In my quest to give away every secret, surgical pearl, and useful bit of knowledge that I have acquired over the past 25 years of doing surgery, I present to you some critical refractive lens exchange (RLE) pearls. RLE refers to performing a lens exchange surgery, removing the human crystalline lens and replacing it with a man-made IOL (intra-ocular lens) implant before a visually significant cataract has developed. The sole purpose of the surgery is to address a refractive issue, which in this case is presbyopia which is the inability to see up close to read that comes with age. This video gives you my best pearls for success in these RLE surgeries, including the two types of patients who are hardest to please.
Are these refractive lens patients getting glare testing (hopefully glaring down to insurance thresholds) to pay for the cataract surgery and then upgrading into a Vivity IOL or are they paying for the whole surgery since the cataract isn’t developed yet?
Also, I had a 42 year old high myope (-8.00 OD and -10.00 OS) who wanted refractive lens exchange surgery the other day. I recently did surgery on both of his parent-in-laws who ended up with great distance vision with monofocal and toric IOLs. He sees 20/20 and J1 with contact lenses and has trace nuclear sclerotic changes. I couldn’t justify offering a Panoptix IOL until he was at least presbyopic. He’s not a candidate for LASIK due to his high myopia and thinner corneas. What is your opinion on these high myopes seeking spectacle independence?
Thank you for all of your great videos and cataract surgery wisdom.
Sorry the previous post did not link to my account and reported as anonymous. Will repost below:
Are these refractive lens patients getting glare testing (hopefully glaring down to insurance thresholds) to pay for the cataract surgery and then upgrading into a Vivity IOL or are they paying for the whole surgery since the cataract isn’t developed yet?
Also, I had a 42 year old high myope (-8.00 OD and -10.00 OS) who wanted refractive lens exchange surgery the other day. I recently did surgery on both of his parent-in-laws who ended up with great distance vision with monofocal and toric IOLs. He sees 20/20 and J1 with contact lenses and has trace nuclear sclerotic changes. I couldn’t justify offering a Panoptix IOL until he was at least presbyopic. He’s not a candidate for LASIK due to his high myopia and thinner corneas. What is your opinion on these high myopes seeking spectacle independence?
Thank you for all of your great videos and cataract surgery wisdom.
If the patients do not have truly visually significant cataracts, then they must pay out of pocket for the whole procedure since nothing will be billed to their insurance companies. For a 42 year old high myope who still has accommodation, I would not recommend refractive lens exchange. The better option would be a phakic IOL for a decade or two and then future refractive lens exchange.