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Summary

Lens replacement surgery involves the replacement of the natural lens in the eye with an artificial lens. This surgery is performed to provide sharpness of vision and reduce the need for glasses or contact lenses. The surgeon will choose a lens based on the purpose of the operation. For example, if you need to reduce the dependency of spectacles for distant vision, the doctor may suggest a monofocal lens. Similarly, a multifocal lens will serve your purpose for near vision. Before the surgery, your ophthalmologist will examine your eyes and measure them to ensure that you get the correct lens for your eyes. The surgery will be done under local anaesthesia. After the procedure, a nurse will cover your eyes with a protective shield. Once you are discharged, make sure to follow the instructions given by the doctor for a speedy recovery. 

  1. What is lens replacement surgery?
  2. Why is lens replacement surgery recommended?
  3. Who can and cannot get lens replacement surgery?
  4. What preparations are needed before lens replacement surgery?
  5. How is lens replacement surgery done?
  6. How to care for yourself after lens replacement surgery?
  7. What are the possible complications/risks of lens replacement surgery?
  8. When to follow up with your doctor after a lens replacement surgery?

In lens replacement surgery, the natural eye lens is replaced with an artificial intraocular lens. The procedure is also known as clear lens extraction or refractive lens exchange (RLE).

An ophthalmologist (eye doctor) will perform this surgery to correct refractive error in your eye, and sharpen your vision.

Lens replacement surgery is similar to a cataract operation. The only difference is that cataract surgery is done to replace a clouded lens in the eye, whereas lens replacment helps reduce the use of contact lenses or glasses.

Based on the purpose of lens replacement, two types of intraocular lens can be used:

  • Monofocal intraocular lens: This helps to reduce the need for spectacles while driving (distance vision).
  • Multifocal intraocular lens: This type of lens reduces the need for glasses for multiple activities such as when using a computer (intermediate vision) or reading (near vision).

Your ophthalmologist will perform this surgery if you have:

  • Hyperopia 
  • Myopia 
  • Presbyopia (this occurs after the age of 40 when the eye lens becomes too flexible. It creates difficulty in focusing on nearby objects)
  • Astigmatism (a condition in which the cornea of the eye is curved, causing blurry vision)

Those above the age of 50 who have prescription glasses of a higher number than that required for laser surgery are also recommended to undergo a lens replacement surgery. 

A doctor may not recommend a lens replacement surgery if you have the following eye problems:

The following preparation are needed before this surgery:

  • The ophthalmologist will ask you to undergo some eye tests. Your eye will be measured using an ultrasound or laser scanning device to see which intraocular lens is suitable for you.
  • Tell your doctor if you are taking any medications, herbs, or supplements. Also tell him/her if you are using any eye drops currently. The doctor will guide you when to stop them before the surgery.
  • Your doctor will prescribe some eye drops before the surgery. Use them as instructed.
  • Usually, fasting is not necessary. However, you must ask your doctor if you need to abstain from food and drink before the surgery.
  • You must avoid smoking for a few weeks before the procedure as it hinders wound healing.
  • You will need to arrange someone, a friend or relative, who can bring you to the hospital and also take you back home after the procedure.
  • You will be asked to sign a consent form to grant your approval for the surgery.
  • You may need sunglasses (wrap-around style preferably) to protect your eyes from light after the surgery.

The surgery will be carried out in the following manner:

  • The medical team will ask you to sit on a chair. They will instil anaesthetic eye drops in your eyes to keep you from moving your eyes too much during the procedure. 
  • After a few minutes, you will be taken to the operating room.
  • The surgeon will cover your face with a drape (to prevent infection in the area of surgery) that has a hole to assess your eyes and will use a spring clip to keep your eyelids open and allow smooth blinking of eyes during the surgery. 
  • He/she will use eye drops to dilate your pupil (a hole in the centre of the iris, the structure that gives colour to your eyes). 
  • Next, the surgeon will make a small entry port at a point where your cornea (the clear part that covers the front of the eye) and sclera (the white part of the eye) meet
  • Through this port, he/she will make an incision in the capsule covering your natural eye lens.
  • Next, the surgeon will use high-frequency vibrating probe to break your natural lens in small pieces, which will then be sucked out.
  • He/she will carefully insert the artificial lens and place it in the position of the natural lens.
  • Finally, the surgeon will clean your eye and refil it with antibiotics and fluid.

This procedure takes 20 minutes to replace the lens in one eye. You will be allowed to go home on the same day as your surgery. You may have an eye shield around your eye after the operation. Before leaving the hospital, the doctor will prescribe some eye drops and schedule a follow-up appointment.

Once you are home, you will need to take the following care for a few weeks:

  • The surgeon may prescribe anti-inflammatory and antibiotic eye drops to ensure a quick recovery and to prevent infection.
  • You may feel a minor headache or discomfort for two days after the surgery. Some mild painkillers may help reduce it.
  • It is normal to feel grittiness, double or blurred vision for a few days after the surgery. You may also have watery eyes or red eyes.
  • You must use an eye shield while sleeping for a week
  • You may be allowed to watch television, read, or use a computer soon after the procedure. 
  • Showering or bathing is not an issue. However, you must wear an eye shield while washing your hair to avoid soap or shampoo getting inside your eyes.
  • Avoid swimming for one week after surgery. 
  • You can start jogging or going to the gym from the day after your surgery.
  • Avoid wearing make-up for at least a month following the procedure.
  • You can ask your doctor when you can resume driving.
  • Clean your eyes at least two times a day or as instructed by your ophthalmologist.

When to see the doctor?

Call or visit your surgeon if you are experiencing the following symptoms:

  • Increase in the intensity of pain 
  • Redness in eye
  • Light sensitivity
  • Decline in vision, especially if it has improved initially
  • A feeling of a shadow or curtain across your vision 
  • Flashes of light even with closed eyes
  • New floaters (feeling of floating material in your eyes)

This surgery has the following risks:

  • Loss of vision 
  • Malignant glaucoma
  • Retinal detachment 
  • Cystoid macular oedema (fluid build-up and swelling in the eye, causing distortion of vision)
  • Bleeding in the subconjunctival (underneath the white part of your eyes) or suprachoroidal (behind the white part of the eye) regions.

A follow-up appointment will be scheduled before you are discharged from the hospital to recheck the health of your eyes after the surgery.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. University of Iowa Hospitals and Clinics [Internet]. Iowa. US; What is a refractive error?
  2. The Royal College of Ophthalmologists [Internet]. London. UK; Refractive lens exchange
  3. National Eye Institute [Internet]. National Institute of Health. US Department of Health and Human Services; At a glance: Cataracts
  4. American Academy of Ophthalmology [Internet]. California. US; Cataract in the Adult Eye PPP - 2016
  5. Salmon JF. Lens. In: Salmon JF, ed. Kanski's Clinical Ophthalmology. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 10.
  6. Tipperman R. Cataracts. In: Gault JA, Vander JF, eds. Ophthalmology Secrets in Color. 4th ed. Philadelphia, PA: Elsevier; 2016:chap 21.
  7. Smith SF, Duell DJ, Martin BC, Aebersold M, Gonzalez L. Perioperative care. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2016:chap 26.
  8. Neumayer L, Ghalyaie N. Principles of preoperative and operative surgery. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 10.
  9. Vancouver Island Health Authority [Internet]. British Columbia. Canada; Before, During and After your Cataract Surgery
  10. Guy's and St. Thomas' Hospital: NHS Foundation Trust [Internet]. National Health Service. UK; Your guide to cataract surgery
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