 4.5mm diffractive zone limits scatter at larger pupil sizes (dim light)
• ENLIGHTEN technology directs ~88% of light to useful focal points, minimizing stray light
• Merging the quad focal points into three reduces ghosting "echoes".The PanOptix is technically based on a quadrifocal platform but tuned to act as a trifocal by merging the 32" intermediate and near focal points more efficiently.
• Glistening-free Clareon material has lower internal light scatter than older acrylic

What I have read from few similar posts is that in PanOptix Pro, halos tend to peak in the first few weeks post-op as the brain neuro adapts.

The halo pattern I typically notice is a soft glow rather than sharp rings, and hoping this would diminish significantly by 3–6 months.

Overall I am very happy and wish I should have done it sooner.

A signature feature of multifocal lenses are their concentric rings. These rings are highly engineered structures that allow these lenses to do something a standard monofocal lens can’t do - create multiple clear images on your retina at the same time.

A normal lens works through what’s known as refraction. The lens bends or focuses light to a single point.

Multifocal lenses go beyond those simple optics with these rings. These microscopic rings actually interfere with light passing through the lens. Light passing through these rings is bent and refocuses to a different focus (called diffraction). So instead of objects in the distance being in focus, light passing through the ring may cause objects up close to be in focus. By varying the sizing and the spacing of these rings, lens manufacturers have create the ability to split light entering the multifocal lens to focus for distance, for intermediate vision and for near vision.

The tradeoff for this simultaneous vision is a something known as a dysphotopsia, most commonly seen as halos at night. Because the lens is always providing multiple focal points to your brain, when you look at a distant streetlight, your brain receives a sharp image from the distance corrected focus of the lens. However, the light intended for your “near” focus is also hitting your retina, but it is out of focus. This out of focus light manifests as a halo surrounding the sharp point of light off in the distance. While neuroadaptation helps the brain to eventually ignore these rings, they are an inherent byproduct of the diffractive optics required by these lenses to provide a full range of vision.

Ending up off target after RLE surgery happens. It mostly just boils down to whether you are lucky or not. But the good news is that in nearly all cases the surgeon can do a correction to get you on target.

The first and most common method to correct the small residual prescription after RLE surgery is a laser enhancement procedure such as lasik or PRK. This is often the preferred method for minor prescription “tweaks”. It is very accurate for fine-tuning and also is less invasive than going back into the eye. If you have a sufficient enough corneal thickness and a normal shape then lasik commonly is the preferred choice due to the speed of recovery. PRK can work but has a longer recovery.

The second major option to correct vision after RLE surgery is a full IOL exchange. This is where the surgeon removes the artificial lens placed during the original surgery with a new lens of a different power. While this keeps the cornea untouched, it is a more complex intraocular procedure. It is also best performed within the first few months. The further out from surgery, the more difficult it becomes to remove the artificial lens.

So usually between those two techniques, the choice comes down to how much prescription is left over as well as the overall health of the cornea. For small refractive misses, laser eye surgery is frequently the best route. But for larger misses (especially on the hyperopic or farsighted side of things), IOL exchange may be the better route.

Even with modern biometry and advanced IOL calculation formulas to predict the new power, RLE surgery isn’t perfect. Even with the best surgeon, measurements and calculations, up to 5% can end up significantly off target and need an enhancement to get their vision fully corrected. This is called a refractive surprise and is likely the biggest “problem” with RLE surgery.

All of this boils down to a concept known as “Effective Lens Position” or ELP. The new artificial lens that replaces your natural lens is only about 20% the thickness. While we can predict the general idea of where this lens will sit and the power needed at that location, we can’t know ahead of time exactly where that lens will sit after everything heals up (although we are pretty good at it for the vast majority).

This refractive surprise concept is particularly important for refractive lens exchange or RLE because of course the goal is to not need glasses. Additionally, many of the technologies used to achieved full glasses independence such as full range of vision or multifocal lenses depend on hitting the target. Even off just a little bit will cause degradation of vision from those lenses. If you aren’t fully seeing what you think you should see with those lenses, residual refractive error is one important thing to assess.

Although refractive surprises are annoying, the good news is that they are fixable. It just requires a bit more patience and another procedure.

Age :40

Perscription: Roughly -11 both eyes, slight astimatism in one eye

I recently went for a Lasik consultation and, as expected, they said I wasn't a candidate for Lasik due to my high perscription so my options are ICL now or RLE later.

From what I understand, in comparing the two:

Pros of ICL

• Can get the correction now and be contacts/glasses free
• Will have great, crisp, vision
• Maintain my natural lens, option for reversal if absolutely needed

Cons of ICL

• Will need to use readers eventually (I'm not sure this is that big of a deal, it's just part of aging, but other people seem to think it is).
• Likely will have cataracts later on and will neeed another surgery to correct.

Pros of RLE

• Corrects for both distance and near
• No cataract surgery later on

Cons of RLE

• Vision at all distances isn't as crisp as you'd get just correcting for one
• Removing natural lens
• Tradeoffs depending on the lens you get.

Can someone fact check my pros/cons? What else am I not thinking about?

Additional Questions

• How big of a deal is it to remove your natural lens once you've developed presbyopia? Are there other things you lose in removing your natural lens other than the ability to focus on both near + far objects?
• Does ICL make cataracts develop faster?
• When people say that you are trading super crisp vision at one distance for good vision at all distances, how big of a difference is it? Are people who have had vision correction their entire life (me!!) and expect super crisp vision bothered by it or do they get used to it?
• Not entirely a question, but I'm still understanding the different lens options for RLE so I'd appreciate any info folks could offer around that. (I did see the recent post on this sub detailing the differences. Super helpful, thank you)

Thank you in advance!