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RLE vs LASIK – Ultimate Comparison

If you’re weighing the options for vision correction surgery, you’re likely wondering about the differences between refractive lens exchange (RLE) and LASIK. These two popular procedures offer distinct approaches: RLE replaces your eye’s natural lens, while LASIK reshapes your cornea.

But which one is right for you? This article dives into each surgery’s details, from how they work to their benefits and risks, assisting you in making an informed decision tailored to your vision needs – RLE vs LASIK.

Key Takeaways

  • Both are vision correction surgeries (refractive surgery) but differ fundamentally; RLE replaces the patient’s natural lens with an intraocular lens to address presbyopia (needing reading glasses) as well as short and long-sight, while LASIK reshapes the cornea to correct refractive errors.

  • RLE is generally only performed on patients aged 45-50 and older.

  • The benefits of RLE include targeting multiple vision issues and potentially preventing cataracts, while LASIK surgery offers a high success rate with a rapid recovery time and little discomfort.

  • Both have risks such as infection, visual disturbances, and rare cases of vision loss, and the best procedure for an individual depends on factors including age, refractive error, and overall eye health.

Comparing RLE and LASIK: An Overview

implantable contact lens

Choosing between refractive lens exchange and LASIK can be difficult. Each is highly effective at correcting vision.

Refractive lens exchange (RLE) replaces the natural lens with an artificial one, addressing common vision issues and reducing dependency on corrective lenses. On the other hand, LASIK reshapes the cornea using a laser, offering a solution to refractive errors such as nearsightedness, farsightedness, and astigmatism.

For those seeking alternative refractive surgeries, it’s essential to consult with an eye care professional to determine the best option for their specific needs.

A comparison of these two procedures aids in determining the most suitable one. Factors like recovery time, potential complications, and the specific vision conditions to be treated play a significant role in this comparison.

What is RLE?

Refractive Lens Exchange (RLE) is a surgical procedure that corrects vision by replacing the eye’s natural lens with an artificial intraocular lens through lens replacement surgery, also known as refractive lens exchange procedure.

refractive lens exchange

It is also known as lens replacement surgery, clear lens exchange and clear lens extraction.

This replacement of the eye’s natural lens is followed by the placement of an intraocular lens (IOL), which enhances the eye’s ability to focus on objects at various distances.

With RLE, different types of IOLs can be implanted, such as monofocal for clear vision at one distance, multifocal for multiple distances, and accommodating lenses for clear vision at all distances. The price of the IOL will vary according to which lens technology is used.

RLE addresses common refractive errors, such as myopia, hyperopia, astigmatism, and presbyopia, often making it a suitable procedure for those over 45 who want to reduce their dependence on glasses or contact lenses.

Refractive lens exchange is the same procedure as cataract surgery. The term cataract surgery is used if there are any cataract changes (opacity) in the lens. If the lens is clear, we call it refractive lens exchange.

What is LASIK?

LASIK, a laser eye surgery, is short for laser-assisted in-situ keratomileusis. It is widely acclaimed and specifically designed to rectify common vision problems like short-sightedness, long-sightedness, and astigmatism. It does this by reshaping the cornea using a laser.

LASIK is the most popular laser eye surgery procedure, followed by LASEK (essentially the same procedure as PRK) and lenticule extraction, such as SILK and SMILE. It excels when used to correct myopia (short-sight) to improve distance vision.

LASIK laser eye surgery

This procedure involves creating a thin corneal flap (typically with a femtosecond laser), using an excimer laser to reshape the cornea based on the patient’s vision prescription, and then replacing the flap to heal.

Outcomes like night driving have been improved with modern laser eye surgery systems, and the treatment extended to patients with thin corneas or higher myopic prescriptions due to technological advancements in LASIK surgery, including the combination of wavefront-guided techniques and a femtosecond laser for flap creation.

LASIK surgery can be tailored to individual needs, such as monovision or blended vision correction for the need for reading glasses, where the dominant eye is corrected for distance and the non-dominant eye for nearsightedness, offering an option for patients with presbyopia.

The Benefits of RLE and LASIK

instilling eye drops after laser eye surgery

Despite their differing techniques, lens replacement surgery and laser eye surgery share a common purpose – to enhance patients’ vision quality and clarity and eliminate blurred vision.

Both procedures can greatly reduce or even eliminate the need for glasses or contact lenses, offering a form of permanent vision correction and enhancing the patient’s lifestyle.

RLE Benefits

Lens replacement is particularly beneficial for individuals over 45-50 as it effectively bypasses age-related vision changes such as presbyopia and provides improved focus, reduced glare, and a clearer colour distinction. It addresses multiple vision issues, including myopia, hyperopia, and astigmatism, reducing patients’ dependency on corrective lenses.

The most common goal of lens replacement is to improve the need for reading glasses and give clear distance vision. If the patient wears glasses to improve their distance vision, this can be corrected at the same procedure as boosting reading vision loss.

Lens replacement surgery is a permanent solution as the underlying problem of an ageing lens is removed.

Patients undergoing RLE have their natural lens replaced with advanced intraocular lens (IOL) options such as AcrySof IQ ReStor, AT LISA tri, FineVision trifocal and TECNIS. However, multifocal lenses may require an adjustment period for the brain to process simultaneous images.

Extended depth of focus (EDOF) IOLs, such as the TECNIS Eyhance and Alcon Vivity, are also popular.

Tecnis Eyhance

Moreover, RLE improves vision for individuals suffering from cataracts and is a preventive measure for those with early cataract development.

LASIK Benefits

LASIK, a popular form of laser eye surgery, has a high success rate in laser vision correction, with many patients noticing complete elimination of their need for eyeglasses or contact lenses. Post-surgical enhancements can further improve vision if necessary, adding to its appeal.

It is most commonly used for patients aged 20-50 but can also be used for older candidates.

One of the primary advantages of LASIK is its rapid recovery time. Most patients can return to their normal routines quickly, experiencing very little pain as numbing drops are used to alleviate discomfort.

Potential Risks and Limitations

While RLE and LASIK offer promising results, they are not without potential risks and limitations. These include infections, visual disturbances, and complications, which should be carefully considered before undergoing either procedure.

RLE Risks and Limitations

The RLE procedure has some risks, which include:

  • Infection

  • Bleeding

  • Discomfort

  • Loss of vision

  • Droopy eyelid

  • Retinal detachment

  • Visual disturbances

  • Swollen cornea or retina

  • Dislocated intraocular lens

  • Posterior Capsule Opacification (PCO)

It is noteworthy that severe vision loss from refractive lens exchange surgery is quite rare, occurring in roughly 1 in 500 people.

Specific risks include a detached retina, swollen cornea or retina, and intraocular lens dislocation. Posterior Capsule Opacification (PCO) is a post-surgery expected event where the back of the lens capsule becomes cloudy, affecting vision.

Patients are advised to follow postoperative management, such as using anti-inflammatory and antibiotic eye drops to avoid discomfort and prevent infection.

LASIK Risks and Limitations

LASIK is best used for a limited range of prescriptions. High myopia (over -8.00 dioptres) is often better corrected by implantable contact lenses, if suitable.

Potential risks include temporary side effects such as dry eyes, glare, or halos. Serious complications from LASIK are rare. They can include corneal ectasia, flap complications such as infection and damage to corneal tissue.

Inaccuracies in vision correction, such as under-correction, over-correction, or induced astigmatism, may necessitate additional surgery or corrective lenses. It is rare to require glasses after laser eye surgery.

Determining Your Candidacy for RLE or LASIK

eye examination LASIK vs RLE

Candidacy for RLE or LASIK depends on a myriad of factors, such as:

  • Age

  • Refractive error

  • Corneal thickness

  • Eye health

An ophthalmologist determines these factors through a comprehensive eye exam, significantly influencing the decision for the most suitable vision correction procedure.

Each is an effective procedure and is considered safe. The eye’s surface must be well lubricated without significant dry eye disease. If dry eye is present, it must be treated before surgery.

Age is the primary criterion for distinguishing whether LASIK surgery or refractive lens exchange is preferred. Most LASIK surgery candidates are between 20-50, whereas most RLE procedures are in patients aged 50+.

However, you may be a good candidate for both procedures if you are in your 50s. The main selection is if there are signs of early cataracts, in which case lens replacement surgery is the right option.

The costs involved need to be considered. Refractive lens exchange is more expensive than laser eye surgery, which costs around £3000 more than its laser alternative. The cost of a new lens (IOL) can be considerable for premium implants.

The LASIK procedure has lower risks and doesn’t require an operating theatre because no instruments enter the eye.

Both are considered elective surgery.

RLE Candidacy Criteria

To qualify for RLE, candidates must be over 45-50, especially those experiencing presbyopia, which requires reading glasses.

RLE may be recommended for patients with severe myopia, hyperopia, or presbyopia, whereas LASIK might not be ideal.

However, patients with diabetes, immune deficiencies, autoimmune diseases, or a history of corneal diseases must discuss their conditions before considering RLE surgery.

LASIK Candidacy Criteria

For LASIK, patients must meet the following criteria:

  • Be over 18 years old

  • Have a consistent prescription for at least one year (though the ideal age for candidates is over 21)

  • Have healthy eyes without severe dry eye syndrome, keratoconus, or eye injuries.

LASIK can correct presbyopia through a procedure known as blended vision. Here, one eye is corrected for distance vision and the other for improved reading. While it sounds strange, most patients are, in fact, suitable for a blended vision approach.

LASIK blended vision is highly effective at restoring near vision. Its main drawback is the limited lifespan of the full benefit. A top-up procedure may be needed after 5-10 years to boost reading vision further. Distance vision improvements are usually retained long-term.

Technological advancements such as Wavefront mapping and femtosecond lasers have broadened LASIK candidacy by allowing more precise and safe corneal reshaping.

Cost Comparison: RLE vs LASIK

Cost comparison: RLE vs LASIK

Cost is a key factor in the decision-making process regarding vision correction surgeries. On average, refractive lens exchange costs around £4,000 per eye, while LASIK prices range from £2000 to £2,500 per eye. LASIK surgery costs vary based on location and the patient’s specific prescription.

It should be kept in mind that both RLE and LASIK surgeries are elective procedures and are unlikely to be covered by insurance. Thus, it is essential to consider future expenses on glasses, contacts, and eye doctor visits in addition to the type of implant lens when evaluating the costs between RLE and LASIK.

Recovery and Healing Time

eye surgery recovery

The recovery and healing time significantly influence the patient’s post-surgery experience. For LASIK, recovery begins immediately after the procedure, with many patients noticing improved vision as soon as the surgery is completed.

The final visual prescription after LASIK settles over 2-3 months but could extend up to 6 months for some individuals. Most LASIK patients can return to normal activities and driving within a day or two, with the complete recovery period spanning up to six months.

On the other hand, recovery from RLE allows most patients to resume normal activities within a week, and full corrective benefits may take several weeks to manifest. Visual fluctuations may occur for a few weeks, with halo and strobe-light symptoms resolving around ten to twelve weeks.

Making the Right Choice: Personalised Advice

Deciding which procedure is right for an individual requires an understanding of one’s personal vision, needs, and goals. This is when the personalised advice from an ophthalmologist proves to be essential. They can discuss individual needs and vision goals to determine the most suitable vision correction procedure.

For instance, RLE may be the more favourable option for patients with a high intolerance for glasses, seeking freedom from glasses for both near and distant vision.

It is important to remember that each person’s eyes are unique; therefore, the decision should be based on what is best for their situation.


Refractive Lens Exchange (RLE) and LASIK are two popular vision correction surgeries with unique strengths and considerations. While RLE replaces the natural lens with an artificial one, LASIK reshapes the cornea using a laser.

Both procedures offer numerous benefits, including improved vision quality and clarity, reduced reliance on corrective lenses, and permanent vision correction. However, they also come with risks and limitations that should be thoroughly considered.

Deciding which procedure is right for an individual requires professional advice, considering age, refractive error, corneal thickness, and overall eye health.

Frequently Asked Questions

What is the difference between LASIK and RLE?

The main difference between LASIK and RLE is that RLE involves replacing the natural lens with an artificial one to correct vision, while LASIK reshapes the cornea using a laser.LASIK is focused on reshaping a patient’s cornea, while RLE replaces the natural lens with an artificial one to correct vision.

What are the disadvantages of RLE?

RLE surgery may not be suitable for some eye conditions, as it is more invasive, may require post-treatment and is costly.

What is the success rate of RLE?

The success rate of refractive lens exchange (RLE) is approximately 90% to 95%, with high patient satisfaction. Success may vary based on individual eye health and the type of intraocular lens (IOL). Therefore, it offers a broad range of treatment options for various conditions.

Which is better, lens replacement or laser surgery?

For patients aged 50+, especially if the early stages of cataract are visible, refractive lens exchange is the right choice. For younger patients, LASIK or PRK are usually the best option.

How long does it take to recover from RLE and LASIK?

Recovery from RLE typically takes a week for most patients to resume normal activities, while most LASIK patients can do so within a day or two.

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