Dr Dylan Joseph gives his expert advice on everything you need to know regarding Customised Lens Exchange, ranging from what the procedure involves, recovery, benefits, what to expect, risks, alternatives and costs. Read through this guide to learn more about Customised Lens Exchange.
Myopia, the clinical term for short-sightedness, is a condition that causes light rays to focus in front of the retina, causing distant objects to look blurry or distorted.
What Is Hyperopia?
Hyperopia, the clinical term for long-sightedness, is a condition that causes light rays to focus behind the retina, causing near objects to look blurry or distorted.
What Is Astigmatism?
Astigmatism is the clinical term for irregularity in the shape of your cornea. The cornea is shaped like a rugby ball rather than a football, causing light rays to focus on multiple points in front or behind the retina rather than at a single point; causing distorted and blurred vision.
The amount of myopia, hyperopia or astigmatism is measured in “dioptres,” a technical term used to describe the power of a lens.
What Is the CLE Procedure?
If you wear soft contact lenses, you will be required to remove them 1 week before surgery.
Rigid (including gas permeable and standard hard lenses) contact lens wearers should leave their lenses out of their eyes for at least 3 weeks before surgery.
On the day, you’ll arrive about an hour before the procedure to fill out consent forms. After completing all the paperwork, you’ll be moved to a preoperative room.
If you currently have or recently have had a cold sore, you should inform Dr Joseph before your procedure.
If you are pregnant, or if there is a possibility that you are pregnant, you should inform Dr Joseph or the staff before your procedure. You should also inform your doctor if you are breastfeeding.
First, your pupil will be dilated and your eye will be numbed with drops. Afterwards, you will undergo light sedation administered by an anaesthetist, or you may elect to have the surgery with a general anaesthetic. Occasionally, the surgeon may need to advise to convert from a local anaesthetic to a general anaesthetic at the time of surgery.
An incision, or opening, is then made in the eye. The incision required to perform this operation is usually self-sealing but may require closure with fine stitches which may require removal later in the clinic.
The natural lens in your eye will then be removed by a type of surgery called phacoemulsification. After your natural lens is removed, an artificial lens called an intraocular lens (IOL) is placed inside your eye. In rare cases, if complications occur at the time of surgery, it may not be possible to implant the preferred IOL or any IOL at all. A secondary procedure may allow for the implantation of another type of IOL later.
A temporary clear plastic shield will be placed over the eye to protect it during the immediate postoperative period.
After the surgery, your eye will be examined the next day. You will return to the clinic for additional postoperative exams as instructed by your surgeon.
What Can You Expect?
You may see some improvement in your vision as early as the first postoperative day, but the visual effects of surgery may take several weeks to stabilise.
There may be discomfort or a foreign body sensation, particularly during the first 48 hours after surgery.
Eye drops will be used postoperatively for about 4 weeks. This is to aid healing and prevent infection. The clinic will provide prescriptions for the required drops when scheduling surgery appointments.
Normal activities can be resumed within 2 or 3 days postoperatively, and your vision will usually be stable within 3 to 6 weeks. Based on the IOL choice made, glasses may be required after surgery and these can be prescribed by your optometrist 6 weeks after surgery, once your vision is stable.
Recovery and What You Should Know
It is advised not to drive immediately after receiving sedation and for eight hours thereafter.
There may be a difference in vision between the two eyes after surgery has been performed on one eye but not the other. This may cause eye strain and make judging distance or depth perception more difficult. Glasses and/or contact lenses may be required during this time to provide balanced vision.
It is important not to rub the eye vigorously postoperatively which could cause damage to the cornea and/or the IOL.
After CLE, the eye may be more fragile to trauma from an impact. Evidence has shown that, as with any scar, a corneal incision will not be as strong as the cornea originally was at that site. The treated eye, therefore, is somewhat more vulnerable to all varieties of injuries, at least for the first year following cataract surgery. It would be advisable to wear protective eyewear when engaging in sports or other physical activities.
What Are the Benefits?
The intended benefit of CLE is to improve vision. As CLE is surgically identical to cataract surgery, those that undergo CLE will not require cataract surgery in the future.
Customised Lens Exchange does not prevent other common ocular conditions such as glaucoma or macular degeneration and it is recommended to have regular appointments every 2 years to monitor your eye health.
What Can I Expect Visually?
There are a wide range of IOLs available for surgeons to use. The IOL selected will be based on your specified vision target.
Targets are prescriptions that we aim for and consequently, the vision that the surgery aims to give you postoperatively. Targets will vary based on several factors including but not limited to; your age, your lifestyle, your job and your prescription.
The IOL(s) required for your surgery will be decided by Dr Joseph based on your visual needs and the measurements taken at your appointment.
The 4 IOL Types
IOLs to Target Good Distance Vision
After surgery, you would be able to see well in the distance without glasses, but you would need to use glasses for near vision tasks such as reading, putting on make-up and using a mobile phone.
This option is open to all patients.
IOLs to Target Good Near Vision
After surgery, you would be able to see well for near vision tasks such as reading, putting on make-up and using a mobile phone, but you would need to use glasses to see in the distance.
This option is open to all patients.
IOLs to Provide Blended Vision
With this option, one eye has an IOL inserted to provide good distance vision and the opposite eye has an IOL inserted to provide good near vision. It offers good distance vision in most situations, but you may require reading and/or distance glasses in some cases.
Blended vision cannot provide perfect vision at all distances but it can provide a good functional vision that would enable you to perform most tasks without the help of glasses.
Blended vision is not an option that suits all patients as there can be a feeling of imbalance. Therefore, certain patients will be excluded from this option based on their visual and/or medical conditions.
With this option, both eyes usually undergo surgery and have multifocal IOLs inserted. These IOLs aim to provide good distance, good intermediate and good near vision in both eyes.
Multifocal IOLs are not an option available to all patients as the cornea (front part of the eye) needs to be regular. Please note that multifocal IOLs are premium and an additional cost will be applied.
Extended Depth of Field IOLs
Extended depth of field IOLs are used to target excellent distance vision and intermediate or computer vision in both eyes. If the same target is applied in both eyes, you will be using reading glasses for anything closer than a desktop computer. Should a blended approach be used, you are likely going to be spectacle independent for the majority of your activities, including reading. There are differences between multifocal IOLs and extended depth of field lenses, which your surgeon will discuss with you during your consultation.
Please note that there are standard and premium IOLs that can be used to achieve the options discussed above. You will not be able to decide which IOL choice is right for you until after you consult with Dr Joseph, who will advise which options are suitable for you’ not.
What Are the Risks?
Depending on the type of anaesthesia, risks are possible; including cardiac and respiratory problems. These should be discussed with your anaesthetist on the day of surgery.
Mild or severe infection is possible. A mild infection can usually be treated with antibiotics and does not lead to permanent visual loss. A severe infection, even if treated with antibiotics, could lead to permanent scarring and loss of vision that may require further surgery.
Severe infection resulting in blindness (1 in 1,000 cases) or loss of the eye (1 in 10,000) is extremely rare.
3: Retinal Detachment
Retinal detachment may occur postoperatively. This is the separation of the retina from its adhesion at the back of the eye which usually results from a tear in the retina and could lead to vision loss.
Who is at risk? Patients with moderate to high levels of short-sightedness have a higher risk of retinal detachment when compared to the general population. This risk level may be increased with complicated Customised Lens Exchange.
4: Corneal Oedema
Corneal swelling (oedema) may develop and/or result in the ongoing loss of cells lining the inner surface of the cornea (endothelial cells). This may lead to a hazy and opaque appearance of the cornea, which could reduce vision.
There may be increased sensitivity to light or night glare. There may be a “star-bursting” or halo effect around lights at night. The risk of this side effect may be related to the size of the pupil, and patients with larger pupils may be at increased risk.
Who is at risk? Patients who have multifocal or extended depth of focus IOLs inserted have an increased risk of glare.
6: Refractive Surprise
While biometry is very accurate in the majority of patients, the final result may be different from what was planned. As the eye heals, the IOL can shift very slightly toward the front or the back of the eye. The amount of this shift is not the same in everyone, and it may cause different vision than predicted meaning glasses are required after surgery.
Who is at risk? Patients who have high prescriptions or previously had refractive surgery (such as LASIK, LASEK, PRK, RK). Your surgeon will advise if you are suitable for a laser refractive procedure to correct this residual prescription.
7: Decentration of IOL
The IOL may change position and needs to be repositioned, removed surgically, or exchanged for another lens implant.
8: Damage to Eyelids
There is a natural tendency of the eyelids to droop with age and eye surgery may hasten this process. There may be some bruising to the eyelids in the initial postoperative period and this will resolve over time.
9: Cystoid Macular Oedema (CME)
Swelling can occur at the macula (the area of the retina that controls central vision) and this is usually successfully treated with non-steroidal anti-inflammatory drops.
10: Posterior Capsular Opacification (PCO)
This occurs when cells around the IOL may lose their transparency, causing blurred vision. This can occur months or years after surgery. This can be corrected with a YAG laser procedure.
11: Lens Remnants
It is possible that as the natural lens is being removed during surgery, some fragments of the lens material may fall back into the cavity behind the lens. This may result in floaters after surgery and in some cases, would require further surgery to remove these fragments.
Alternatives to Customised Lens Exchange
Contact lenses or glasses are non-surgical, extremely accurate and permit easy changes in prescription.
Glasses: Although there are essentially no risks to wearing glasses, the quality of vision with strong short-sighted or long-sighted glasses may be impaired due to the slight decrease in peripheral vision caused by the thickness of the lenses.
Contact Lenses: While contact lenses provide higher quality and more normal vision than glasses, they have a slight risk of complications, especially if they are worn overnight. The risks of contact lenses include infection, allergies, irritation, and discomfort.
Other refractive procedures can provide independence from glasses. These include LASIK, LASEK, TE-PRK, PRK and Implantable Collamer Lens (ICL).
Each patient differs and Dr Dylan Joseph will advise you.
How Much Does CLE Cost?
Medical aids generally do not cover Customised Lens Exchange. Therefore, the patient is responsible for all costs; including the surgeon’s fee, anaesthetist’s fee, and the hospital’s fee.
In the event of a complication, it may be possible that other surgery, eye drops, or even hospitalisation may be required. The patient is responsible for the costs of any uncovered surgery-related procedures that may be required.
If a patient chooses to have a premium IOL, the patient will be responsible for the additional cost of that IOL, regardless of whether they have health insurance or not.
Whether the CLE procedure is funded partially or fully by the patient’s medical aid, there will be no charge for the day 1 and 1-month postoperative visits, but there will be a charge for all other postoperative visits and/or further procedures necessary. Some medical aids may cover part of the consultation.
Our staff will assist you with this, but the account is the responsibility of the patient to settle in the office if the medical aid does not contribute.
To find out what Customised Lens Exchange costs, as well as your payment options, contact us today.
Dr Dylan Joseph
Cataract and Refractive Surgeon
MBChB(Pret), Dip Ophth(SA), FC Ophth(SA), MMed Ophth UFS (cum laude)