Refractive Lens Exchange

Surgical solution to correct refractive errors and eliminate cataract risk long term by replacing the eye’s natural lens with a custom intraocular implant.

Refractive Lens Exchange

Types of Dry Eye

The RxSight® Light Adjustable Lens™ (LAL) is the first and only FDA-approved intraocular lens that can be customized to your specific visual needs after cataract surgery. 

Customized results

The Light Adjustable Lens (LAL) offers unparalleled flexibility by allowing post-surgical adjustments to fine-tune vision to the patient’s needs. This revolutionary lens can be modified with UV light after implantation, ensuring patients achieve optimal visual clarity that can be customized even after surgery. Dr. Manusis can preview and adjust your vision to your own personal visual requirements after the lens has been implanted.

Light Adjustable Lens

Refractive lens exchange (RLE) replaces your eye’s natural lens with an intraocular lens (IOL) to correct refractive errors and improve your vision. As a result, you may not need to wear glasses at all, or you may need them only for certain tasks.

    Who is RLE for:

    Generally, the surgery is best for people over 40 who rely on contacts or glasses for their daily needs. The procedure can treat nearsightedness, farsightedness and astigmatism.

    What to Expect:

    Dr. Manusis will perform an in-depth evaluation to discuss the best refractive option for your eyes.  Available lens options discussed include:

    • Monofocal IOLs: Provide clear vision at a single distance (near, intermediate, or far); glasses may still be needed.
    • Multifocal IOLs: Offer clear vision at multiple distances, minimizing the need for glasses.
    • Toric IOLs: Specifically designed to correct astigmatism.
    • Extended Depth of Focus (EDOF) IOLs: Improve vision over a range of distances.
    • Light Adjustable Lens (LAL): Allows for postoperative vision adjustments to fine-tune clarity.
    • Pinhole IOL: Helps improve near vision for patients not candidates for multifocal lenses.

    The choice of the IOL is driven by the eye's health and your daily needs.

    Advantages of RLE

    Like any surgery, refractive lens exchange has pros and cons. The main benefits are:

    • The surgery can treat all types of refractive errors.
    • You can be free or mostly free of glasses. About 4 out of 5 people don’t need glasses at all after their surgery.
    • You don’t have to worry about developing cataracts later in life. Cataracts only form on natural lenses, not IOLs.

    Corneal cross-linking is a surgical procedure aimed at:

    • Patients with progressive keratoconus, where the cornea becomes thin and weak.

    What does the procedure involve?

    Riboflavin (Vitamin B2) is applied to the eye every 5 minutes for 30 minutes, and then the cornea is illuminated with UV-A light for approx. 10 – 30 minutes. The eye is covered with a bandage contact lens which is removed 5 to 7 days after the procedure. The cornea will be examined and scanned at frequent intervals to monitor for its stability.

    Common Symptoms

    Signs you may have dry eye syndrome include:

    • Blurred vision
    • Burning or stinging
    • Feeling like something is in your eye Itching
    • Itching
    • Pain when you wear contact lenses
    • Sensitivity to light

    Causes Dry Eyes?

    Allergies
    Seasonal or environmental allergies (like pet dander) cause eye dryness and redness.

    Medications
    Medicines like antidepressants, antihistamines, decongestants and oral contraceptives can reduce your tear production.

    Blepharitis
    Blepharitis is an inflammatory condition of eyelid margins associated with meibomian gland dysfunction and poor lipid production resulting in premature tear film evaporation and dry eye.

    Diabetes
    People with diabetes have decreased corneal sensation and therefore do not produce enough tears to provide an adequate tear film. 

    Autoimmune diseases

    • Sjögren’s Syndrome
      This is a relatively common autoimmune condition involving arthritis, dry skin, dry mouth, and dry eyes. Females are more likely to present with this condition, which can be detected by a blood test.
    • Rheumatoid Arthritis
      This common arthritic autoimmune condition can predispose to severe dry eyes. It can be diagnosed with blood tests and a detailed history.

    Refractive surgery
    It is now established that post-LASIK patients will experience dry eyes in the short term.  Once corneal nerves repopulate, dry eye symptoms typically improve. 

    Contact Lenses
    Long-term use of contact lenses decreases sensation, especially when worn overnight. Various treatment options are available to ensure comfortable long-term contact lens tolerance.

    Eye fatigue
    Long-term computer use and reading both have one thing in common — a reduced rate of blinking. After a while, the eyes feel fatigued, and vision blurs due to increasing dryness.

    Environment
    Airplanes, sitting near air-conditioners, prolonged use of computers, or forced air heating, driving a car, and lack of sleep all can cause dry eye symptoms.

    Dry eyes also have dietary components. Increasing water intake and decreasing caffeine and alcohol consumption will most likely improve tear film.

    Eyelid disorders
    Poor eyelid closure, sleeping with eyes partially open, or having a poor blinking reflex can lead to eye exposure and dryness.

    Risk Factors

    Age
    People older than 50 are at a higher risk for dry eye. Tear production and meibum (oil) production decline with age.

    Sex
    Women are more likely than men to have dry eye due to fluctuating hormones, especially during pregnancy and menopause.

    Smoking
    Smoking and exposure to second-hand smoke increase your risk of eye irritation and dryness.

    Vitamin A and Omega-3 Deficiency
    Low levels of vitamin A or Omega-3 fatty acids can contribute to dry eye syndrome.

    Treatment Of Dry Eye

    Autologous Serum Eye Drops
    Serum eye drops come from the patient’s own blood serum. They resemble natural tears and contain critical biological factors that can help treat dry eye disease.

    Eyelid Thermal Treatment (TearCare®):
    TearCare is an eyelid thermal treatment that combines localized heat therapy with manual compression of the eyelids. It treats meibomian gland dysfunction and improves oil production.

    Medicated Eye Drops
    Your provider may prescribe eye drops that help your eyes increase tear production.

    Ointment
    Medicated ointment helps to reduce inflammation on the surface of your eyes.

    Special contact lenses
    Special contact lenses can help treat ocular surface diseases, including dry eye disease.

    Tear Duct Blocking
    Small silicone plugs are placed in your tear ducts to slow the drainage of your tears. This helps your eyes retain more moisture and helps the tear film better lubricate your eyes.

    BlephEx
    A special medicated brush cleans eyelids to remove debris and bacterial toxins.

    More info can be found at: Dry Eye Statistics

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