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Laser Eye Surgery vs Refractive Lens Exchange: A Conversation with A/Prof Chameen Samarawickrama

When most people think of refractive eye surgery, they typically associate it with laser eye surgery such as LASIK. However, there are other refractive surgery treatment options commonly performed to address vision correction needs. Determining the best vision correction treatment involves considering several factors. Things like age, prescription stability, and overall eye health play a crucial role in the decision making process. In this blog we chat with A/Prof Chameen Samarawickrama as he shares his expertise on the difference between two commonly performed refractive surgery procedures, Laser Eye Surgery and Refractive Lens Exchange (RLE).

What are the key differences between laser eye surgery and RLE?

Laser eye surgery involves reshaping the cornea using a laser, to correct vision reducing the need for glasses or contact lenses. 

On the other hand, RLE or Refractive Lens Exchange is a surgical procedure that involves removing the eye’s natural lens and replacing it with an artificial intraocular lens (IOL). The IOL is implanted at the time of the surgery, and its power is calculated specifically for your eye. 

Both procedures are commonly used to treat refractive errors to reduce dependence on glasses or contact lenses.

What factors make someone a suitable candidate for laser eye surgery?

Laser eye surgery is most suitable for individuals with stable prescriptions, generally under the age of 40. Good candidates have healthy corneas with sufficient thickness and no underlying eye conditions like glaucoma or severe dry eyes.

What characteristics make someone an appropriate candidate for RLE?

RLE is often recommended for individuals over 40, especially those starting to experience presbyopia (age related difficulty focussing at near and requiring reading glasses). For this age group there are fewer years of visual benefit from refractive laser surgery before the development of cataracts which would eventually require the removal of the natural lens during cataract surgery. 

Another reason we would consider RLE rather than laser is the amount of correction required. RLE is more suitable for those with higher degrees of refractive error that are often outside the treatable range for laser correction or other modalities such as Implantable Collamer Lenses (ICL).

How does astigmatism factor into the decision between laser eye surgery and RLE?

Astigmatism can be corrected through both laser eye surgery and RLE. However, the extent of astigmatism and other refractive errors will influence the choice of procedure. Laser eye surgery is often an excellent option for individuals with mild to moderate astigmatism. For those with higher levels of astigmatism or other complex vision issues, RLE with a toric IOL may offer more effective correction in older patients.

How does the longevity of results compare between laser eye surgery and RLE?

Refractive laser surgery provides long-lasting results, but it’s important to note that eyes can still undergo age-related changes, such as presbyopia and cataract formation. Refractive Lens Exchange, being a lens replacement, offers a more stable correction for presbyopia and also eliminates the need for cataract surgery in the future.

In summary, what advice would you give to someone considering refractive eye surgery?

It’s crucial to consult with an experienced eye surgeon to determine the most suitable option based on individual needs and eye health. Understanding the differences between refractive laser surgeries such as laser eye surgery and Refractive Lens Exchange, along with thorough pre-operative evaluations, ensures a well-informed decision and successful outcome.

A/Prof Chameen Samarawickrama is an experienced Eye Surgeon with expertise in cataract surgery, laser eye surgery, corneal and anterior segment surgery, complex corneal diseases, keratoconus and corneal transplantation. He consults at Nexus Eyecare Norwest and Nexus Eyecare Blacktown.