29 EyeWorld Asia-Pacific | March 2025 REFRACTIVE SURGERY With expanding options in refractive surgery for patients at different ages, many physicians are seeing an uptick in refractive lens exchange (RLE). Marjan Farid, MD, D. Rex Hamilton, MD, and Luke Rebenitsch, MD, discussed their experience with RLE, including considerations when explaining this option to patients. The average age of cataract surgery in this country has come down with advancing technologies and the ability to restore vision with advanced-optic IOLs, Dr. Farid said. “We have a lot of patients who come in who are precataract and very frustrated with their vision and spectacle and contact lens requirements and want refractive solutions,” she said. “The whole arena of refractive surgery has expanded beyond LASIK, with phakic IOLs, SMILE, PRK. Patients come in and ask if they’re a candidate for LASIK because they don’t want to wear glasses anymore, and in a certain population of patients, refractive lens exchange is a much better solution.” Dr. Farid said patients who are presbyopic, between the ages of 40–60, may not be the best candidates for LASIK because that will keep them in glasses for certain activities. by Ellen Stodola, Editorial Co-Director A Shift Toward RLE This night driving simulation (Rendia) shows initial large halos (left) around headlights that are less noticeable over time (right) as neuroadaptation occurs. Source: D. Rex Hamilton, MD Other patients who are great candidates for refractive lens exchange are younger patients who are very hyperopic; hyperopic LASIK is less predictable, even with available nomograms, Dr. Farid said. Patients with higher hyperopia have smaller eyes and are at risk for future narrow anglerelated glaucoma. “We have 40-year-olds coming in who have been told they have narrow angles and might need laser peripheral iridectomy and are high hyperopes where laser peripheral iridectomy is temporary. [RLE] is a refractive solution because these patients often have poor vision and need coke bottle spectacles or contact lenses.” Given that RLE patients generally want spectacle independence, Dr. Farid considers advanced-technology IOLs for them first. She particularly likes the TECNIS Odyssey IOL (Johnson & Johnson Vision) and the Light Adjustable Lens (LAL, RxSight).
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