Refractive Lens Exchange surgery (cataract surgery without the cataracts)

Miscellaneous and Personal Stuff I Must Share
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I was at my eye doctor’s office last week, discussing, conveniently enough, my eyes. I’ve been nearsighted most of my life, but I’ve reached the point that I’m starting to have trouble reading in bed without my glasses. That effectively means that there is little that I can comfortably do without glasses. I’ve often said, partially jokingly, that this would be the point when I’d consider something like Lasik.

I’m not a good candidate for Lasik. I have a dry eye condition - MGD (Meibomian gland dysfunction). I’ve mentioned some of the treatment parts elsewhere. The intense light pulses I’ve had actually do wonders for me, and the omega-3 supplements have increased the quality of my tears. But one of the major side effects of Lasik is increased dry eyes, and neither my regular eye doctor nor my dry eye specialist think that’s a good idea.

Discussing all this with my eye doctor - she said that I don’t want to look at Lasik. I want to look at Refractive Lens Exchange surgery. It’s basically cataract surgery with the fancy corrective lens, but without waiting for cataracts to form. She recommended a specific doctor in the area. He’s a pioneer in doing this particular surgery with lasers instead of blades. It’s three tiny laser bursts. This results in a much faster recovery time, and fewer side effects. She says the only reaction she’s had from patients was “Why did I want so long to do this?”

Yesterday, I saw my dry eye doctor. I asked him what he thought. Turns out, he’s considering the same surgery, but he just had something else done and needed to complete healing. He agrees that I should not do Lasik, and that this option is much better for patients like me. He thinks doing it sooner rather than later makes sense, because…why wait for the benefit?

I also saw my general practitioner. She wasn’t familiar with the option to do this without cataracts, but after discussing it with her, she’s on board too.

The procedure is targeted for people over 40. I’m in my early 50s. The replacement lens would be good for the rest of my life, and doesn’t degrade. That means, if things go well, no more glasses. And also no future cataracts.

I have a consultation with the surgeon this coming Tuesday to learn more and see if he likes me as a candidate. And to discuss what he thinks he can produce as an outcome.

I’m nervous. But excited.

I’ll be happy to answer any questions as I’m learning stuff. And even happier to get advice from anyone who has gone through this, especially without cataracts. I’ve read several of the cataract threads here already, and appreciate the information that was shared there

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This.

I’ve had both eyes done due to cataracts. I now wear my corrective lenses in my eyes. No glasses, no contacts. Nothing.

Life changer.

Now, if they could only do something about tinnitus…

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It’s not just LASIK. Be careful:

LINK TO 16 PAGE PDF - An algorithm for the preoperative diagnosis and treatment of ocular surface disorders

I wish you all the best of luck with whatever choice you make.

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I’m always hearing about RLE on the radio. I always wonder if the lens is fixed-focus, or if they somehow attach it to the muscles so you can focus far away, up close (like for reading), and everywhere in between.

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I’ve had the surgery you’re about to have, OP. That is, I had surgery to replace the internal lens after the ones they inserted during cataract surgery in my forties needed replacing. (Long story and not applicable to your situation.) It’s an easy surgery, and except for people like me, it almost always results in vastly improved vision. I’m excited for you!

The lenses are fixed-focus. The one in my left eye is calibrated for near vision, so I use it for reading. The one in the right eye was calibrated for distance. (Actually, it’s “the ones,” as I have piggyback lenses in there now.) But some people prefer to have both lenses calibrated for distance and to wear reading glasses.

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Thanks for the links! My dry eye specialist actually commented on that. Because of the smaller footprint of the laser version of the surgery, there is a much lower chance of damaging the nerves related to the tear production. We also routinely monitor things like my tear evaporation rate, which is apparently a common measure of the quality of the tears.

I’m actually going to see him Tuesday morning before I see the surgeon, so we can do a full re-eval and know exactly what shape my eyes are in for the surgical eval. I’ll have fresh pictures of videos showing the eyelid margins, the tear distribution, and all that other fun stuff. It’s actually really cool stuff, from a scientific perspective. In this case, it’s primarily to make sure that the data the surgeon gathers can be the best quality, aiming towards the best results.

The second link is very much in line with how we are treating my eyes today. I have a daily wipe in the morning with hypochlor. Three days a week, I scrub the margins with a tea tree oil. Both of these work towards making sure the tear ducts are clear. The omega-3s vastly improved the quality of my tears. When I started, they would evaporate in under 5 seconds. Two months ago, we measured them at 26 seconds. We just did a touch-up round of intense pulse light, which effectively melts residual fatty globs in my glands, and then he “expresses” - squeezes - them out.

It’s really comforting to see that the things they are discussing in both links line up well with the things my dry eye specialist was talking about, and the treatments we are doing…so again, thanks for those links!

They have a few multi focus lens solutions. From their brochure:
“including ReSTOR and Tecnis multifocals and the Crystallens accommodating lens - tailoring the procedure to match each patient’s unique visual and lifestyle requirements.”

Yeah…that’s a whole different thread, and I’d love to be part of that if there were a solution :frowning:

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I’ve got the duel focus or whatever. Good for distance and reading.

I’m not going to explain this very well, but it works because your pupils not only dialate and contract for brightness, they also do at different distances. So your looking out of a different part of the lens (or more/less of it).

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Good luck to you. I’m having cataract surgery this Friday myself.

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Good luck to you, too! Let us know how it goes, please. Do you know if you’re going to have to take time off from staring at a computer screen? Those of us who enjoy your jokes thread will wonder what’s going on :rofl: (This is actually one of my questions for my consultation, since I’m a programmer and spend all day on the computer.)

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Nobody’s mentioned anything about me needing to take a break from computers, but I’ll probably shorten my online periods anyway for a couple of days.

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My jokes thread? You have me confused with someone else.

I’m also a programmer. About 10 hours a day on the computer. No problem at all. But I don’t have dry eye issues or anything.

After the surgery, sure. Take a little break.

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That was a reply intended for the good Professor. I screwed up the reply because I was going to quote both of you at first, and then realized I had misread part of your post that I was going to comment on. Apologies.

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How’d it go?

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Very well. My vision in that eye’s gonna be blurry for a few days, and the other eye’s having sympathy pains, but it’s supposed to all sort out in a couple more days. There was no pain, only a slight soreness in my eye. I have the other eye done in two weeks.
I hope yours goes as well as mine did.

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That’s great to hear! The doctor I’m going to see does both eyes in the same seating most of the time, so I’m hoping not to be too blurry. Consultation is the day after tomorrow.

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I saw my dry eye specialist for a day-of eval, and he was very pleased with my status.
The surgeon seems to agree. He thinks I’m a very good candidate for RLE, and has high expectations for the outcome with a multi-focal lens. He said the worst side effect he’d expect is some nighttime halo for 3-6 months. I asked what the realistic worst case scenario was, and he said it was that I’d be in the 5% that needs a touch-up surgery.

I booked the surgery :open_mouth: End of May.

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I hope it goes better than expected, and that you never look back.

Or that – if you DO look back – you see better than 20/20 :sunglasses:

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Wondering if y’all could share cost info? And what insurance covers v out of pocket? Thanks.

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It’s roughly $11k. That includes the laser surgery, astigmatism correction, the multifocal lens, the surgeon’s fee, and the anesthesia fee. (They use a mild IV sedative.)

It’s completely out of pocket for me, because I don’t have cataracts. It’s considered elective surgery. If I had cataracts, I believe most of it would be covered, except the actual fancy lens.
I’m very lucky to be in a position to drop that money on a surgery like this.

There are three eye drops I need - two for the days before the surgery, and one for after. Those, happily, are covered by my insurance.

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…and the coordinator called me this morning. There was a cancellation. I’m now scheduled for surgery next Thursday, on May the 4th.

I’ve asked for the Jedi enhancement.

I also have a follow-up appointment on CInco de Mayo. I’m hoping they have tequila on the snack bar in the office.