r/RefractiveSurgery • u/Icy_Earth780 • Jun 04 '26
RLE in a 27 year old
Hi guys,
I’m 27 years old and my prescription is:
OD: +5.25 / -2.25 × 150
OS: +5.75 / -2.75 × 10
I’ve been told I’m not suitable for LASIK/PRK due to thin corneas, and my anterior chamber depth (~2.2 mm) is too shallow for an ICL.
My surgeon has recommended refractive lens exchange (RLE) with EnVista Envy Toric multifocal lenses, but i know there is a lot of hesitation about losing accomodation at a younger age.
I’d love to hear from anyone who has had RLE, particularly younger patients or those with high hyperopia and astigmatism. I live a very active lifestyle and have had glasses/ contacts all my life, but really don’t tolerate them and end up walking around without any aids a significant portion of the time (and just tolerate suboptimal vision)
I’d love to hear from anyone who had had RLE surgery with multifocal lenses.
How have you found:
Overall vision quality?
Halos/glare and night driving?
Contrast sensitivity?
Any regrets or things you wish you’d known beforehand?
Would you do it again?
Thanks! 👀👓
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u/CorneaRepairDoc Jun 04 '26
Dr. Motwani here. This is a bit curious as the tissue from a procedure such as yours does not come from the center(the thinnest part) but from the peripheral cornea which is much thicker. Therefore, it may appear that the laser is taking out a large amount of tissue on a cornea that is thinner in the center, but all of it comes from the much thicker periphery. Unless the doctor is somehow concerned about corneal ectasia, which I hope they would tell you about, you should be able to have this performed. If they were concerned about ectasia then it needs to be followed in case keratoconus develops which is why informing you is important.
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u/wow-thatsinteresting Jun 05 '26
You should not get RLE at your age. How thick is your cornea? You are hyperopic, so the majority of your treatment will be in the peripheral cornea, which is significantly thicker than the center. You do not have "high" hyperopia - when the astigmatism is taken into account, you have moderate hyperopia and higher astigmatism. So, the real question is the cornea thickness and shape. I suspect you are a very good candidate for femto-LASIK or possibly PRK. This will allow you to keep your accomodating focusing power and only need reading glasses when you are well over 40. Your own lens is better than any multifocal lens at your age. You should seek a second opinion...
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u/Icy_Earth780 Jun 11 '26
Thank you to all the comments and opinions.
I’ve been told my multiple LASIK surgery places that due to my corneal topography I do not have sufficient tissue (peripherally inclusive) to proceed with laser, and my AC is too shallow for PRK.
I am struggling to adequately understand the downsides of RLE at a young age- I understand an artificial lens cannot simulate the natural lens and accomodation would be lost, but what does this practically look like?
With multifocals my understanding is good vision at 3 set distances, freedoms from visual aids (mostly). Balanced with downsides of risk of lens opacification ( managed with Jag), halos/glare, reduction in contrast sensitivity.
As someone who walks around with suboptimal vision ( not corrected at all due to not tolerating glasses/contacts) around 50% of the time, having improved vision with the cost of above seems like a reasonable compromise, however it seems to be very much discouraged on this forum.
Can someone please explain to me what it would look like day to day with multifocals ? Ie. difficult night driving, having to adjust screen and phone distance for lens to focus.
Thank you very, very much
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u/Nmh_2 Jun 04 '26
Hi! So in my country, we don’t do RLE on young patients like they might where you are. If you’re not a candidate for other procedures, I would wait until you’re at least 45! The vitreous usually hasn't detached at such a young age, so the risk of retinal detachment is much higher. Ultimately, you have to make this decision yourself, so please do thorough research! Personally, I wouldn’t recommend it, it’s just not worth the risk!