Can I Get Refractive Lens Exchange If I Have Cataracts?

In recent years, vision correction procedures have become more and more popular. While the most popular refractive procedure is LASIK, there are a variety of options. 

Although LASIK is an incredible procedure, it’s unsuitable for everyone since it only corrects refractive errors. Adults over the age of 40 are more likely to develop two prevalent age-related conditions: cataracts and presbyopia. For these patients, there are other vision correction choices available. 

Presbyopia is a condition that makes it harder to focus up close. If you have presbyopia, you may be a good candidate for a vision correction procedure that treats presbyopia, called refractive lens exchange. 

Refractive lens exchange, or RLE, is designed for adults with presbyopia. But another common condition in adults over the age of 40 is cataracts. 

If you have cataracts, can you have RLE? The answer may surprise you, as RLE and cataract surgery are essentially the same procedure. Keep reading to learn more about refractive lens exchange!

How RLE Works


RLE is a minimally invasive surgical procedure. During refractive lens exchange, a surgeon removes the natural lens of the eye. The natural lens is then replaced with an artificial lens, called an intraocular lens or IOL. 

IOLs come in several varieties, with many designed to correct presbyopia. Some can also help correct mild astigmatism, nearsightedness, or farsightedness. 

If you have presbyopia and find it difficult to focus on things right in front of you, like when you’re reading, RLE is a procedure worth considering. After all, it can even reduce or eliminate the need for glasses or contact lenses in patients.

There’s another benefit to RLE. If you choose to have it, it means you’ll never have to worry about developing cataracts in the future. 

Why? Because refractive lens exchange is an almost identical procedure to cataract surgery that prevents you from developing cataracts later on. 

Cataract Surgery

woman sitting on couch holding glasses

When you have a cataract, it forms on the natural lens of the eye. With a cataract, the lens becomes cloudy and harder to see through. Patients with cataracts end up with blurry or hazy vision, among other symptoms. 

Over time, the lens becomes more and more opaque and makes it harder to see. To treat cataracts, they have to be removed. 

The only way to remove a cataract is to also remove the entire natural lens with it. When you have cataract surgery, both the natural lens and the cataract get removed from the eye. The lens is then replaced with an IOL.

If this sounds a lot like refractive lens exchange, it’s because cataract surgery is almost identical to it. The only difference is that when patients get RLE, they don’t have cataracts. 

Patients that choose to get RLE may have the beginnings of a small cataract that hasn’t caused any vision problems yet, or they don’t want to deal with cataracts when they get older. Because the natural lens is what’s removed and replaced, refractive lens exchange patients cannot develop cataracts. 

A cataract can only form on a natural lens, not an artificial intraocular lens. 

Who is a Good RLE Candidate?

person holding ticket

Refractive lens exchange is for patients in reasonably good health who want to be less reliant on reading glasses to correct their presbyopia. If you have severe presbyopia and don’t have cataracts yet, getting RLE is a great way to get ahead of things. You can correct your vision and also ensure you won’t get cataracts.

If you do have cataracts, cataract surgery can do the same thing for you that RLE can. Whether you have cataracts or not, you’ll be able to benefit from enhanced vision with an IOL.


Unlike LASIK, which permanently reshapes the cornea to correct refractive errors, RLE works by replacing the natural lens of the eye. The level and degree of vision correction you can achieve entirely depend on the kind of IOL you choose before having RLE. 

There are many different kinds of IOLs to choose from. Each type of IOL has unique benefits to consider, depending on your visual needs and lifestyle goals. 

The standard option is a monofocal lens. A monofocal lens is uniform and set to one refractive power, meaning it’s either designed to see up close or far away. 

You can achieve what’s known as monovision when you have one lens set to see up close and the other lens set to see far away. The combination allows for good vision at an intermediate distance, but patients often still need reading glasses to see up close.

Premium IOLs

There are other IOLs known as premium lenses, meaning you’ll have to pay out of pocket for them, but they also provide excellent vision. Standard monofocal lenses are usually covered by insurance if you have cataract surgery, but premium IOLs are not. 

intraocular lens

You’re already paying for vision enhancement if you have refractive lens exchange, so it makes sense to opt for a more advanced IOL that can give you your best vision. Premium IOLs also come in several varieties, many of which we offer at New England Eye Center. 

These IOLs can reduce or eliminate the need for reading glasses and also extend your range of vision. IOLs like the multifocal or trifocal lenses are made up of different refractive powers that your eye automatically looks through, depending on how far away the object you’re looking at is. 

Accommodative IOLs change shape when you focus on something up close to help you see more clearly. Toric IOLs are specifically designed for patients with astigmatism to correct astigmatism. There are even more options, all with their unique features and benefits.

With all these options, it can be hard to choose what IOL is best for you. But your eye doctor can help by going over the different kinds and making recommendations based on your specific needs. 

Luckily, with so many great options, it’s hard to go wrong when it comes to choosing a premium IOL. Whether you decide on RLE or you need to have cataract surgery, a premium IOL can give you the best vision you’ve ever had. 

Are you looking for more information about refractive lens exchange? Schedule an appointment at New England Eye Center in Boston, MA, to learn more about what may be best for your vision needs!

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