What you need to know about refractive lens exchange

Don’t decide on the basis of an advert or a leaflet.

Lots of people make quick decisions based on what they read in a magazine or in a leaflet.  Sometimes, these can be misleading, or make things sound simpler than they actually are. 

As a starting point, read impartial patients’ advice from the Royal College of Ophthalmologists  and then make a more informed decision. A panel of experts have taken a lot of time to come up with really good advice for people who are thinking of having refractive lens exchange. The information you get from a private clinic should not contradict this advice in any way 

Weigh up the risks compared to the benefits

All surgery carries risk and patients have to consider whether the risk is too high for them. In refractive lens exchange, approximately one in five hundred patients will end up with vision worse than the driving standard in one of their eyes because of problems related to the surgery . Everyone has a different motivation for getting this surgery done. If you have cataracts, it may be an easy decision, but for people who want to correct short sightedness, or long sightedness, it may be harder to choose. But for many people, the chance of being glasses free has a major impact on their quality of life. They may be completely incapacitated if they can’t find their glasses. The bottom line is that is all about informed consent. Does the patient understand the risks and benefits of the procedure and is the risk worth taking for them?

Have you considered all the options?

Refractive lens exchange, is usually an option for people over the age of 50 if laser eye surgery isn’t appropriate. But many patients over 50 are suitable for laser eye surgery, and for the right patients this is generally a lower risk option. Laser eye surgery (LASIK, PRK, or SMILE) is a common procedure which involves using a laser beam to change the curvature of the cornea – the part in front of the eye. 

Phakic intraocular lens implantation is a good alternative for younger patients who are out of range for laser treatment. This is a surgical procedure which involves making an incision in the white of the eye and inserting a lens in front of the natural lens to correct its focus. This has the advantage that it keeps the healthy lens in place, which can still thicken and flatten to change focus at different distances. 

Your surgeon will go through the pros and cons of alternative options, including staying as you are, at your pre-surgical consultation.

Be aware of the cost

Refractive surgery in the UK is all self-pay. It is not available on the NHS and private health insurers don’t cover it because it isn’t considered a medical necessity. The average fee for two eyes is around £6000 but it can be more or less, depending on where you go. 

Choose your clinic wisely

As well as some major high street clinics, there are many smaller private clinics now offering different types of eye surgery. Always choose a clinic that offers all three main types of eye surgery to correct vision, including laser eye surgery, refractive lens exchange and phakic intraocular lens implantation . That way, they can offer you a genuine choice and there is less temptation to make you ‘fit’ the wrong procedure. 

Take a check list

Check that you will be having an appointment with the surgeon who will carry out your procedure before you decide to go ahead with it. You should also have some cooling off time to reconsider your decision – the College recommends a cooling off period of at least a week. You can also aske whether your surgeon will also be seeing you at your postoperative review visits.


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