Lens Replacement Surgery

Also known as refractive lens exchange, clear lens extraction, presbyopic lens exchange (PreLex) lens exchange surgery and clarivu refer to a surgical treatment where the natural lens in the eye is replaced with a synthetic one.

This is a frequently performed procedure for people whose natural lens can no longer ‘fine-tune’ their vision (a natural but largely unwelcome part of ageing also called presbyopia).

In young eyes, the muscles allow the lens within the eye to contract and change shape which permits the ‘fine-tuning’ needed to see well at all distances. Early-stage ageing of the eye can usually be resolved by the occasional use of glasses, but over time it inevitably worsens and depending upon baseline vision, can eventually result in being unable to see well at any distance. Wearing multiple pairs of glasses or multifocals does not work for everyone and a corrective procedure where the natural lens is replaced with a lens that can focus at different distances can make all the difference.

Some people find their poor vision is made worse by the presence of an early-stage cataract. The procedure for Lens Replacement Surgery is almost identical to cataract surgery, in that the lens is removed and replaced with a clear lens. In the NHS this is a monofocal lens (which, has a single focal point, glasses are therefore needed for good all-round vision). In Professor Aggarwal’s private practice, a full range of premium lenses are available, including multifocal, bifocal and trifocal lenses. The lens that most suits your needs will be chosen, following a comprehensive assessment of your eyes, vision and visual needs. Lens Replacement Surgery in an eye without cataract is not currently carried out on the NHS.

Lens Replacement Surgery may also involve the correction of ‘higher-order’ as well as ‘lower-order’ refractive errors of the eye. Higher-order errors tend to be quite minor and often go unnoticed until they are combined with other issues (like presbyopia or cataract). Lower order refractive errors refer to short-sightedness, long-sightedness and astigmatism. These can also be low grade or severe and can be corrected with the right type of lens sometimes combined with a laser treatment.

It is not unusual to find the beginnings of an early cataract in patients over 50 years of age. Lens replacement surgery prevents the cataract from worsening and from another developing.

Who is suitable for Lens Replacement Surgery?

  • People who wish to reduce or eliminate the need for glasses or contact lenses make ideal candidates for Lens Replacement Surgery.

  • People who are unsuitable for laser eye surgery may be suitable for Lens Replacement Surgery.

  • People with cataracts (at all stages) who would like good quality all-round vision without an array of glasses or contact lenses.

  • People who wish to avoid getting cataracts and who wish to have good quality all-round vision without glasses or contact lenses.

As with all surgical procedures. The benefits must be weighed against the risks. The procedure is one of the most frequently performed procedures and it has an excellent safety profile. Some patients who have had this procedure have never had the benefit of good eyesight and for them, the surgery is often described as life-changing. Others have experienced a slow but definite deterioration of their sight and they too are overjoyed to regain their youthful vision.

The Procedure

Make an appointment to chat to Professor Aggarwal either at one of the hospitals where he has a clinic or via the telephone where he will ask you a few questions about your eyes, your vision (have your prescription handy, if you have one) and your overall health and visual requirements.

To ascertain whether you are suitable and what your likely outcome would be, your eyes would need to be fully assessed. For the patient, this is a pain-free simple set of eye tests.

If you decide to go ahead (you will never be coerced) you can choose an available appointment at one of the three hospitals where Professor Aggarwal works from.

On the day of the procedure, you should ask someone to attend with you who can drive you home.

The type of anaesthesia used to numb your eye (so that the procedure is pain-free) will be discussed with you before you are booked in for the procedure. Most people opt for drops. Once numb, your eye will be held open with a device designed to prevent you from blinking during treatment. The procedure takes about 20 minutes. You may notice an immediate improvement in your vision after surgery but most people need a day or two for the eye/s to completely settle down and it can take days or weeks before you are completely accustomed to your new vision.

The cornea (the transparent part that covers the eye) heals very quickly but may feel a little itchy or uncomfortable once the numbing drops wear off. Having a sleep can help as can a couple of paracetamol and the use of lubricating eye drops, which will be prescribed.  Many people manage without either.

You will not be able to drive home and should arrange for someone to collect you.

You should not rub your eye/s after surgery

After Surgery

Although this type of surgery is routine and has an excellent safety profile, it is still a surgical procedure and you should rest afterwards. Use of prescribed eye drops can help encourage healing, but you must take care to keep your eyes free from unnecessary touching or getting makeup or soap or water in them.

Bathing may therefore be better than showering and makeup should be avoided (especially eye makeup) until the eye has fully healed which can take a few weeks.

It is OK to take part in an activity that is non-strenuous after a few days but strenuous exercise should be avoided for a few weeks along with flying.

A post-op leaflet of do’s and don’ts will be given to you before you leave the hospital along with information explaining what is normal (blurred vision, redness, itching, some discomfort and watery eye) and what should be reported (increased pain or deterioration in vision or extremely sticky).

Professor Rajesh Aggarwal

BM MRCP FRCS FRCOphth Pg.Cert Med.Ed

Consultant Ophthalmologist