Refractive Lens Exchange

For prescriptions too high for laser in people over 40: replacing the eye’s own lens with an artificial one.

3 min read
Medical content: Prof. Dr. Banu Coşar
Last updated: 6 October 2026

When the prescription is too high to be corrected with laser, the refractive error can be corrected in people over 40 with a method called “refractive lens exchange”. In this method the person’s own clear lens is removed and replaced with an artificial lens, which can be chosen as a distance lens or as a combined distance-and-near lens.

Technically, refractive lens exchange is early cataract surgery on an eye that does not have a cataract. For this reason, people who have had refractive lens exchange no longer face the risk of developing a cataract later.

How Refractive Lens Exchange Is Performed

The eye is numbed with anaesthetic drops.
The eyelids are held open with an instrument called a “lid speculum”.
A 3.2 mm incision is made in the eye with a “slit knife” or a femtosecond laser.
The eye is entered through this incision, and the capsule over the lens is opened in a round shape.
Fluid is injected around the lens inside the capsule.
The lens is broken up and aspirated with the tip of the phacoemulsification device.
An artificial lens is placed inside the remaining lens capsule.
An antibiotic–steroid injection and ointment are applied, and a protective shield is placed over the eye.

Possible Complications of Refractive Lens Exchange

During the operation:
A tear in the lens capsule
Fragments of the lens, or the whole lens, dropping into the back of the eye
After the operation:
A serious eye infection called “endophthalmitis”
Corneal oedema (fluid build-up and swelling)
Displacement of the implanted lens
Detachment of the nerve layer of the eye (retinal detachment)
Oedema of the macula, the central part of the retina

Care After Surgery

No hospital stay is needed after the operation. The eye is checked the next day. The prescribed eye drops must be used regularly; they are applied during waking hours by pulling the lower eyelid down.

First week: do not sleep on the operated eye. Keep water and soap out of the eye. Wash your hair with your head tilted back, as at a hairdresser. Do not use cream or make-up around the eye. Wear sunglasses outdoors, or your own glasses if you have them (with the lens on the operated side replaced by a plain one). Walking is fine; swimming, lifting weights and prostrating in prayer should be avoided.

From the second week: normal daily life can be resumed. However, the eyes should never be rubbed hard.

Success Rate of Refractive Lens Exchange

If multifocal artificial lenses are implanted, about 90% of patients can see both near and far without glasses.

If only a distance lens is implanted, reading glasses will always be needed for near vision.

If some prescription remains three months after surgery, an additional laser treatment (LASIK) can be done to remove it.

Eye Check-ups After Refractive Lens Exchange

Routine eye check-ups are done the day after the operation, after one month and after six months. At the six-month examination we check whether the capsule holding the artificial lens has lost its transparency — “posterior capsule opacification”. This can develop anywhere between three months and four years after the operation. When it does, the centre of the clouded capsule is opened with a YAG laser, removing the curtain effect in the central area.

At a glance