Clear Lens Extraction: A Surgical Solution for Glass-Free Vision

Patients in their mid to late 40s who are adamant about becoming glass free commonly ask us, “Is LASIK possible for me?” 

They are looking for a refractive procedure to get freedom from glasses.  Most of these patients have gotten reading glasses and don’t like the idea of having to carry them all the time. These patients are looking for a solution for correction of presbyopia. Some of them also wear distance vision glasses along with reading glasses.

While there is no medical contraindication for LASIK in their 40s and 50s, the procedure might be counterproductive. They will become glass-free for distance vision; however, they will still require near glasses. As we observe their dejection, questioning why this choice was not made 20 years ago or whether the lack of technology prevented them from having a glass-free life, we see disappointment on their faces. This gives us an opportunity to describe a surgical procedure that can make their dreams come true.

In this blog, we will discuss a procedure known as Clear Lens Extraction (CLE) or Refractive Lens Exchange (RLE). This is a surgical refractive surgery option.

What is Clear Lens Extraction?

Clear Lens Extraction or refractive lens exchange is a procedure in which we replace the clear crystalline lens that is present inside the eye since birth with an artificial Intraocular Lens (IOL). The surgical technique used is similar to that of cataract surgery, with the only difference being the absence of cataracts. CLE Surgery is thus an alternative to LASIK or laser refractive eye surgery.

Patients who choose to undergo CLE, have a range of intraocular lenses to choose from,

1. Monofocal lenses – will continue to need reading glasses
2. Trifocal or Multifocal implants or lenses – Will be glass free for far, computer and near vision. In other words there is preservation of accommodation.
3. Toric Lenses – Used in astigmatism.  Toric lenses are available for monofocal lenses, multifocal lenses and trifocal lenses.

Thus, just like in cataract surgery, the intraocular lenses implanted can correct all the refractive errors like far-sightedness, near-sightedness, presbyopia (most common), and astigmatism. Patients are provided with a choice to select the premium IOL which makes them clear for far, computer distance and near (Trifocal IOL), which is the intended result any presbyopia wants.

To know more about lenses visit our Best Cataract lens page.

The correct lens power is calculated by performing an A Scan which measures the size of the eye.  With these measurements we use some lens power calculation formulas to help us decide the lens power.

Who is an ideal candidate for Clear Lens Extraction? 

The best candidates for CLE Surgery are:

• Those who are self-motivated to become independent of glasses and contact lenses.
• Age group of 45 – 75 years
• Individuals with high myopia (nearsightedness), high hypermetropia (farsightedness), presbyopia, or astigmatism.
• Are poor candidates for LASIK/PRK due to high powers or thinner cornea
• Have no retinal or other ocular pathology
• Have no major systemic illnesses

Clear lens extraction is also a preferred procedure for primary angle closure glaucoma, where the intraocular pressure increases and the thickness of the natural lens may contribute to the condition. By performing a clear lens extraction, the IOL is much thinner than the natural lens, and the eye pressure may reduce after the procedure. It is important to note that the same procedure would not work in synechial angle closure. 

From our perspective, it is crucial to follow patient selection protocols to ensure complete satisfaction for our patients.

Who are not candidates for clear lens extraction? 

Patients with retinal problems, such as a history of retinal detachment, and those with other eye diseases are not suitable candidates for clear lens extraction. 

What are the benefits of Clear Lens Extraction?

The advantages of CLE Surgery include,

• Quick recovery of vision
• The frontmost part of the eye, called the cornea, is untouched.
• There is no need for cataract surgery in future.
• Vision remains stable throughout life, provided no other ocular pathology shows up in future.
• Presbyopic correction or glasses for reading may be required.
• Patients with thin corneas where LASIK/PRK is contraindicated can also be benefited from CLE and experience glass-free vision.
• One achieves the benefits of refractive surgery and also doesn’t need a cataract surgery later in life.

What is the procedure for Clear Lens Extraction?

The same methods used for cataract surgery are used for clear lens extraction treatment.

• The operating eye is administered with a topical or local anaesthetic to lessen pain during the surgery.
• The crystalline natural lenses of the eye are removed by a very small (2mm or less) incision
• Intraocular lens Placement – It is then replaced with a foldable IOL that is implanted through the same opening. The lens is unfurled and moved into its permanent place in the eye.
• No stitches are required because the incision will be able to close on its own.
• Clear lens extraction surgery offers patients significant and quick benefits in under 10 minutes.
• Both eyes cannot be operated on the same day; usually, a gap of 2-3 days is maintained between the eyes.
• Follow-up period usually lasts for about a month.

What does recovery from Clear Lens Extraction involve?

• Following a clear lens extraction, patients can go home the same day and resume their normal activities the following day or two.
• Many people report seeing better right away, and as the brain gets used to the new lens, eyesight will only become better.
• While the lenses restore vision and shield the patient’s eyes from acquiring cataracts in the future, once vision has stabilised, it will probably remain the same over time.
• Patients need to put steroid eye drops and antibiotic eye drops 

What are the potential risks and surgical complications that may occur during CLE Surgery?

As with any surgery, there are theoretical risks to some extent. These concerns should be thoroughly discussed with the surgeon. Similar to Cataract Surgery, clear lens extraction carries the same risks and potential complications, including: 

• Retinal complications like retinal detachment. 
• Eye infection. 
• Glaucoma. 
• Vision distortion. 

However, it’s important to note that in the hands of experienced surgeons, these complications rarely occur.

Summary

CLE Surgery can be the treatment of choice for patients who are poor candidates for Laser eye surgery or have high prescriptions. The procedure is preferred by presbyopes who are motivated to eliminate their dependence on glasses.