Refractive Lens Exchange (RLE)
Refractive lens exchange (RLE) is a lens-replacement procedure that uses the same technology as modern cataract surgery to reduce dependence on glasses and contacts, particularly for adults 40 and older. At Gordon Schanzlin New Vision Institute, our team pairs a full range of premium intraocular lens options with decades of refractive surgery experience.
- How Does Refractive Lens Exchange Work?
- Am I a Good Candidate for Refractive Lens Exchange?
- Which Lens Options Are Available for RLE?
- How Do I Prepare for RLE Surgery?
- What Should I Expect During Surgery?
- What Should I Expect During Recovery?
- What Are the Risks and Realistic Expectations?
- How Is RLE Different from LASIK, EVO ICL, and Cataract Surgery?
- Why Choose Gordon Schanzlin New Vision Institute?
- FAQs About Refractive Lens Exchange
What Is Refractive Lens Exchange?
Refractive lens exchange (RLE) is a vision correction procedure that replaces the eye’s natural lens with a premium artificial intraocular lens (IOL) to reduce or eliminate the need for glasses and contact lenses. RLE is the same procedure as cataract surgery, performed proactively before a cataract has developed. At Gordon Schanzlin New Vision Institute in La Jolla, our team brings decades of refractive experience to RLE for adults 40 and older whose focusing ability has declined with age, and for patients who are not ideal candidates for LASIK or PRK because of a high prescription, thin corneas, or presbyopia.
How Does Refractive Lens Exchange Work?
The natural lens sits behind the iris and works with the cornea to focus light onto the retina. Beginning in the early 40s, this lens loses elasticity and clarity, causing presbyopia (age-related loss of near focus) and, over time, cataract formation. RLE replaces that natural lens with a premium IOL to restore focusing power.
Am I a Good Candidate for Refractive Lens Exchange?
Ideal RLE candidates are 40 or older, in good general eye health, and motivated to reduce reliance on glasses or contacts. RLE is particularly well suited to:
- Adults with presbyopia who are tired of readers, bifocals, or progressives
- Patients with moderate to high farsightedness (hyperopia) that laser vision correction cannot fully treat
- People who are not LASIK candidates due to thin corneas, dry eye, or a high prescription
- Patients showing early lens changes that will progress to cataract within a few years
RLE is generally used more selectively in patients with high myopia because clear lens extraction carries an elevated risk of retinal detachment in that population, particularly in patients under 60 with longer axial lengths.
Every RLE candidate at Gordon Schanzlin New Vision Institute undergoes a detailed evaluation, including corneal topography, macular imaging, and biometry. This helps us match you with the lens most likely to meet your visual goals. If RLE is not the best fit, we will discuss alternatives such as monovision LASIK, EVO ICL, or observation until cataract develops. Not every patient is a candidate, and individual outcomes vary.
Which Lens Options Are Available for RLE?
The IOL you choose is one of the most important decisions in the RLE process. At Gordon Schanzlin New Vision Institute, we work with the full range of premium intraocular lens platforms available today. A standard monofocal IOL is also available for patients who prefer it. See our full range of IOL options for more detail on each lens type.
Trifocal IOLs
Trifocal IOLs are designed to provide clear focus at distance, intermediate, and near. A 2024 study of 5,226 patients found high spectacle independence and patient satisfaction three months after trifocal RLE.
EDOF IOLs
EDOF lenses provide an elongated range of clear vision with fewer nighttime visual side effects than some multifocals.
Toric IOLs
Toric IOLs correct astigmatism during the same procedure and are available in monofocal, EDOF, and trifocal versions.
The Light Adjustable Lens™
The Light Adjustable Lens (LAL) from RxSight® is a monofocal lens whose optical power can be fine-tuned after surgery using targeted ultraviolet light treatments. Gordon Schanzlin New Vision Institute was the first practice in San Diego to offer the Light Adjustable Lens. Peer-reviewed data show favorable visual and refractive outcomes with the LAL in eyes with prior LASIK or PRK, which are historically more difficult to plan for with fixed-power IOLs.
Your surgeon will help match the lens to your anatomy, lifestyle, and priorities.
How Do I Prepare for RLE Surgery?
At your consultation, one of our eye doctors will assess your vision and eye health and discuss your goals for the procedure. If RLE is the right fit, we will walk you through the pre-procedure guidelines specific to your case. This typically includes instructions about contact lens wear before your measurements are taken and arranging a ride home after surgery. RLE is typically scheduled one eye at a time, about a week apart, so your surgeon can confirm your results before treating the second eye.
What Should I Expect During Surgery?
RLE is an outpatient procedure. We numb your eye with anesthetic drops and offer a mild oral or IV sedative to help you stay comfortable. Most patients report a comfortable experience shorter than they anticipated. Surgical time is typically 10 to 15 minutes per eye, and the two eyes are treated on separate days. Your surgeon removes the natural lens through a microscopic corneal incision. The incision is so small that it seals on its own, with no sutures needed. Your surgeon then places a premium IOL inside the lens capsule to restore focusing power and correct nearsightedness, farsightedness, astigmatism, or presbyopia. Because the natural lens has been replaced permanently, RLE also eliminates the future development of cataracts in that eye.
What Should I Expect During Recovery?
You will need a friend or family member to drive you home. Vision typically begins to sharpen within 24 to 48 hours, and many patients return to computer work and routine activities within two days. Complete visual stabilization can take several weeks, particularly with multifocal or Light Adjustable Lenses, which may involve staged UV adjustment sessions and a final lock-in treatment. Your surgeon will prescribe eye drops and schedule follow-up visits to monitor your recovery.
What Are the Risks and Realistic Expectations?
RLE shares its core technique with modern cataract surgery, one of the most-studied procedures in medicine. In a 2022 study of 17,603 patients who had trifocal RLE, permanent significant vision loss occurred in approximately 0.08 percent of patients after appropriate follow-up care.
That said, RLE is real eye surgery, and every candidate should understand the range of possible side effects and complications, including:
- Nighttime halos, glare, or starbursts, particularly with multifocal IOLs
- Residual refractive error that may require glasses or a laser enhancement
- Posterior capsule opacification, a hazy film treated with a brief in-office YAG laser
- Dry eye, especially in the first weeks
- Elevated eye pressure, inflammation, and, rarely, infection or retinal detachment
Results may vary. Not every patient is a candidate for every lens type.
How Is RLE Different from LASIK, EVO ICL, and Cataract Surgery?
LASIK and PRK reshape the cornea. They work best for younger patients with stable prescriptions and do not address presbyopia or future cataracts.
EVO ICL™ places a soft Implantable Collamer® Lens in front of the natural lens. It is reversible and preserves the natural lens, making it a strong option for younger adults with high myopia or thin corneas.
Cataract surgery is a medically necessary lens replacement performed once the natural lens has clouded.
RLE is the same lens replacement performed proactively, before a visually significant cataract has developed. Because RLE is elective, it is not covered by insurance.
How the options compare:
Why Choose Gordon Schanzlin New Vision Institute for Refractive Lens Exchange?
Gordon Schanzlin New Vision Institute is one of the most experienced refractive practices in California. The team has performed over 100,000 laser vision correction procedures and treated more than 80,000 refractive patients.
Dr. Michael Gordon, a founding partner and board-certified ophthalmologist with over 45 years of refractive experience, performed the world’s first all-laser custom wavefront-guided LASIK.
Dr. David J. Schanzlin, a board-certified ophthalmologist and corneal specialist with more than 42 years of refractive and corneal surgery experience, is recognized as an early pioneer of LASIK.
Dr. Alison Gordon, a board-certified ophthalmologist with over 15 years of experience, focuses on refractive surgery, cataract surgery, and corneal disease.
Dr. Julio Echegoyen, a board-certified cataract, corneal, and anterior segment surgeon with an MD/PhD background, completed fellowship training at UC San Diego Shiley Eye Center.
Gordon Schanzlin New Vision Institute was the first practice in San Diego to offer LASIK vision correction. It was also the first in the region to offer the RxSight® Light Adjustable Lens™ for cataract and RLE patients.
Beyond credentials and technology, our patients tell us it is the personal attention that stands out. From your first consultation through every follow-up visit, your surgeon takes the time to understand your goals and answer your questions in plain language. You’ll always know what to expect at each stage of your RLE journey. Better vision should feel like a partnership with your surgeon.
“Want to do something that will change your life? Dr. Gordon did an amazing job on my eyes. I can’t describe what it feels like to see correctly. The people at New Vision Institute make the visits and process so easy. I have never waited in their waiting room. I always felt valued, safe, and most of all confident that Dr. Gordon and his team were committed to the best possible results. I highly recommend them.”
— Chris W., Google Review ★★★★★
FAQs About Refractive Lens Exchange
How much does refractive lens exchange cost, and is it covered by insurance?
Total cost varies by lens type and any add-on technology such as femtosecond laser assistance or Light Adjustable Lens treatments. Because RLE is elective, it is not covered by insurance, unlike medically necessary cataract surgery, which is covered by Medicare and most insurance plans. We offer financing options to help fit premium vision correction into your budget.
Are the results permanent?
The implanted intraocular lens is designed to last the rest of your life without clouding or changing focus. Some patients may still need reading glasses for small print depending on their chosen IOL. Enhancement procedures such as a laser touch-up or LAL adjustment can fine-tune the result.
Can I have RLE if I already had LASIK?
Yes. Prior LASIK does not disqualify you. Peer-reviewed data show the Light Adjustable Lens can perform well in post-LASIK eyes, which are historically harder to plan for with fixed-power IOLs.
How soon can I return to work?
Many RLE patients are back at a desk within a day or two, though full visual stabilization continues over the following weeks. Your surgeon will give you activity guidance specific to your lens choice and recovery.
Will both eyes be treated on the same day?
No. The two eyes are treated on separate days, typically about one week apart. This allows your surgeon to confirm your response to the first lens before proceeding to the second.
Contact Us
If you are ready to explore whether refractive lens exchange is right for you, the team at Gordon Schanzlin New Vision Institute welcomes you to schedule a complimentary consultation. Our office is located in La Jolla, serving all of San Diego. Our team will review your goals, examine your eyes, and walk you through every IOL option available.
The Patient Experience
I was sick and tired of glasses but not sure what could be done with my eyes. Dr Gordon recommended Refractive Lens Exchange, and the whole process went very smoothly. My vision is now 20/20 both near AND distance. Glasses-free for the first time since I was a teenager!
Sources1 Rodríguez-Calvo-de-Mora M, Rocha-de-Lossada C, Rodríguez-Vallejo M, Zamora-de-la-Cruz D, Fernández J. Retinal detachment after refractive lens exchange: A narrative review. Archivos de la Sociedad Española de Oftalmología. 2023;98(9):507-520. https://pubmed.ncbi.nlm.nih.gov/37364678/
2 Llovet-Rausell A, Ortega-Usobiaga J, Albarrán-Diego C, Beltrán-Sanz J, Bilbao-Calabuig R, Llovet-Osuna F. Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia. Journal of Refractive Surgery. 2024;40(7):e468-e479. https://pubmed.ncbi.nlm.nih.gov/39007809/
3 Jones M, Terveen DC, Berdahl JP, Thompson V, Kramer BA, Ferguson TJ. Clinical outcomes of the light-adjustable lens in eyes with a history of prior corneal refractive surgery. Journal of Cataract and Refractive Surgery. 2024;50(9):936-941. https://pubmed.ncbi.nlm.nih.gov/38736178/
4 Brenner LF, Nistad K, Schonbeck U. Rethinking presbyopia: results of bilateral refractive lens exchange with trifocal intraocular lenses in 17,603 patients. British Journal of Ophthalmology. 2022;107(7):912-919. https://pubmed.ncbi.nlm.nih.gov/35110276/
The doctors at Gordon Schanzlin New Vision Institute have either authored or reviewed and approved this content.
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