31 EyeWorld Asia-Pacific | March 2025 REFRACTIVE SURGERY About the Physicians Marjan Farid, MD | Director of Cornea, Cataract, and Refractive Surgery, Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California | mfarid@hs.uci.edu D. Rex Hamilton, MD | Medical Director, Hamilton Eye Institute, Beverly Hills, California | rex@rexhamiltonmd.com; rexhamiltonmd.com; hamiltonrle.com Luke Rebenitsch, MD | Medical Director, ClearSight, Oklahoma City, Oklahoma | lrebenitsch@gmail.com Relevant Disclosures Farid: Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision Hamilton: Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision, RxSight Rebenitsch: Carl Zeiss Meditec, Johnson & Johnson Vision, RxSight, STAAR Surgical This article originally appeared in the December 2024 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. ASIA-PACIFIC PERSPECTIVES Joon Young HYON, MD Professor, Seoul National University Bundang Hospital 82, Gumi-ro 173beon-gil, Seongnam, Korea jyhyon@snu.ac.kr Refractive lens exchange (RLE) is gaining popularity as a solution for patients seeking spectacle independence. Drs. Marjan Farid, D. Rex Hamilton, and Luke Rebenitsch, have endorsed RLE as a viable option for presbyopic patients (ages 40–60) and hyperopes who may not be ideal candidates for LASIK. By replacing the natural lens with advanced intraocular lenses (IOLs), RLE not only addresses refractive issues but also prevents future cataract development, offering patients a full range of vision. Cutting-edge IOLs, such as the TECNIS Odyssey and the Light Adjustable Lens (LAL), deliver exceptional optical quality, minimize side effects, and allow postoperative customization. The growing demand for RLE is driven by advancements in surgical technology, superior patient outcomes, and its efficacy in addressing frustrations with glasses and contact lenses. Many practices have reported substantial growth in RLE volume, with this procedure surpassing LASIK as a revenue generator in some clinics. As technology continues to evolve, RLE expands the horizons of personalized refractive care, particularly for aging populations. Despite its benefits, RLE is a more invasive intraocular procedure compared to refractive corneal surgeries. While the associated risks are rare, it is imperative that patients fully understand these potential complications. Comprehensive preoperative evaluations are critical for identifying and mitigating risk factors before surgery. When recommending RLE, clinicians must carefully weigh its benefits against the risks, particularly for younger patients or those with high myopia. These patients are at an elevated risk of retinal detachment, necessitating close collaboration with retina specialists. In such cases, phakic IOLs may remain a safer alternative. Clear communication is essential to managing patient expectations, especially regarding potential dysphotopsias and the possibility of postoperative enhancements. Utilizing tools like simulators can help align patient expectations with realistic outcomes, fostering trust and satisfaction. Moreover, understanding the psychological readiness of the patient is crucial in determining the timing of surgery. Patients undergoing cataract surgery typically experience a significant improvement in vision due to preoperative lens opacity. In contrast, RLE patients compare their preoperative best-corrected vision with postoperative results, which may make them more sensitive to aberrations that are sometimes unavoidable. Therefore, careful selection of IOLs is vital, and thorough consultations are essential to educate patients about the trade-offs associated with achieving spectacle independence. Editors’ note: Dr. Joon Young Hyon disclosed no relevant financial interests.
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