Clear Lens Exchange (CLE)

Clear Lens Exchange (CLE) involves removing the eye's lens, just like in a cataract surgery. This is done with a special ultrasound instrument and may be accompanied by eyedrop anesthesia. A flexible synthetic lens implant of the proper power is then placed inside the eye through an extremely small incision to correct the refractive error. This outpatient procedure is typically pain free, takes 20 minutes or less to perform, and can be completed without sutures. Visual recovery is quite rapid. As with LASIK, most clear lens exchange patients are able to return to work the day following their procedure.

CLE is most commonly performed to treat higher levels of farsightedness in patients over age forty. The optical results are superior to laser vision correction (ie: LASIK or PRK) for these higher corrections. CLE may also be used to correct higher levels of nearsightedness and may be fine-tuned with laser vision correction if a small refractive error remains.

Clear Lens Exchange patients have the same choice of lens implant designs as cataract surgery patients. These include traditional monofocal lenses, multifocal lenses (ReStor, ReZoom), and accommodating lenses (Crystalens).

Lens Implants

Following removal of the eye’s natural crystalline lens during either cataract or Clear Lens Extraction surgery, we have the option of implanting various styles of intraocular lens implants. All of the lens implant styles we commonly use may be implanted through a self-sealing (usually no need for stitches) opening of approximately 3 mm (varies somewhat based on lens design).

Most commonly is the standard single focus lens implant which gives the surgeon the opportunity to correct the patient for either distance vision in both eyes or for monovision (or “blended vision.”). With monovision, the surgeon corrects your dominant eye for seeing at a distance and your nondominant eye for near vision, thereby reducing the need for reading glasses. When both eyes are functioning together, the brain naturally selects the image from the eye that has the clearer focus. Having eyes for different purposes might sound unsettling, but many patients do quite well with monovision. Blended vision simply refers to monovision with a smaller discrepancy between the eyes. Monovision and Blended Vision are common goals for patients over the age of 40, whether they are undergoing laser vision correction (ie: LASIK or PRK) or a lens implant procedure (ie: cataract or Clear Lens Extraction surgery) in order to help them achieve good functional vision at both distance and near without the need for glasses or contact lenses.


Presbyopia Lens Implants (Crystalens, ReSTOR, ReZoom)

While monovision is a good option for many Presbyopia lens implant patients, more elaborate lens designs have made it possible for us to correct patients’ eyes so that both eyes can see far and near without glasses or contact lenses.


Multifocal Lens Implants (ReSTOR, ReZoom)

Similar in concept to bifocal contact lenses, multifocal lens implants are designed with both near and distance viewing zones. Unlike bifocal or “progressive” spectacles, these lens implants do not require the patient to gaze in different directions (ie: up for distance, down for near) in order to utilize each zone of the lens implant. The first lens FDA approved for this purpose was the Array lens. The biggest problem with this lens was the incidence of night vision disturbances in some patients. Refinements in lens designs have improved upon this initial model such that newer multifocal lenses are better tolerated. The most popular multifocal lens implants are the ReStor and ReZoom implants.


Accomodating Lens Implants (Crystalens)

Accomodating lenses are single focus implants that attempt to change their focus when a patient makes an effort to view objects at varying distances. The concept is to reproduce the natural mechanism of accommodation that begins to deteriorate in all of us around the age of 40. The Crystalens is the prototype accommodating lens implants, and the only one that has been FDA approved. The revolutionary design element of the Crystalens is "hinges" which allow the lens to move, or accommodate, to seamlessly focus on objects at a full spectrum of distances.


Lens Implant Conclusions

While there are advantages and disadvantages to any lens implant style, the vast majority of patients who receive presbyopia lens implants are able to function without glasses or contact lenses for all, or nearly all, of their daily tasks. No matter which style of lens implant is selected, it is important that the power (strength) of the implant is appropriate for your eye. A sequence of sophisticated preoperative tests and calculations are done in order to maximize the accuracy. If the lens implant power is significantly off target, laser vision correction can be performed once the eye heals in order to fine tune the focus (Bioptics).

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In ten to 15 minutes, with eyedrop anesthesia, special lens implants may be inserted that allow patients to see both distance and near without glasses. The best candidates are people over the age of fifty with either high prescriptions or incipient cataracts.

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