Clear Lens Extraction & IOL - Laser Eye Surgery Guide

Clear lens extraction (CLE) is also sometimes referred to as refractive lens exchange (RLE). It is a procedure that is used as an alternative to laser eye surgery techniques such as LASIK. CLE can be employed in the treatment of cataracts - where the eye lens clouds over due to protein accumulation - or severe refractive errors such as long-sightedness, short-sightedness or astigmatism. If you wish to learn more about the cataract aspect of IOL treatment, please refer to our guide entitled 'Cataract Extraction & IOL'.

The CLE procedure is a subcategory of implantable contact lenses (ICL). This type of treatment involves a specialised lens being implant into the eye, to prevent you from having to wear glasses or removable contact lenses in future. The purpose of the ICL is to correct refractive errors of different levels, generally from moderate to severe.

What actually is CLE/RLE?

CLE/RLE is a type of surgery performed on the eye to resolve problems with cataracts or refractive disorders including long- or short-sightedness. The procedure can be carried out in two different ways. Firstly, the cataract may be removed to make way for the insertion of the synthetic IOL. Alternatively, the lens may be left in place and the IOL may be inserted merely to improve vision. So therefore the technique can either be replacement or addition.

The replacement method is discussed in more detail in our 'Cataract Extraction & IOL' guide. The addition method can further be separated due to the type of IOL used. The IOL may be single focal or multi focal depending on what will best suit the patient. This method is very effective in the treatment of moderate to severe refractive errors (myopia, hypermyopia or astigmatism) that many laser eye surgeries cannot resolve. This can eliminate the requirement for visual aids in the future, such as contact lenses or glasses, that you may feel inconvenience your day-to-day life.

The two types of IOL lenses that can be used in the CLE/RLE procedure are monofocal (single vision) or multifocal (accommodation). The monofocal lens tends to be used to correct just one type of refractive error, for example, myopia (short-sightedness); this is due to its fixed focus nature. As a result, you may find that you still require glasses for looking at near objects (if the surgery was conducted to resolve myopia). Alternatively, the multifocal lens can be inserted to correct both myopia and hypermyopia (long-sightedness), which can remove your requirement for glasses and/or contact lenses completely.

Furthermore, the multifocal lenses can then be separated out into three different designs: ReSTOR, CrystaLens and ReZoom. Which type you will require will be determined during the consultation with your surgeon after they have analysed your health, budget, lifestyle etc.

What can CLE/RLE treat?

The CLE/RLE procedure has been proven effective in the treatment of cataracts and serious refractive errors. Another disorder it can be used to correct is keratoconus. This condition occurs when the front of the cornea seems to be swollen. This is generally a result of the cornea becoming thinner and may cause your vision to become distorted and interrupted.

If you are a sufferer of keratoconus, you should not undergo laser eye surgeries such as LASIK, LASEK or PRK. This is because a common outcome of such treatments is further thinning of the cornea due to the loss of tissue. This could enhance your disorder further and cause more issues.

Am I a suitable candidate for CLE/RLE?

CLE/RLE is sometimes offered as an alternative if you have been deemed unsuitable for laser eye treatments such as PRK, LASIK or LASEK.

It is likely that if you suffer from cataracts or a severe refractive error, you will be considered suitable for CLE/RLE. However, other factors will also be taken into account when assessing your suitability. These include age, health, medical history, lifestyle and expectations.

If CLE/RLE has been offered as an alternative to laser eye surgery, it is probable that you will also have been offered the option of implantable contact lenses (ICL). However, if you are over 60 years old, then CLE/RLE will probably be better suited for you. The reason for this is because the treatment involves replacing the lens, whereas the ICL does no remove the cloudy lens.

At your consultation, many aspects of your life will be discussed and analysed in detail and as a result your surgeon will be able to inform you of the procedure that would most benefit you.

Potential risks of CLE/RLE

As with all surgical procedures, CLE/RLE does carry some risk of complications. Although the chances of them occurring are rare, they are still worth considering before committing yourself to undergoing the surgery. Potential risks associated with CLE/RLE include:

Developing glaucoma
The integrity of the eye may become compromised and its structure may be damaged
The cornea may decompose
You may experience problems with your retina
The synthetic lens may be rejected
You may develop cystoid macular oedema
The vitreous jelly at the back of the eye may become detached

If you suffer from a serious form of myopia (short-sightedness), which is worsening or if you have got detached retinas, then CLE/RLE will be ineffective in resolving these problems.

All potential risks should be discussed with you, in detail, at your pre-surgery consultation.

Benefits of CLE/RLE

The primary benefit of the CLE/RLE procedure is that your vision will vastly improve. This is especially rewarding for those who have had to suffer from blurry or inhibited vision due to the development of cataracts. If you have undergone the procedure due to a refractive error, then you will also notice that you are now able to see objects in focus that you previously needed glasses or contact lenses to visualise clearly.

Your CLE/RLE consultation

You will be required to attend a consultation with your surgeon prior to the day of your CLE/RLE procedure. This consultation offers you the time to ask any questions that are on your mind and will allow you the ability to get to know your surgeon. It may be worth having a number of consultations so that you can ensure that the surgeon is best suited to you, the price is right and that the quality is satisfactory.

You should ask your surgeon questions about their experience, the procedure, risks and other outcomes. If you would like some ideas as to what sorts of questions may benefit you, please take a few minutes to look at our page entitled 'Laser Eye Surgery: General FAQs'. Here you will find a broad list of questions about laser eye surgery as a whole, but it is very simple to adapt them to your procedure.

How much will the CLE/RLE procedure cost?

It is very difficult to offer you a precise estimate as to how much your procedure will cost. This is because the price varies between clinics depending on the surgeon, location, technology and other aspects. The eye disorder you wish to resolve may also influence the price.

At your consultation, your surgeon should be able to offer you an accurate quote for the surgery. For a more rough guide, you may be able to look on the clinic's website. Alternatively, we have noted that on average, the cost of a CLE/RLE treatment is often in the region of £1,395 per eye.

The CLE/RLE procedure

Your eye will first be held open by a special clip, designed to prevent you from blinking. Then the first stage of the CLE/RLE procedure is the administration of eye drops and an injection. These contain local anaesthetic, which is required to numb the area so you feel no pain or discomfort. Antibiotic eye drops will also be given to minimise the risk of you obtaining any infections during the procedure.

The next step involves the surgeon using an ultrasound probe to degrade the lens. Once it has been broken down sufficiently, a suction device will be employed to remove the lens debris completely, leaving an empty space.

Into this empty space, the surgeon will then insert the IOL. This is often positioning in front of the cornea. For ease of insertion, the lens often enters the eye in a folded manner but once in location, it is able to unfurl into its natural state.

The IOL is held in place by the application of supporting loops. The surgeon will then carefully close up the tiny cut previously made and will then put a protective eye patch over the eye.

How long can I expect the results of CLE/RLE to last?

Studies have proven that the effects of CLE/RLE are good and seem to last for a long time. Despite this, there is the possibility of the retina becoming detached, which would consequently lead to the requirement of more surgery.

The CLE/RLE recovery period

During your recovery, you will be required to use antibiotic eye drop to protect your eyes from developing any infections. You should also avoid touching your eyes. This can especially be a problem during sleep, so you may wish to wear a special eye patch or shield to protect the eye over night.

The majority of patients notice that their vision improves relatively quickly, in a matter of days. They also find that they can return to work and everyday life within two weeks. However, this varies depending on the individual.

You will have an aftercare package that will begin with an appointment the day after your surgery. This aftercare package involves a number of appointments over the coming months so the progress of your healing can be monitored and assessed. It is important that you attend these appointments.

If you are every concerned or have any questions during your recovery, do not hesitate to contact your surgeon for further advice.