Presbyopia is something that happens to all of us as we age. If you have developed presbyopia it may have started around age 40. Presbyopia is a condition in which the lens of the eye loses its ability to focus, making it difficult to see objects up close. If you all of a sudden you did not need glasses and now cannot see up close you may have started to get presbyopia. This condition is not even correctable by laser vision correction. Fortunately, a surgical option called refractive lens exchange can correct this issue. Refractive lens exchange is allowing patients a clear alternative to reading glasses and is capable of reducing or eliminating presbyopia by using an advanced multifocal intraocular lens implant

What Are the Benefits of Refractive Lens Exchange?

The Refractive Lens Exchange Procedure

Refractive Lens Exchange uses the same technique used in cataract surgery. This technique has been used for decades and is the best method for cataract removal and lens insertion. During the surgical procedure the patient is first prepped using a local anesthetic and drops. After the eye has been sterilized the surgeon will make a 2.5 to 3 millimeter incision in the eye. In order to see inside the eye our doctors perform this delicate surgery with a powerful magnifying microscope. A device known as the emulsifier is inserted to the eye and begins to remove the natural lens. Once all of the lens material has been evacuated, a foldable intraocular lens is inserted in the same place as the old lens. Refractive lens exchange is performed on an outpatient basis and only one eye is treated at a time. After the surgery is complete you will be required to go home and rest for the remainder of the day. Most patients report rapid visual improvement immediately after surgery.

After Surgery

Following your refractive lensectomy, the recovery will be fast and in most cases dramatically noticeable. The day after surgery most patients are able to perform normal activities with their new vision. Most patients do experience some temporary blurriness for the first few days and also may experience some light sensitivity for the first few weeks. Sunglasses are recommended to be worn more often than usual. Since the lensectomy is an intraocular surgery, there is a risk of complication that may occur. Dr. Whitson will discuss all complications and risks with you prior to surgery.

Am I a Candidate?

In order to be a patient for a refractive lensectomy you must have a high prescription for short-sightedness or long-sightedness, meaning has to be much greater than what LASIK could treat. The procedure also is suitable for some patients who have a low prescription but are developing a cataract that will need to be removed in the near future. Dr. Whitson will discuss are surgery options with you and make sure you are a strong candidate for any procedure recommended.


Because Refractive Lens Exchange is a procedure using the same technique as cataract surgery the procedure is regarded as relatively safe and effective. Although AAO guidelines prohibit ophthalmologists from calling this surgery safe it is clear that millions of eyes have received intraocular lens implants during cataract surgery and have had successful outcomes. With the advent of the new multifocal IOL, patients experience excellent vision after surgery. The main difference between these two surgical types is that one is for cataract removal and the other for insertion prior to a ripened cataract.

Multifocal Lens Implants For Refractive Lens Exchange

Multifocal IOL lens implants enable patients to see at near far and intermediate distances after surgery. The 2 major brand names in this category are the The AcrySof® ReSTOR® IOL by Alcon and the Tecnis® by AMO. (Recently acquired by Abbott). With a multifocal IOL the central portion of the lens has a series of steps that are carved in a very precise arrangement with varying step heights and distances between steps. Each of the steps of this diffractive optic bends the incoming light differently; creating a near focus that is quite separated from the distance focus formed by the remaining refractive portion of the lens. This large separation between the two images allows for less artifacts or distortion in either of the images, providing good quality of vision at both distance and near.

Multifocal Lens Implants

ReSTOR® Lens Implants by Alcon

ReSTOR Lens ImplantsThe ReSTOR® lens is an artificial lens implant that is designed to replace the natural lens of the eye. Made of a soft, flexible plastic material, the ReSTOR® lens has a patented design that allows it to focus light on the retina for clear vision at near, far, and intermediate distances. In just a few hours, the ReSTOR® lens can be inserted in the eye, then quickly and easily unfolded to restore vision during the surgery process. The result is a remarkable improvement in both the quality (sharp, clear images at all distances) and quantity (a full range) of vision.

Who is a Candidate for ReSTOR® Lens Implants?

The ReSTOR® lens is FDA approved for the treatment of cataracts. ReSTOR® lens implants are available at our Indianapolis eye center to all patients with cataracts and/or presbyopia (difficulty with close-up vision). The ideal candidate for the ReSTOR® lens is someone who is seeking better vision at all distances – near, far, and intermediate – without the hassle of glasses or contact lenses.

Accommodating Intraocular Lenses


CrystalensAn accommodating intraocular lens is one that can move or change its shape in the eye. By doing this it changes its power so that it can focus from far to near. The only accommodating lens currently available is Crystalens originally made by Eyeonics. This is wonderful technology and is especially useful in those people who want the crispest distance vision as well as an excellent ability to see intermediate distance which includes things like computer, grocery shelves, auto gauges. In fact much of our time is spent looking at things in the intermediate range. Most people who receive Crystalens in both eyes are thrilled with the quality and range of vision. The one drawback of this lens is that some people will still need glasses for very close vision and when trying to read the smallest print.

Toric IOL by Alcon

Alcon Toric IOL

Toric LensMany cataract patients suffer from astigmatism and have required glasses or contact lenses to drive or read for much of their adult lives. Toric lens implants correct for astigmatism when positioned in the eye. Toric IOLs are placed in the patient’s eye during routine refractive lens exchange.

In the same way that Toric contact lenses reduce or correct astigmatism, patients can receive Toric intraocular lens implants to restore sharper distance vision. When the eye’s natural lens (cataract) is removed and replaced with a Toric IOL, imperfections in the eye’s shape are improved, resulting in clearer vision without the need for multiple incisions, as is common in other astigmatism surgeries. In addition, recovery time is shorter and more comfortable than with older methods.


Advances in medical technology can now allow your eye surgeon to correct both cataracts and astigmatism at the same time. As a result, this can reduce the need for eyeglasses after surgery. Unlike monofocal lenses, which can only allow a patient to see well at specific distances, the Trulign™ allows patients to see a broad range of vision. The lenses are custom selected to fit your degree of astigmatism. It is important to understand that since vision, expectations and lifestyles differ from person to person, it is difficult to determine how much a patient will be dependent on glasses after surgery.

PRECAUTIONS: As with any type of surgery there are risks involved including disturbances and secondary surgical intervention. The effect on vision with the Alcon Toric IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases has not been studied.