Alternative Treatments: What is Clear Lens Exchange (CLE)?
Clear Lens Exchange (CLE) – also known as Refractive Lens Exchange (RLE) – is another alternative to Laser Eye Surgery. The basis of the procedure is exactly the same as that of cataract surgery, except it is performed when no cataracts are present.
Like Implantable Collamer Lenses (ICL) surgery, CLE can be used to correct almost any prescription.
However, unlike ICLs, CLE removes the internal crystalline lens and replaces it with a synthetic lens that has been designed to correct the specific prescription of the patient. This synthetic lens is placed inside the capsular bag that contains the eyes’ natural lens. In contrast, ICLs are placed in front of the natural lens.
The fixed focus of the synthetic lenses used in CLE means that the eye’s natural ability to focus is removed. For this reason, CLE is usually used in presbyopia patients who have little short focus reserves. For younger patients (usually under the age of 65), ICLs are preferred.
Clear Lens Exchange may also be an option for presbyopia patients who are unsuitable for Laser Eye Surgery and whose eyes will not accommodate ICLs.
Common Misconceptions about CLE
There are several inaccuracies in the information often provided to patients with regard to CLE. For example, many patients are under the impression that CLE surgery will provide them with permanently corrected vision. While it is true that the change in refraction caused by CLE is permanent, this claim can be a little misleading.
Our corneas continue to change continuously from the age of around 40. As we age, this process affects prescriptions for around a third of all people – usually through changing the astigmatism of our eyes. It is possible for the natural changes in the cornea to affect the refraction of CLE.
Another advantage is that CLE will remove the need for future cataract surgery. Clear Lens Exchange removes the eyes’ natural lenses and replaces them with artificial ones. In contrast, Laser Eye Surgery reshapes the cornea, leaving the natural lens in place; therefore, cataract surgery may still be required in the future.
This sounds great, however, when you weigh up the risk of developing visually significant cataracts following Laser Eye Surgery with the higher risks associated with intraocular surgery, things get a little more complicated.
It is estimated that only around 30% of people in the UK develop visually significant cataracts that require surgery. Of course, this risk is eradicated in patients who undergo CLE. However, intraocular surgeries like CLE carry a more significant risk of complications due to their more invasive nature – particularly in patients under the age of 60.
This point is often overlooked or minimised.
Potential Side Effects
The technology used in IOL procedures has been consistently evolving to provide patients with the best level of care. However, even the most up-to-date IOL technology has its limitations. Patients who undergo IOL surgery can expect to experience glare, halos, and decreased contrast sensitivity, to name a few.
Nonetheless, as technology continues to advance, it is likely that many of these side effects will be addressed, leaving patients with a more natural range of vision.
Is Lens Surgery Right for You?
Before making a final decision about any form of intraocular lens surgery (including CLE), it is important to understand if, and to what extent, natural lens changes are taking place in your eyes.
As we age, a “yellowing” of the natural crystalline lens becomes more common – this can begin as early as 40. Normal changes like this are often referred to as “early cataracts” or “dysfunctional lens syndrome”; however, they are often a natural part of the ageing process.
It is, therefore, important to get an expert opinion before making any decisions regarding refractive surgery. Using a microscope, refractive surgeons and clinicians can get a clearer picture of the crystalline lens to help them assess the changes more closely.
As part of a normal lens evaluation, a number of instruments should be used to help quantify the changes. These include the HDA Optical Scatter Index (OSI), Oculus C-QUANT, and Tracey iTrace.
Clear Lens Exchange can offer an effective alternative to patients who are not suitable for Laser Eye Surgery. However, it is important that all other options are discussed with you thoroughly to ensure you are aware of treatments that may be more suited.
As stated in The Royal College of Ophthalmology Guidelines, all alternative interventions need to be discussed that could meet the vision correction needs with less risk, including from other practitioners.
For more information on Laser Eye Surgery, Clear Lens Exchange, and alternative treatments, get in touch with one of our friendly clinic coordinators today. To find out if you could be suitable for Laser Eye Surgery, Book a Consultation today.
