RLE benefits most eyes

In most eyes, the benefits of refractive lens exchange (RLE) outweigh the risks and it can provide a large improvement in patient quality of life, David Hardten said.

"One patient told me 'This surgery has had a more positive impact on my quality of life than anything I've ever done for myself'. That's how big a difference it can make," Dr Hardten remarked.

Dr Hardten noted that quality of life metrics can be hard to establish. "There are no quality of life surveys specifically for refractive lens exchange, but some other studies show that there is a link between improved vision and quality of life."

He cited a Quality of Life Impact of Refractive Correction (QIRC) Questionnaire paper that showed lower satisfaction in patients in contact lenses and glasses than refractive surgery (Pesudovs, et al., JRS 2006;22:19).

Another survey using the National Eye Institute - Refractive Error Quality of Life (NEI-RQL) instrument found that emmetropes experienced the greatest quality of life, post-refractive patients came second, while those using presbyopic glasses had the least quality of life (Hays, et al., Ophth. 2003;110:2292).

Dr Hardten remarked that RLE provided many advantages over alternative refractive solutions. He noted that, with glasses there was a higher incidence of re-do's, while contact lenses had a higher incidence of re-fits. There were higher complications with radial keratotomy (RK), automated lamellar keratoplasty (ALK), LASIK, photorefractive keratectomy (PRK).

But with RLE people with reduced vision experience less handicap because there is less handicap because of less dependence on glasses and contact lenses, there is less magnification or minification of images than spectacles, and the risks associated with contact lenses are minimized.

Furthermore, there's no risk of future cataract development and there are a large variety of RLE IOLs available to today's surgeon, including monofocal, aspheric, monovision and presbyopic.

"You also get high quality outcomes," he concluded.

Ophthalmology Times Europe reporting from the XXIV Congress of the ESCRS, London, 9-13 September, 2006.