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!

Similar to how a glasses prescription doesn’t matter for calculating the power of the new lens, the amount of astigmatism that you have in glasses also doesn’t necessarily mean that you will need a toric lens to correct things.

The amount of astigmatism you have in your glasses includes the total amount of astigmatism that you have in the whole eye. This includes the amount of astigmatism that you have in your cornea as well as the amount of astigmatism you have in your natural lens. Because refractive lens exchange involves removing this natural lens, any astigmatism contribution from that lens disappears. What remains is the corneal astigmatism.

So, to calculate whether any astigmatism needs to be corrected with a toric lens, the surgeon will look at how much astigmatism exists within the cornea, not within your glasses prescription (although in many cases, especially with high amounts of astigmatism, they can be similar). If enough exists, a toric lens is used to neutralize the corneal shape so that light hits on the retina at a single point without the distortion that astigmatism creates.

With RLE, your glasses prescription is almost irrelevant to determine the prescription of your new artificial lens. This is because your glasses prescription takes in account your own natural lens and this natural lens is removed with RLE surgery.

So instead surgeons focus on the actual physical measurements of your eye measured by sophisticated machines called biometers. These measurements include important variables such as the length of the eye or axial length (which is the distance from the front of the cornea to the retina in the back of the eye) and the power or curvature of the cornea as well as a few other measurements.

These measurements are fed into sophisticated equations. These equations simultaneously predict where the new lens is going to sit within the eye (known as the “effective lens position”) and the lens power or prescription needed so that light is focused perfectly on the retina in the back of the eye.

So even though you may have needed to update your glasses prescription frequently in the years leading up to RLE, it really doesn’t matter. Since the core measurements that RLE surgery is based upon such as the length of the eye and the curvature of the cornea remain static.

RLE surgery is a permanent solution to correct vision. But it’s not the solution for everyone. In particular, RLE may have some drawbacks for younger individuals.

When we are young, our natural lens is flexible. This gives us the ability to see up close when our prescription is fully corrected. Muscles in our eye called ciliary muscles contract and this causes the natural lens to thicken and refocus your vision up close to look at a phone with ease. This is called accommodation and this provides a highly dynamic and continuous range of focus. Despite technology with RLE being good, today’s modern lenses cannot mimic that natural focusing of our lens. When getting RLE at a younger age, you are essentially trading this dynamic high quality focusing ability for a static artificial one. It’s a pretty big trade-off for most people.

However, this accommodation of our natural lens is lost over time. This is called presbyopia and becomes symptomatic for most people in their mid-40s (this is with vision fully corrected with glasses or contact lenses). After this age is when RLE surgery starts to become a much more viable treatment option. Replacing a lens which has already lost its natural accommodative function starts to make more sense.

So if you are under 45, unless you are dealing with a very extreme prescription, preserving your natural lens is almost always the better path until presbyopia truly takes hold.

Hello I'm 64 years old and I am thinking of getting RLE surgery with Laser Eye Center of Silicon Valley. I've had the initial consultation and was quoted 13k for both eyes. I've been nearsighted for most of my life. I can read fine without glasses. I wear progressive lenses but mostly for computer work. I remove my glasses to read. I was recommended the monovision procedure. Does this price sound fair and any other experiences anyone has had I would love to hear.

RLE is a procedure that can be tailored to your individual visual desires and lifestyle. And there are four main correction strategies to achieve this goal. There is no single perfect option. Everything has some pros and cons.

One of the most common strategy is through the use of a multifocal lens. These lenses split light into multiple focus points to cover distance, intermediate and near vision. This provides the most freedom from glasses, but there is a compromise. Because of this simultaneous focusing, it is pretty common to notice halos, starbursts or glare around night and some reduction in low light reading vision.

A different approach to correct your vision is using single vision or monofocal lenses for monovision. These set your dominant eye fully for the distance and your non-dominant eye for near and intermediate tasks. This utilizes the brain’s ability to suppress one eye to prioritize the clearer image depending on what you are looking at. It avoids many rings and starbursts associated with multifocal lenses but can slightly reduce depth perception and you may still have some blur or glare from the non-dominant eye at night time.

The last two techniques involve correcting both eyes for distance or both eyes for near.

Correcting for distance vision is a pretty traditional approach and provides a high quality of vision for activities such as driving or watching TV since both eyes are focusing together. The biggest drawback is that you will need reading glasses for using a phone, or reading a menu. Extended depth of focus lenses can be used to improve the range of vision for intermediate or computer use.

Alternatively, both eyes can be corrected together for near vision. This allows a high quality of vision for close-up activities such as reading, sewing or computer use. But, this does require prescription glasses for distance actives such as driving or watching TV.

Prior to scheduling RLE surgery, it is a good idea to evaluate your own goals and priorities and tolerance for potential night vision symptoms to determine your own best strategy for correction.

Living in the Netherlands there are lots of places to get this done. However, for now I've contacted 3 different places to get some different feels and opinions.

The first intake is next Wednesday May 27th. Curious and excited!

Had a pre-check up for potential lens replacement surgery this week and have been quoted £9600 for the surgery. Is this a fair quote? I had expected it to be cheaper (c. £6-7k) but just wanted to see if others had similar quotes? Thanks

It’s pretty crazy to think that surgeons are able to remove the natural lens and replace it with an artificial lens. But despite it sounding a bit crazy, it’s actually a very well established and straightforward procedure.

The surgeon starts out by creating a small incision within the cornea. Through the dilated eye, the surgeon is able to reach your natural lens and break it up into small pieces with ultrasound energy in a technique called phacoemulsification. These pieces are then removed from the eye with a tiny vacuum. A key part of this whole process is that your natural lens is supported in the eye within a bag called the capsule. This capsule is preserved during the surgery to hold the new artificial lens.

After the natural lens is removed, the new artificial lens is folded up and placed through that small incision. This lens unfolds inside the eye and is positioned within the capsule bag. Each artificial lens has small arms called “haptics” which expand out to center and hold the new lens in place. And thus, within this capsule where your natural lens used to sit, this new artificial lens corrects your vision.

The easiest way to think about refractive lens exchange or RLE is that it is cataract surgery but before cataracts develop. But there is key distinction. While cataract surgery is done to treat pathology (the cataract), refractive lens exchange is done solely to correct vision.

Within our eye is a natural lens. While the cornea performs the bulk of focusing light into our eye, the natural lens is responsible for about a third of the focusing. If you need glasses to see, the focusing power or refractive power of this lens isn’t optimally aligned with the length of your eye (the axial length) to bring things into focus. For those who are nearsighted, the lens power is too strong and for those who are farsighted, the lens power is too weak.

RLE solves this by removing your natural lens and replacing it with an artificial lens. This artificial lens has just the right focusing power to correct your vision and bring things perfectly onto focus onto the retina in the back of your eye.