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The Ultimate Guide to Refractive Lens Exchange Surgery Success in Nigeria

Refractive lens exchange (RLE) surgery is a type of eye surgery that can correct vision problems such as nearsightedness, farsightedness and astigmatism. It is similar to cataract surgery, but instead of removing a cloudy lens, it removes a clear lens and replaces it with an artificial one that matches the patient's refractive error. RLE can be an alternative to laser eye surgery (LASIK) for people who have thin corneas, dry eyes, or high prescriptions.

In this article, we will explain what RLE is, how it works, what are the benefits and risks, how to prepare for the surgery, what to expect during and after the surgery, and how much it costs in Nigeria.


What is RLE and how does it work?

RLE stands for refractive lens exchange, also known as clear lens extraction or lens replacement surgery. It is a procedure that involves removing the natural lens of the eye and replacing it with an artificial intraocular lens (IOL) that corrects the patient's vision. The natural lens is responsible for focusing light on the retina, but as we age, it becomes less flexible and less transparent, leading to vision problems such as presbyopia (difficulty seeing near objects) and cataracts (clouding of the lens). RLE can prevent or treat these conditions by replacing the natural lens with a new one that has the desired power and shape.

Different types of IOLs can be used in RLE, depending on the patient's needs and preferences. Some of the most common ones are:

1. Monofocal IOLs: These are the simplest and most widely used types of IOLs. They have a single fixed focus for either distance or near vision. The patient may still need glasses for the other range of vision or for intermediate tasks such as using a computer.

2. Multifocal IOLs: These are IOLs that have multiple zones of focus for distance, near and intermediate vision. They can reduce or eliminate the need for glasses after RLE, but they may also cause some side effects such as glare, halos or reduced contrast sensitivity.

3. Toric IOLs: These are IOLs that have a special shape to correct astigmatism, which is a condition where the cornea (the front surface of the eye) is irregularly curved, causing blurred or distorted vision. Toric IOLs can be combined with monofocal or multifocal IOLs to provide a more complete correction of refractive errors.

4. Accommodating IOLs: These are IOLs that mimic the natural ability of the lens to change shape and focus on different distances. They use a hinge mechanism that allows them to move slightly inside the eye in response to the eye muscles. They can provide a more natural and dynamic vision than other types of IOLs, but they may not work well for everyone.

The choice of IOL depends on several factors such as the patient's age, lifestyle, eye health, expectations and budget. The ophthalmologist will discuss the options and recommend the best one for each case.


What are the benefits and risks of RLE? 

RLE has many benefits for people who want to improve their vision and reduce their dependence on glasses or contact lenses. Some of the main benefits are:

- It can correct a wide range of refractive errors, including high degrees of nearsightedness, farsightedness and astigmatism.

- It can prevent or treat cataracts, which are a common cause of vision loss in older adults.

- It can provide a permanent solution for presbyopia, which is the age-related loss of near vision that affects most people over 40 years old.

- It can offer a more stable and predictable outcome than laser eye surgery, which may require enhancements or revisions over time.

- It can be performed on people who are not suitable candidates for laser eye surgery, such as those who have thin corneas, dry eyes, or severe refractive errors.

However, like any surgery, RLE also has some risks and complications that should be considered before deciding to undergo the procedure. Some of the possible risks are:

1. Infection: This is a rare but serious complication that can occur after any eye surgery. It can cause inflammation, pain, redness, discharge and reduced vision. It can be treated with antibiotics and anti-inflammatory drugs, but in some cases it may require further surgery or lead to permanent vision loss.

2. Retinal detachment: This is a condition where the retina (the light-sensitive layer at the back of the eye) peels off from its underlying tissue. It can cause flashes, floaters, shadows or blind spots in the vision. It can be caused by trauma, inflammation or aging, but it can also occur as a complication of RLE, especially in highly nearsighted people. It can be treated with surgery, but it may result in permanent vision loss or impairment.

3. Glaucoma: This is a condition where the pressure inside the eye becomes too high, damaging the optic nerve (the nerve that connects the eye to the brain). It can cause gradual vision loss, starting from the peripheral vision and progressing to the central vision. It can be caused by various factors, but it can also occur as a complication of RLE, especially in people who have narrow angles or pre-existing glaucoma. It can be treated with medication, laser or surgery, but it may not be reversible.

4. Dysphotopsia: This is a term that refers to any abnormal visual phenomena that occur after RLE, such as glare, halos, starbursts or ghost images. They are more common with multifocal IOLs than with monofocal IOLs, and they tend to decrease over time as the brain adapts to the new lens. However, they can be bothersome for some people and affect their quality of life. They can be managed with glasses, eye drops or surgery, but they may not be eliminated.

5. Dissatisfaction: This is a subjective outcome that depends on the patient's expectations and satisfaction with the results of RLE. Some people may not be happy with their vision after RLE, either because they still need glasses for some tasks, or because they experience side effects such as dysphotopsia or dry eyes. They may regret their decision or wish to have a different type of IOL. They may seek a second opinion or request a revision surgery, but this may not always be possible or advisable. 

The risks and complications of RLE are rare and can be minimized by choosing a qualified and experienced ophthalmologist, following the pre-operative and post-operative instructions, and reporting any problems or concerns as soon as possible.


How to prepare for RLE?

Before undergoing RLE, the patient will need to have a comprehensive eye examination and consultation with the ophthalmologist. The purpose of this is to: 

- Evaluate the patient's eye health and medical history

- Measure the patient's refractive error and corneal curvature

- Determine the type and power of IOL that is best suited for the patient

- Explain the procedure, benefits, risks and alternatives of RLE

- Answer any questions or concerns that the patient may have 

The patient will also need to undergo some tests and measurements to ensure a safe and successful surgery. These may include: 

1. Corneal topography: This is a test that maps the shape and curvature of the cornea using a computerized device. It helps to diagnose any corneal abnormalities that may affect the outcome of RLE.

2. Optical coherence tomography (OCT): This is a test that uses light waves to create detailed images of the retina and optic nerve. It helps to detect any retinal diseases or abnormalities that may affect the outcome of RLE.

3. Biometry: This is a test that measures the length and depth of the eye using ultrasound or laser. It helps to calculate the power and position of the IOL that will be implanted during RLE.

4. Pupillometry: This is a test that measures the size and reaction of the pupil using a device that shines light into the eye. It helps to determine if the patient is at risk of developing glare or halos after RLE. 

The patient will also need to follow some instructions before the surgery day, such as: 

- Stop wearing contact lenses at least two weeks before the surgery, as they can alter the shape of the cornea and affect the accuracy of the measurements.

- Stop taking certain medications such as blood thinners, anti-inflammatory drugs or herbal supplements that may increase the risk of bleeding or interfere with healing.

- Arrange for someone to drive them to and from the surgery center, as they will not be able to drive themselves after the surgery.

- Bring their glasses, sunglasses and any medications that they need to take on the day of the surgery. 


What to expect during RLE?

RLE is usually performed as an outpatient procedure under local anesthesia and sedation. The patient will be awake but relaxed and comfortable during the surgery. The surgery typically takes about 15 minutes per eye, but it may vary depending on the type of IOL and any additional procedures that may be required.


Refractive Lens Exchange (RLE) surgery offers a safe and effective solution for vision correction in Nigeria. Proper patient selection, advancements in technology, careful surgical techniques, and thorough post-operative care are key factors contributing to successful outcomes. With the availability of various intraocular lens options and the adoption of advanced surgical techniques, RLE surgery has gained popularity and provided improved visual outcomes for patients in Nigeria. As technology continues to advance and surgeons refine their skills, the success rates and patient satisfaction of RLE surgery are expected to further improve, making it an attractive option for those seeking freedom from glasses or contact lenses.

Author: adekunle-oludele