Refractive Lens Exchange (RLE)

Welcome to the Center for Information of Refractive Lens Exchange (RLE)

How do our eyes change with age?

Our eyes are like any other organs inside the body. Yes, they also change while you are aging. Today we will learn how aging affects your eyes and your vision. What is supposed to be normal? What should I be concerned about? What are the symptoms and warning signs, and how can I prevent myself from serious eye conditions?

When does your age start affecting your eyes?

I think this is very common question, and a concern for many people, because no one likes to accept the wear and tear of our body. Everyone should learn to differentiate possible serious symptoms from the natural changes in their eyes.

When you are in your 40s

Eye specialists agree that the very first sign of age-related changes of the eye start in and around your 40s, when the natural lens inside the eye starts losing its flexibility and becomes more rigid. You will notice that it becomes more difficult to focus on close up objects, and as a result, many people need reading glasses, bifocals, or even multiple pairs of eye glasses. This is called “presbyopia” (pres•by•o•pi•a). It is just like the camera that is losing its automatic focusing function.

This is considered to be a perfectly normal part of aging, but will become worse over time. In the end, you may lose all of your close up vision, and will totally depend on eye glasses to see up close.

Various treatment solution have been developed to combat this condition, which includes use of bifocal/progressive glasses, correcting close up vision by contact lenses in one eye, laser vision correction, or lens replacement surgery. All of these solutions have varied success rates, stability, efficacy, and risk profiles.

When you are approaching your 60s

The major eye changes start again when you reach your 60s. Since there are many parts inside the eye that change around this age, I will separate the conditions according to the parts of the eye.

Natural lens becomes cloudier

At this time, the natural lens inside the eye (which is already rigid) becomes cloudier over time. This condition is called a “cataract”. I have found that patients are usually surprised when they are diagnosed with cataracts. Some have even asked, “How is it possible?” I want to take this opportunity to explain that cataracts are not the end of the world. It only means that your natural lens has started to turn cloudy, that’s all.

In the modern medical era (in developed countries or in modern cities in Thailand), cataracts are rarely considered to be sight threatening conditions. Cataracts require surgery (lens replacement surgery). Cataract surgery is not urgent; the time for considering surgery is varied, and the severity of the cataract is only part of the surgery recommendation decision. Because the risk of the surgery is minimal, the eye specialist may recommend lens replacement surgery right away, even if the cataract is still mild, if they can foresee the potential for improvement in your vision.

Eyes become drier

Changes will occur in other part of the eyes as well, not just the lens. A significant amount of patients (especially women) may experience more dryness; some may feel stickiness inside the eyes. This happens because of a decrease in natural tear production and a change in the tear quality. Therefore, some patients will be recommended to use artificial tears to substitute the reduction in natural tears for an extended period.

Flashing and floaters

There are also changes that happen in the back part of the eye. The interior of the back part of the eye is filled with a gel (doctors call it “vitreous”). Around this time, some part of the vitreous will liquefy, or start shrinking. This may make you see black spots (called “floaters”). If the shrinkage of the vitreous affects your retina (your eye nerve), you may see lightning or sparkles when you move your eyes, called “flashing”. So, if you have numerous floaters over a short time, or a flashing sensation, please see an eye specialist as soon as possible, because it may be a warning sign of retinal tearing, or even retinal detachment.

Increasing risk for glaucoma

In short, glaucoma is a condition that causes damage to your eye’s optic nerve, and gets worse over time. Its main risk factor is caused by increasing the pressure inside the eye. There are many risk factors that contribute to the development of glaucoma. Your age is one of them. The most dangerous type of glaucoma is chronic glaucoma. This form of glaucoma can severely damage your eyes before you know about it, due to its slowly progressive nature. The best way to prevent glaucoma is to have an annual eye checkup to evaluate your risk for it, which increases every year as you age.

Degenerative change of focus point inside the eye

Our eye functions like a camera, with a focal point. This is called the “macular”. Age related Macular Degeneration (AMD) is the leading cause of vision loss among people age 60 and older. It can manifest as one of two types, wet or dry.

In some people, AMD advances so slowly that vision loss does not occur for a long time (found mostly in the dry type). In others, the disease progresses faster, and may lead to a loss of vision in one or both eyes (found mostly in the wet type). As AMD progresses, you may experience progressive enlargement of a blurred area or increased numbers of black spots in your central vision. Objects also may not appear to be as bright as they used to be.

The early and intermediate stages of AMD usually start without symptoms. Only a comprehensive dilated eye exam can detect AMD. That is why there is a recommend guideline of annual eye checkups after you reach your 60s.

This is a summary of how your age affects your eyes. I think you can see that the most serious ages-related diseases are slowly progressive conditions, and most of them don’t show any obvious symptoms in their early stages. In short, even if you feel that you vision is still ok, it doesn’t mean that your eyes are healthy. Because of this reason, it is recommended to have a comprehensive eye examination every two years if you are between 40 and 60, and every year if you are over 60.

Fig 1: When you have presbyopia, you will lose close-up vision
Fig 2: A sudden increase in the amount of floaters may indicate serious conditions, such as retinal tearing or detachment.
Fig 3: Glaucoma is called the “silent thief of sight”, because it slowly destroys the patient’s field of vision.

Am I a candidate for procedure?

You are likely candidate for procedure if you:

  • Ages over 50 years old.
  • Depending on eye glasses for performing your daily activities e. g. reading, cooking, using computer or sports.
  • No serious eye disease.
  • No previous cataract/lens surgery or previous Lasik surgery.
  • No major health problem.
  • Have realistic expectation on vision correction surgery.

Your benefit of procedure

  • Most effective procedure in vision collection in patient that age over 50.
  • Let you enjoy most of your activities and living without depending on eye glasses.
  • Restore full range of vision (both far vision and reading)
  • If you have cataract, the procedure will also remove your cataract.
  • Never worry about the cataract will happen later on in life.
  • Permanent stable vision after surgery.
  • Painless surgery and very rapid recovery.

Overview of procedure

During the procedure, the lens inside the eye is replaced with an artificial refractive lens. The premium refractive multifocal lens will enable patients to see near, far and in between clearly without or less dependence on eyeglasses or contact lenses.

1. Preparation
After the eye is numbed, and the surrounding area is cleaned, a small incision is made in the cornea. Because there are no blood vessels in the cornea, there is usually little or no bleeding. An opening is made in the lens capsule to allow access to lens.

2. Breaking Up the Lens
An ultrasonic probe is inserted into the incision. It vibrates at high speed, breaking the lens into tiny pieces.

3. Removing the Lens
The pieces of the lens are removed by suction through the probe’s hollow tip.

4. New Lens Inserted
Using an injector device, a flexible synthetic lens is inserted. As the lens unfolds, it is positioned inside the same capsule that held the eye’s natural lens in place.

End of Procedure
The injector is removed, and the incision seals shut without stitches. The absence of stitches helps the eye to heal quickly and properly. Most patients are back to their normal activities the day after

Schedule and how to prepare yourself for your procedure

First step: obtain an eye examination report from your local optometrist/eye specialist.

The basic information that this report must provide is as follows (please write it down if you can’t remember):

  1. A visual acuity test (both uncorrected and best corrected visual acuity);
  2. A refraction test;
  3. Your current glasses/contact lens prescription;
  4. A report on your general eye health.

Second step: complete the questionnaire

The questionnaire is very important, because it will give us information about your visual needs and your lifestyle. Therefore, please download and complete this form.

Third step: schedule your appointment for a pre-operative eye examination
Time required: 2-3 hours.

Our staff will schedule your appointment for an eye examination and consultation with our RLE (Refractive Lens Exchange) specialist. This pre-operative examination and consultation will take around 2-3 hours. It is very important to note that your vision will be temporarily blurred for 3-4 hours after the examination is completed, so you must arrange for someone to drive you back to your home/hotel.

This is what you need to prepare before the eye examination and consultation date:

  • Bring all of the glasses, reading glasses and/or contact lenses that you currently use with you.
  • Bring all of your eye drops and current medication with you.
  • Make a list of your current medication, any underlying health diseases, and any medication allergies you are aware of.
  • Cease using any blood thinning medication (such as aspirin) for at least 1 week before the consultation.
  • Remove any makeup from the eye area.
  • Cease using soft contact lenses at least 1 week, hard lenses for at least 1 month, before the examination. This is very important for your results!

In this visit, you will find out about:

  • Whether you are good candidate for the procedure or not;
  • The complete details regarding the risks and benefits of the procedure;
  • What you should expect from the procedure;
  • In-depth information regarding the procedure, and how to prepare yourself before and after surgery;
  • Your complete eye health condition, from the preoperative examination.

After the complete eye examination is finished, and you wish to go on with the procedure, we will ask you to obtain a screening basic heath checkup before you proceed to the next step.

Operation (Day 1)

  • Time required: 2-3 hours
  • Operation time: 40-60 minutes.

The procedure date is usually scheduled 1-3 days after the examination (but may be longer, depending on the results of your eye examination and the waiting time for the lens implant that is the best match for your eyes). The overall process will take around 3-4 hours in hospital. You can go back to home or to your hotel after the procedure is finished, and return to our office the next day for the follow up.

Operation (Day 2)

The operation for the second eye is usually scheduled for the next day after the first eye is treated and our RLE specialist has approved that the result of the first eye is good and stable enough, and that there are no complications. The waiting period between the first eye and the second eye may be longer, depending on the patient’s recovery.

Follow up visit

The follow up visit will be scheduled around 7-10 days after the operation on the second eye. This follow up visit is very important for the patient’s safety, because it will let our RLE specialist know if there are any problems that have occurred.

The overall time that you need to prepare to stay in Phuket, Thailand, is 2 weeks.