Vision Learning Center Navigation... Refractive Surgery Options   -iLASIK® (CustomVue™ blade-free LASIK with Intralase)   -RL-Refractive Lensectomy/PRELEX℠   -CK-Conductive Keratoplasty   -ICL-Verisyse™ and Staar™ Implantable Contact Lenses   -PRK-Photorefractive Keratectomy   -INTACS®-Corneal Segments   -AK-Astigmatic Keratotomy Valley Eye Report Card Financing Options Testimonials Cataracts Frequently Asked Questions Prevention Guide Insurance Information Valuable Vision Links   Refractive Lensectomy/PRELEX℠ What is Refractive Lensectomy with Intraocular Lens Implantation? Refractive Lensectomy with Intraocular Lens Implantation (or RL/IOL for short) is a surgical procedure designed to reduce or eliminate nearsightedness, farsightedness, astigmatism, and presbyopia. Nearsightedness, also called myopia, occurs when the shape of the eye is elongated so that light is focused in front of the retina (the "seeing" part of the back of the eye). Farsightedness, also called hyperopia, occurs when the length of the eye is shortened so that light is focused behind the retina. Presbyopia is the inability to see objects close up after the age of 40 in an otherwise normal eye, because the lens within the eye hardens, losing its "zoom feature". RL/IOL corrects nearsightedness by removing the lens in the eye and replacing it with an intraocular lens implant of different focusing power to allow light rays to fall onto the retina. The lens is responsible for the focusing of light rays in the eye much like a camera lens. RL/IOL corrects hyperopia, astigmatism, or presbyopia in the same fashion. RL/IOL is a variant of modern cataract surgery, which has been one of the major advancements in the restoration of sight in the last decade. RL/IOL has been performed extensively in Europe over the last 10 to 15 years with excellent results. The number of RL/IOL procedures performed has dramatically increased in the USA. Who is a Candidate for RL/IOL? Candidates for RL/IOL may experience difficulty wearing glasses and contact lenses. Some people have tried contact lenses and have difficulty wearing lenses due to allergies, dryness of the eyes, astigmatism, or other irritants. Generally the best candidates are those who are over the age of 50 and using bifocals, have early cataract formation, or whose eyes are outside the effective treatment range for LASIK or other types of laser vision correction. The surgery works particularly well for those who are farsighted. In addition, their lifestyle or career may require good vision without the use of glasses or contact lenses. Candidates are encouraged to attend a free educational seminar or visit the office for a Free Complementary Consult. A thorough eye examination by your eye doctor is required prior to having RL/IOL surgery. If there are no contraindications for surgery, the next step is a "RL/IOL Evaluation". This includes computer mapping (computed topography) of the cornea, measurements of the eye (A scan with the IOL Master™ and pachymetry), and a counseling session. Computed topography creates a 3-dimensional map of the cornea to guide your surgeon in formulating a specific surgical plan. The evaluation (including observation of a video tape) allows patients the opportunity to have their questions answered by the surgeon in a face-to-face session. How Will My Eyes be Corrected? No two individuals are alike and your surgeon will take the time to discover your unique lifestyle, career goals, and physical needs. No single formula can provide the perfect correction for everyone. Your specific needs are taken into consideration when the surgical plan is developed. This is why the refractive evaluation is so important in planning for RL/IOL. For example, if you spend 8 hours a day working at a computer screen, your visual needs will differ from someone who spends much of the day driving. If you are over 40, you may experience problems with your near vision focusing up close. By setting the focus point for one eye at near, the need for reading glasses can be reduced. This technique, called monovision, has proven successful in helping individuals cope with the natural aging process. Another option is PRELEXSM, which employs a multifocal intraocular lens implant, which allows for both distance and near vision. A multifocal implant is not for everyone, however, and your surgeon can give you more information about this implant and let you know if it is right for you. As the accuracy of RL/IOL is not always perfect, the surgeon may need to perform an enhancement after the initial operation. If more surgery is needed, iLASIK or other procedures may be performed to fine tune the result. What is the IOL? The specific implant that will be used depends on the length of your eye as measured by the IOL Master™, ultrasound, and the shape of the cornea. The implants are made of acrylic or silicone and designed to be permanently implanted into your eye. They also block harmful UV rays. What if I have Astigmatism? Astigmatism is a condition in which light that enters the eye is focused at more than one place inside the eye. This is caused by an irregularly shaped cornea (many times the shape of a football.) Astigmatism can be reduced by limbal relaxing incisions (LRI) made at the time of RL/IOL. A toric implant can be used to reduce or eliminate astigmatism. Finally, Astigmatic Keratotomy (or AK for short) or LASIK, has been performed over the last 15 years to reduce or eliminate astigmatism. What Happens before the Day of Surgery? Prior to your surgery date, you will receive a list of pre-operative instructions including food and liquid restrictions for the day of surgery. A pre-operative history and physical examination may be necessary by your family doctor. You are required to make arrangements for a relative or friend to drive you home after the surgery. You will be instructed to stop wearing your contact lenses 3 days prior to surgery if they are soft lenses and 1-2 months prior to surgery if they are hard or gas-permeable contact lenses. What Happens the Day of Surgery? Surgery is performed on an outpatient basis at the Pinnacle Cataract and Laser Institute. In this relaxed atmosphere, you will receive professional experienced care. The staff is there to answer your questions and assist you in understanding the procedure. Before the operation you will receive a pre-operative sedative (usually a Valium pill). Your pupil will be dilated. An intravenous line will be started for additional sedation if necessary. A topical anesthetic (numbing drops) with a local anesthetic is all that is usually needed so that you will not feel discomfort during the operation. During the procedure you will be positioned on a surgical bed under an operating microscope in a sterile operating room. The microscope is used to view your eye during the surgery. A small incision (2-3 mm in size) is made to gain access to the lens. The lens is removed with several small probes. The IOL implant is then placed into the eye. The wound rarely requires suturing. The actual procedure will take about 15 to 20 minutes. After surgery a shield will be placed on your eye. This will be removed later in the office. Post-operative medications will be given to you and the staff will discuss your post-operative written instructions with you. How do I Care for My Eye After Surgery? You should avoid rubbing or bumping the eye after surgery. You may experience mild discomfort such as scratchiness, tearing, foreign body sensation, or other sensations in the operative eye. This is normal and may last for a few days. Pain relievers are occasionally needed and prescribed if necessary. Women should refrain from wearing eye make-up for a few days. The limitations on activities may vary from person to person. However, generally speaking, you may immediately resume normal activities like watching TV, reading, or driving a car the following day after surgery. Contact or racquet sports should be avoided for 2 weeks after surgery. We recommend that you wear protective eye wear anytime you participate in racquet sports, regardless of whether or not you have had RL/IOL or other eye surgeries. Care must be taken not to get soapy water in the eye for a week, and patients are encouraged to bend at the knees when lifting objects off the floor (keeping their head above their heart). In most patients, the eye is completely healed in 3 weeks. What Follow-up Care is Necessary? Patients are generally seen 1 day, 1 week, 1 month, and 6 months after surgery. More frequent visits may be necessary. Visits during the first 6 months after surgery are included in the surgical fee, so no additional payment is required. Of course, regular eye examinations by your eye care provider are essential to maintain healthy eyes. In general, if one eye has RL/IOL, a patient is asked to wait at least several weeks before having the other eye done. Patients referred by their optometrist may receive a portion of their post-operative care from this doctor. There is no additional fee for this service. If there is a complication as a result of the surgery, additional visits to other doctors may be required. These visits or treatments are not covered by the surgical fee, but may be covered by your insurance. What are the Risks of RL/IOL? As with any surgery, there is always a slight risk of post-operative infection, although this is minimized by the use of pre-operative and post-operative antibiotics. With RL/IOL there is a chance that the eye will be overcorrected or undercorrected which would mean that glasses, contact lenses, additional refractive surgery, or replacement of the IOL (quite rare) would be needed to obtain the best possible vision. In the first weeks after surgery, you may be sensitive to bright lights or see starbursts around lights at night (glare). This usually decreases several days after surgery. Patients who choose a multifocal IOL implant typically will notice halos around lights at night for a longer period of time. Other complications that have been described with RL/IOL (but are rare) include continued problems with glare, halos, or vision fluctuations, development of irregular astigmatism with distortion of vision even with glasses or contact lenses, monocular diplopia, glaucoma, bleeding in the eye, elevated intraocular pressure, lid droop, unequal pupil size, enlarged pupil, capsule opacification, chronic uveitis, dislocation of the IOL, retinal detachment, retinal edema, corneal edema (lack of clarity), loss of vision not correctable with glasses or contact lenses, and loss of the eye (extremely rare). These complications are less common with the newer, advanced surgical equipment used by your surgeon. Additional surgery that would be required to correct these complications, might include, but are not limited to, corneal transplantation, glaucoma surgery, retinal detachment surgery, and YAG laser capsulotomy. These operations are not covered by the surgical fee. If RK, LASIK, or AK is performed after RL/IOL, the patient is subjected to the inherent risks and benefits of these operations as well. iLASIK or AK is included in the cost of the surgical fee, if indicated, within one year of the initial date of surgery. This list should not be considered a complete list as it would be impossible to list all potential complications and it is possible that complications may occur weeks, months or years after surgery. In general, the risk of a severe complication with RL/IOL is approximately 1% in farsighted patients, and 2-3% in highly near sighted patients (who have a greater chance of retinal detachment). The success rate is approximately 95-97%. Since the IOL implant that is used is approved by the F.D.A. for insertion into the eye after cataract surgery, RL/IOL is technically considered an "off label" use of the IOL implant. Will I Have "Perfect Vision"? The goal of RL/IOL is to reduce your dependence on glasses or other optical aids. A small amount of correction may be needed for near vision or far vision. Contact lenses can be used after RL/IOL. The results of RL/IOL will depend on your eye's response to the surgery and the healing process. How Much Will Surgery Cost? Your payment covers the surgeon's fee, a facility fee, and if applicable, a co-management fee paid directly to your optometrist, for each eye. Your payment also covers follow-up visits for each eye for the next six months. Prior to surgery you can meet with a financial counselor who will answer your questions about the fees. For our patients' convenience, we accept cashier checks, cash, MasterCard, VISA, and Discover. A discount for cash payment is available, as well as a 0% down 0% interest financing plan. Payment in full is required 5 business days before the first eye is scheduled to be performed, unless a financing arrangement has been made. If payment is not received 5 business days before the procedure, the procedure will be postponed. No surgery will be done on your second eye until this fee is paid as well. Very few insurance companies cover refractive surgery. However, we do encourage you to check with your insurance provider before the surgery.