RLE & Cataract
The Comprehensive Guide
Jump to...
TOP 10 FAQ
How successful is this surgery?
Top 10 FAQ
18:52
26:52
5:36
3:26
5:41
15:56
14:14
5:52
5:09
2:46
Bonus
11:22
4:19
6:55
3:12
3:50
Multifocal lenses have been available for about 15 to 20 years. They offer clear vision at all distances—far, intermediate, and near—in each eye, providing balanced, excellent vision.
A downside is the presence of rings or halos around headlights at night. However, newer lenses like the Odyssey and Panoptix Pro significantly reduce these side effects. Typically, you’ll notice these rings as three concentric circles about a foot wide around headlights and taillights during night driving. Historically, this made multifocal lenses less ideal for frequent night drivers such as truck drivers or police officers. Fortunately, these visual effects typically diminish within 9 to 12 months as your brain adapts.
To ensure satisfaction, we may ask personality-based questions to identify individuals who prefer perfection, as adaptability impacts satisfaction with multifocal lenses. However, the latest lenses are so advanced that even highly detail-oriented patients usually find the results of refractive lens exchange (RLE) satisfying.
No lens is perfect; there’s always a balance between the range of vision and overall visual quality. The Odyssey and Panoptix Pro lenses deliver great visual quality, with contrast sensitivity nearly matching monofocal lenses, which traditionally provide the highest quality vision but with limited range.
These newest lenses improve night vision significantly by efficiently using and transmitting light, thereby reducing halos and ring effects.
Recent advancements also mean multifocal lenses can now be considered for patients who previously had LASIK surgery, though this requires careful evaluation of your eyes.
Despite precise measurements and planning, around 5% (1 in 20 patients) may still have a slight prescription after healing. If this occurs, we’ll fine-tune your vision with LASIK surgery at no extra cost once your vision stabilizes, typically around three months after your RLE or premium cataract surgery.
Nearly 100% of appropriately selected patients no longer require glasses for everyday tasks. Near vision clarity typically begins at about 10-12 inches from your eyes; tasks closer than this distance may still require reading glasses.
The video is about Dr. Tian’s experience and outcomes using the Light Adjustable Lens (LAL) in the setting of restorative lens exchange (RLE), focusing not only on visual clarity but also on how it lets patients “dial in” their vision post-surgery for a more customized result.
Introduction to LAL
The Light Adjustable Lens is a type of intraocular lens whose refractive power can be adjusted after surgery using UV light.
This gives patients opportunity to refine vision corrections—distance, near, or intermediate—once healing has started and refraction has stabilized.
Why Use It in RLE
In situations where patients are replacing their own natural lens (for presbyopia, cataract, or refractive need), small residual prescriptions or patient visual preferences can vary.
LAL helps manage “surprises” in postoperative refraction.
Gives flexibility: patient feedback used to adjust outcome rather than having to do more invasive touch-ups or deal with disappointments.
Patient Journey / Process
Surgery is done as per standard RLE procedure: lens removal & implantation of LAL.
After healing, several postoperative refraction checks are done.
Adjustments are made using UV-light treatments (usually multiple sessions) where needed.
Once patients are satisfied, there’s a “locking” phase to finalize the lens power.
Outcomes & Benefits
Better visual satisfaction due to customized optics.
Reduced need for glasses or additional corrective procedures.
Patients often happier with contrast sensitivity and fewer side effects because adjustments can be made rather than overcorrecting or leaving residual error.
Considerations / Limitations
Requires patient compliance (they must return for adjustment sessions).
Requires controlling exposure (avoid UV light sources outside until locked, etc.).
It may be more expensive than standard fixed IOLs, both for provider and patient.
Timing: adjustments happen during healing when eye is stable enough, but not so stable that changes become difficult.
Dr. Tian’s Insights
Emphasis on patient counseling about the possibilities & expectations.
Using LAL especially for premium RLE patients who have higher expectations.
Dr. Tian suggests that the ability to adjust vision afterward can reduce anxiety and improves satisfaction.
Why It Matters
For your clinic, using LAL could help with refractive outcomes especially for tricky cases (patients expecting premium performance).
It aligns with your emphasis on patient experience, using algorithms and systematic follow-ups.
It adds flexibility to your “decision tree” for off-target vision or maladaptation: instead of immediately doing PRK, LASIK, or IOL exchange, LAL gives an additional lever.
RLE and Cataract surgery are very safe and take 5-10 min to perform.
We do both eyes together on the same day for RLE, and for cataract in most places where I operate. It is safer to do both on the same day, this is called immediate sequential cataract surgery and is well acknowledged to be safer than delayed sequential surgery in the up to date medical literature.
There are no needles. No pain. We will numb your eye with eye drops and numbing medicine. You will be very relaxed with a “melt in your mouth” medicine and feel free to ask for more to get even more comfortable. These benzodiazepine medicines are very safe.
- You won’t feel pain. We’ll use numbing medicines so your eye is comfortable. You’ll be awake, but relaxed from the medicines that help you stay calm. Don’t worry there will not be any needles or IVs, this will not be a scary experience at all.
- The surgery is quick. The procedure usually takes about 10 minutes. It’s done one eye at a time, and you’ll go home the same day. You will receive more directions from my surgery team about specific arrival times.
- Eating and drinking before surgery is dependent on the rules of the surgery center. While there is no harm eating a light meal 2 hours before your procedure, some surgery centers are more strict than others, my team will let you know specifically what is expected. For the curious, food affects the absorption of medicine, especially the sedatives and this is taken into account for oral medicines. Certainly for major procedures (not what we do) you would not want to eat or drink especially if you undergo heavy sedation such as general anesthesia.
- You’ll need someone to drive you. Your vision will be foggy and blurry after surgery from the surgery and dilation, and you will have taken some sedation medicine, this makes driving illegal right after surgery, and so make sure someone can take you home safely.
- We’ll give you instructions and eye drops. These help your eye heal and prevent infection. It’s important to use them exactly as directed. I strongly recommend that you use the postop medical eye drops at least 4 more times before you go to bed that night.
- Expect blurry or hazy vision at first. That’s totally normal. You will often see halos, blurrier peripheral vision, jiggling of the lens as you move your eyes, and flashes of bright or dark arcs, all of this is expected in the first couple of days to weeks as the lens heals into the surrounding tissue. Most people notice clearer vision within a few days. For RLE surgery, the distance vision is generally good by the following day after dilation has worn off, and the near vision will get clearer over the first week or so if you have chosen a multifocal lens. For cataract surgery, the healing times are slower. We all heal at different rates, some patients will be slower to heal, and others heal very quickly.
- You’ll come back the next day for a quick check-up to make sure your eye is healing well.
- Your eye might feel a little scratchy or watery. Some describe it as a hair or sand in the eye. This is expected. It is rarely painful.
- Vision will be blurry or cloudy. You will see halos, blurrier peripheral vision, jiggling of the lens as you move your eyes, and flashes of bright or dark arcs, all of this is expected in the first couple of days to weeks as the lens heals into the surrounding tissue. Most people notice clearer vision within a few days.
- Vision usually starts to clear up. Distance vision usually clears first, followed in a few days by near vision if you have chosen a multifocal lens.
- You might notice brighter colors and better focus if you had cataract removal, but sometimes this is noticeable for RLE patients as well.
- Your eye might still be a little sensitive to light. This is normal.
- If you notice that your vision is fluctuates, this is also normal and usually due to temporary dry eye after surgery. The medical eye drops have a side effect of producing mild dry and irritated eyes temporarily. The drops will sting and this is normal.
- For light adjustable lenses, you will have good distance vision at first, and you will not have good near vision until the adjustments are underway (this process starts 1 month after implantation of the lenses).
- Most people feel more comfortable by now.
- Keep using your eye drops as told. At this point it is usually 3 times per day spaced out.
- Avoid rubbing your eye, hot tubs, swimming and applying eye liner or any eye lash makeup over the first 10 days.
- Vision should keep getting better but at a slower rate.
- All normal activities are okay now.
- Final results are usually in for fixed lenses (monofocal, toric, multifocal lenses)
- Light adjustable lenses will start to be adjusted at this point and adjustments will take approximately 1 month to complete.
- You’ll likely have a follow-up to check your vision.
- For those who chose monofocal lenses, you will be prescribed glasses for your distance and upclose vision at this time.
Yes, RLE (Refractive Lens Exchange) is very safe. It’s basically the same procedure as cataract surgery, which is one of the safest and most common surgeries performed around the world. Millions of these surgeries happen every year, and complications are rare.
We take careful steps to ensure safety:
We use numbing eye drops, so you won’t feel pain.
We use very precise, gentle techniques.
We closely monitor you during and after surgery to avoid problems.
Most people have excellent results and a smooth recovery. While no surgery is completely risk-free, serious problems are extremely rare.
You’re in experienced hands, and we’ll take great care of you at every step.
- Infection (very rare, less than 1 in 10 thousand)
- Swelling in the eye is actually very normal and expected temporarily, but sometimes it can be prolonged.
- Increased eye pressure, this is more common in patients with glaucoma and is managed with eye drops but also observed with healthy eyes. It is usually short lived and limited to the first day to first week. Your eye pressure will be checked at every followup visit.
- Lens not centered properly, this is very rare and may need a surgical adjustment. Maybe once per every thousand surgeries do we see a malrotated or decentered lens, it is usually an easy adjustment to further improve your vision.
- Retinal detachment (rare, but can be associated with long eyes as measured from the surface of the eye to the retina in the back of the eye, patients with longer eyes are often nearsighted. In my own experienced after performing 5000 lens based surgeries – I have not observed retinal detachment and a significant portion of my patients have long eyes.
What the Video Covers
The video compares the financial and timing trade-offs between doing Refractive Lens Exchange (RLE) now versus waiting to have premium cataract surgery later.
It discusses patient decision points: whether to opt for RLE sooner if one is already presbyopic or has early lens changes, versus waiting for cataracts to develop and selecting a premium intraocular lens (IOL) at that time.
💡 Key Points & Comparison
| Aspect | RLE Now | Premium Cataract Surgery Later |
|---|---|---|
| Cost | Upfront higher cost. Patient pays for premium lens options without insurance coverage. | May be less upfront (once cataract develops), but could incur additional costs (premium lens, upgrades). Insurance may cover standard cataract portion. |
| Convenience & Timing | Provides improved vision (distance, intermediate, possibly near) earlier; earlier reduction in dependence on glasses. | Patient waits until cataract develops; vision may degrade in meantime; potential for patient dissatisfaction during that period. |
| Lens Technology | Can choose premium or adjustable lenses now (depending on provider), perhaps more advanced IOL designs. | Similar lens options later, but outcomes may be influenced by cataract density, eye health, etc. |
| Visual Experience Over Time | longer period of high quality vision without cataract symptoms in the future. Earlier adoption of premium optics. | Might face cataract symptoms like glare/opacity before deciding on premium options; patient has to deal with more years of declining lens quality. |
| Risk / Patient Suitability | Must ensure the patient is a good candidate (healthy eyes, realistic expectations). | Some patients may prefer or need to wait; but delaying means living with worsening vision or lens changes. |
Considerations & Advice Given
Dr. Tian suggests thoroughly assessing patient’s visual needs, lifestyle, and expectations when discussing whether RLE “makes sense now.”
Emphasis on counseling: patients should understand that waiting might mean more years dealing with decreasing lens clarity, but RLE has higher upfront cost and may be elective (not covered by insurance).
Importance of lens type: premium versus standard, and how premium options may offer better outcomes but add cost.
Also addressed is that once cataract is significant, outcomes might be slightly less predictable, or additional risks like dealing with dense lens matter might increase the complexity and complication rates.
Bottom Line
If a patient is already presbyopic or starting to notice lens changes, choosing RLE now may provide better visual quality earlier and reduce/eliminate glasses dependence. But the trade-off is cost and ensuring suitability. Premium cataract surgery later is a reasonable route but involves waiting, potentially degraded vision, and possibly lower-level insurance coverage for standard lens, with patient paying extra for premium upgrades.
Can I Have RLE if I Already Had LASIK?
Yes. Having LASIK in the past does not disqualify you from having RLE.
But it does require extra planning and testing to make sure we select the best lens power and type for your eyes.
What’s Different for Post-LASIK Patients?
Measurements Are Trickier: LASIK changes the shape of your cornea, which makes lens calculations more complex.
Risk of “Residual Error”: There is a slightly higher chance of needing temporary glasses, contacts, and a small touch-up procedure afterward to optimize the result.
Extra Testing: We use advanced biometry and formulas designed for post-LASIK eyes to improve accuracy.
Lens Choices: Some lenses like LAL or “forgiving” multifocal designs (Odyssey and Panoptix Pro) may be the best options.
What to Expect
Evaluation: We’ll review your LASIK history, current prescription, and eye health.
Counseling: We’ll discuss whether your main issue is presbyopia, cataract changes, or refractive error; or a combination.
Surgery & Healing: The RLE procedure itself is the same as in non-LASIK patients.
Fine-Tuning: a minor enhancement (like LASIK/PRK, or IOL exchange) to optimize the result.
Benefits of RLE After LASIK
Freedom from glasses or contacts, especially for near and far vision.
Prevention of cataracts later in life (since the lens is already replaced).
Better long-term vision quality than continuing to rely on aging natural lenses.
Bottom Line: If you’ve had LASIK before, you can still enjoy the benefits of RLE — but careful planning, realistic expectations, and open communication with your surgeon are key to success.
We’ll make sure you clearly understand what’s possible, and I’ll guide you every step of the way.
If you’re not sure about refractive lens exchange (RLE), here are some other options we can consider:
1. Glasses or Contact Lenses
The simplest option to correct vision without surgery.
2. LASIK or PRK (Laser Vision Correction)
Uses a laser to reshape the front surface of your eye to improve vision.
Good if your prescription isn’t very high and your eyes are healthy.
- Is not permanent, your natural lens will keep changing as you age and this will lead to reliance on glasses with due time.
3. Implantable Contact Lens (ICL)
A thin lens placed inside your eye to correct your vision, without removing your natural lens.
Great for higher prescriptions and younger patients.
- But also is not permanent, your natural lens will keep changing as you age and this will lead to reliance on glasses with due time.
4. Waiting (No Surgery)
If your vision isn’t too bothersome, you might choose to wait and monitor it.
Each option has pros and cons. What’s best for your eyes is a very personal choice and we will discuss your vision needs, and your lifestyle, to determine what is most valuable to you.
Jack J. Tian, MD
Board Certified Ophthalmologist, Refractive Surgeon
Education
B.A. University of California, Berkeley
Molecular and Cell Biology
M.D. David Geffen School of Medicine at UCLA
Post Graduate
University of Rochester Medical Center
Internship, Dept of Internal Medicine
Ophthalmology Residency, Flaum Eye Institute
Chief Resident, Flaum Eye Institute
04/25-Present Surgeon, Sharpevision
Bellevue WA, Refractive Lens Exchange, Cataract, Glaucoma.
08/24-Present Surgeon, IQ Laser Vision
Medical Director, San Francisco CA, Refractive Lens Exchange, ICL, SMILE, Lasik, PRK.
09/24-Present Surgeon, Will Vision
Vancouver WA, Refractive Lens Exchange, Cataract, ICL.
01/23-Present Clinical Assistant Professor
Department of Ophthalmology, University of Washington
Surgical training of ophthalmology residents at Harborview Hospital.
04/23-10/24 Surgeon, K2 Vision and King Lasik
Refractive Lens Exchange, ICL, Lasik, PRK. Washington State.
04/22-12/23 Surgeon, Northwest Eye Surgeons
High volume cataract, glaucoma and oculoplastics surgery. Sequim, Washington
Clinical Research, Clinical and Surgical precepting
07/21-04/22 Assistant Professor, Comprehensive ophthalmologist,
Department of Ophthalmology, Casey Eye Institute, Astoria, OR
Clinical Research, Resident Education (Clinical and Surgical preceptorship)
Surgical emphasis on cataract, glaucoma and oculoplastics
07/15-06/17 Research Fellow at Doheny Eye Institute UCLA, Los Angeles, CA
Clinical and Basic Science Ophthalmology Research in Neuro-Ophthalmology, Cataract and Retina
10/11-08/12 Associate Scientist at Novartis Molecular Diagnostics, Cambridge, MA
Cancer Diagnostics Assay Design and Optimization. Assay Automation. Phase I Clinical Trial.
02/11-09/11 Research Assistant at Brigham and Woman’s Hospital, Cambridge, MA
Animal Surgery and Histology. Constructing PDMS microfluidic devices.
10/09-07/10 Junior Scientist at Life Technologies, Foster City, CA
- Usually improves in a few days. This is related to swelling of the cornea which is common after any eye procedure.
- We will check your eye closely during follow-ups to make sure your vision clears as expected.
- Normal for the first few days.
- Eye drops and artificial tears can help soothe your eye. We will guide you on exactly which drops to use.
- Very common and usually improves within a few days to weeks.
- Wearing sunglasses can help until it gets better.
- Usually goes away within days.
- We can prescribe anti-inflammatory drops to speed healing if needed.
- Common after surgery, often improves in a few weeks.
- Artificial tears are helpful, and we can provide additional treatments if dryness continues.
After cataract or RLE surgery, your vision might become a little blurry again over time. This is usually because of something called Posterior Capsular Opacification (PCO), sometimes called a “secondary cataract.” It’s not a real cataract coming back; instead, it’s just a thin film or cloudiness forming behind your new lens.
The good news is, fixing it is very simple and quick. We use a procedure called a YAG laser capsulotomy, where a gentle laser creates a small opening in that cloudy film. It’s painless, takes only a few minutes, and quickly restores your clear vision. There’s no cutting, no stitches, and recovery is usually very fast. PCO is very common, easy to treat, and rarely comes back again afterward.
You don’t have to do RLE surgery right now—you can certainly wait until your natural lens becomes cloudy enough for cataract surgery. Here’s how to decide:
If your main goal is to reduce your need for glasses and your vision bothers you now, RLE could help you sooner rather than later.
If your vision isn’t a big issue yet, you can safely wait until cataracts form, which usually happens naturally with age.
Both surgeries are very similar and very safe. The main difference is timing. RLE can give you clearer vision earlier, while cataract surgery is typically done once vision becomes noticeably worse.
Either choice is perfectly okay, and I’m here to support you in whatever decision feels right for you.
During cataract or refractive lens exchange (RLE) surgery, we typically use local anesthesia. This means you’ll get special numbing eye drops that keep your eye comfortable and pain-free throughout the procedure.
You’ll stay awake during surgery, but you’ll be relaxed and won’t feel pain. We also give you a gentle calming medicine that melts under your tongue help you feel relaxed and less nervous. It is called an MKO melt and stands for a combination of Midalozam (sedation), Ketamine (sedation and anesthetic) and Ondansetron (antinausea). You may be glad to know that IV’s and needles are not used and unnecessary for this procedure.
Most people are surprised by how quick and painless the procedure is, and you’ll be able to go home immediately afterward, feeling comfortable and safe.
I will be guiding you throughout the procedure and will let you know what we are doing and any sensations to anticipate such as “bright light”, “light pressure”, and “background noises” from my machines that convey surgery settings to me. There will be no surprises and you will stay informed throughout the 5-10 minute procedure.
Cataract or RLE surgery itself doesn’t usually cause long-term dry eyes, but your eyes might feel a little drier than normal for a few weeks afterward. This temporary dryness happens because the surgery can briefly change the surface of your eye, making it feel scratchy, irritated, or dry.
The good news is, it’s usually mild and gets better quickly. We recommend using artificial tears (eye drops) after surgery to help keep your eyes comfortable. Most patients return to normal within a month or two, but if dryness continues longer, we have plenty of ways to help you feel comfortable again and my team will help you get through this period of discomfort.
*It is also worthwhile to note that dry eye not only causes some discomfort but that it also causes the symptom of intermittent or fluctuating blurry vision. Dry eye is the most common culprit if you have blurry vision that occurs at specific times of the day or intermittently throughout the day or with specific activities such as driving, or reading, or watching TV.
You’ll stay awake during surgery, but you’ll be relaxed and won’t feel pain. We also give you a gentle calming medicine that melts under your tongue help you feel relaxed and less nervous. IV’s and needles are rarely used and unnecessary for this procedure, and you will find these mostly at the hospital setting.
During cataract or refractive lens exchange (RLE) surgery, we typically use local anesthesia. This means you’ll get special numbing eye drops that keep your eye comfortable and pain-free throughout the procedure.
Most people are surprised by how quick and painless the procedure is, and you’ll be able to go home immediately afterward, feeling comfortable and safe.
Summary of RLE / Premium Cataract surgery journey
Lenses and Surgery
7:22
18:52
4:42
26:52
20:44
5:28
5:36
5:52
Common
3:27
6:55
5:06
3:12
3:50
3:19
1. How do we select the lens?
We choose lenses based on detailed measurements of your eyes, your lifestyle, your vision needs (near, far, or both), and whether you have astigmatism. We’ll talk about your daily activities to help find the best match for you.
2. How does an IOL (intraocular lens) compare to my natural lens?
An IOL replaces your natural lens after it’s removed. It’s clear and won’t cloud over time like your natural lens can. While your natural lens could change shape to focus, an IOL has a fixed shape, so it focuses clearly at set distances.
3. What is the difference between monofocal, multifocal, and toric lenses?
Monofocal: Clear vision at one distance (usually far) but does not treat astigmatism which would yield clearer distance vision. You’ll probably need glasses for close-up tasks such as computer work and reading.
Multifocal: Clear vision at multiple distances (near, mid, and far). Reduces need for glasses overall.
Toric: A type of monofocal lens, but also available for multifocal and EDOF lenses, that specifically corrects astigmatism to sharpen your vision.
4. Can I get an IOL that corrects both distance and near vision?
Yes. Multifocal or extended-depth-of-focus (EDOF) lenses help you see clearly at both near and far distances. Many people who choose these lenses rarely need glasses for the rest of their lives.
5. Do IOLs correct astigmatism?
Yes, special IOLs called toric lenses correct astigmatism and give you even sharper vision.
6. Which IOL is best for me?
The best IOL for you depends on your vision needs, eye health, lifestyle, budget, and whether you want to rely less on glasses. For most clients who have not had previous lasik surgery, the best option is a multifocal lens. For clients who have had previous lasik surgery, then the light adjustable lens has the best performance, although we can still do a multifocal lens depending on the shape and condition of your cornea (surface of the eye).
7. Can I get an IOL that enhances night vision?
While there’s no lens specifically made just to enhance night vision, certain lenses (monofocal lenses or light adjustable lens are designed for clearer optics) can greatly improve your nighttime vision compared to what it was with cataracts.
8. Can I choose to have one eye for near vision and one for distance?
Yes, that’s called monovision. An improvement on Monovision is called blended vision (less noticeable difference between the eyes). One eye focuses on distance/mid, the other mid/near tasks. It helps reduce your dependence on glasses, but it’s not for everyone. We’ll test and discuss if this works well for you.
9. Can I choose a lens that gives me better vision than I had before cataracts?
In almost all cases, yes! Modern premium lenses can often improve your vision beyond what you had before cataracts formed, giving you sharper, clearer, and brighter vision.
Multifocal lenses have been available for about 15 to 20 years. They offer clear vision at all distances—far, intermediate, and near—in each eye, providing balanced, excellent vision.
A downside is the presence of rings or halos around headlights at night. However, newer lenses like the Odyssey and Panoptix Pro significantly reduce these side effects. Typically, you’ll notice these rings as three concentric circles about a foot wide around headlights and taillights during night driving. Historically, this made multifocal lenses less ideal for frequent night drivers such as truck drivers or police officers. Fortunately, these visual effects typically diminish within 9 to 12 months as your brain adapts.
To ensure satisfaction, we may ask personality-based questions to identify individuals who prefer perfection, as adaptability impacts satisfaction with multifocal lenses. However, the latest lenses are so advanced that even highly detail-oriented patients usually find the results of refractive lens exchange (RLE) satisfying.
No lens is perfect; there’s always a balance between the range of vision and overall visual quality. The Odyssey and Panoptix Pro lenses deliver great visual quality, with contrast sensitivity nearly matching monofocal lenses, which traditionally provide the highest quality vision but with limited range.
These newest lenses improve night vision significantly by efficiently using and transmitting light, thereby reducing halos and ring effects.
Recent advancements also mean multifocal lenses can now be considered for patients who previously had LASIK surgery, though this requires careful evaluation of your eyes.
Despite precise measurements and planning, around 5% (1 in 20 patients) may still have a slight prescription after healing. If this occurs, we’ll fine-tune your vision with LASIK surgery at no extra cost once your vision stabilizes, typically around three months after your RLE or premium cataract surgery.
Nearly 100% of appropriately selected patients no longer require glasses for everyday tasks. Near vision clarity typically begins at about 10-12 inches from your eyes; tasks closer than this distance may still require reading glasses.
Both manual and femtosecond laser-assisted cataract surgery (FLACS) are excellent and safe methods, but manual surgery can have certain advantages:
—
Advantages for manual cataract surgery:
Proven track record:
Manual cataract surgery is one of the safest and most commonly performed surgeries worldwide, with decades of successful outcomes.Surgeon Experience:
Experienced surgeons often achieve excellent results manually because of their skill, precision, and judgment during surgery.Flexibility and Control:
Surgeons have greater direct control to quickly adjust techniques and handle any unexpected situations that might arise during surgery.- Laser assisted surgery may not be reliable in certain situations such as small pupil dilation, cloudy cornea, unintentional movement and device failures. Sometimes this results in unexpected complications during surgery such as a rupture of the posterior capsule which requires repair. While these situations are rare, my opinion is manual surgery is safer in my hands than laser assisted surgery as I am much more adept at circumventing the above scenarios.
Is laser-assisted surgery bad?
Not at all—FLACS is precise and safe. However, studies consistently show similar visual outcomes and complication rates for both methods, meaning lasers don’t necessarily offer a clear advantage in most cases.
In short, manual cataract surgery remains highly effective, safe, reliable, and affordable. How safe obviously depends on the experience of your surgeon. Most importantly, choosing an experienced surgeon and discussing your specific situation is key to getting great results.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
This is a wonderful video by a patient (I do not know this patient). I watched this video and was impressed by her thoughtful descriptions journaling her experience and I think the discussions with her physician and videos are very accurate. You will find her journey to be very standard for how the LAL is adjusted to improve your vision.
You should stop wearing your contact lenses before your RLE or Premium Cataract Surgery consultation and not necessarily before your surgery.
Contacts can slightly change the shape of your cornea (the clear part of your eye), which can affect the accuracy of our measurements and the results of your surgery. Stopping contacts gives your eyes time to return to their natural shape, helping us choose exactly the right lens for the clearest vision after surgery.
Assuming this measurement is taken at your consultation appointment, you would stop using your contact lenses as follows before this appointment and you are free to resume using your contact lenses after measurements have been successfully taken.
Soft contacts: Stop wearing at least 1 week before surgery (only 3 days prior if non-toric soft contact lenses).
Hard or rigid gas-permeable contacts: Stop wearing at 4 weeks before surgery if you have used any form of hard/rigid contact lenses for under 10 years. For every decade of hard/rigid contact lens use over 10 years, add an additional 4 weeks to the duration of the contact lens pause. This allows your cornea to dewarp adequately to obtain truer measurements prior to surgery. You should also make it very clear to us why you were prescribed a hard/rigid contact lens (for example: high prescription, high astigmatism, irregular astigmatism, cornea scarring, and keratoconus).
RLE and Cataract surgery are very safe and take 5-10 min to perform.
We do both eyes together on the same day for RLE, and for cataract in most places where I operate. It is safer to do both on the same day, this is called immediate sequential cataract surgery and is well acknowledged to be safer than delayed sequential surgery in the up to date medical literature.
There are no needles. No pain. We will numb your eye with eye drops and numbing medicine. You will be very relaxed with a “melt in your mouth” medicine and feel free to ask for more to get even more comfortable. These benzodiazepine medicines are very safe.
- You won’t feel pain. We’ll use numbing medicines so your eye is comfortable. You’ll be awake, but relaxed from the medicines that help you stay calm. Don’t worry there will not be any needles or IVs, this will not be a scary experience at all.
- The surgery is quick. The procedure usually takes about 10 minutes. It’s done one eye at a time, and you’ll go home the same day. You will receive more directions from my surgery team about specific arrival times.
- Eating and drinking before surgery is dependent on the rules of the surgery center. While there is no harm eating a light meal 2 hours before your procedure, some surgery centers are more strict than others, my team will let you know specifically what is expected. For the curious, food affects the absorption of medicine, especially the sedatives and this is taken into account for oral medicines. Certainly for major procedures (not what we do) you would not want to eat or drink especially if you undergo heavy sedation such as general anesthesia.
- You’ll need someone to drive you. Your vision will be foggy and blurry after surgery from the surgery and dilation, and you will have taken some sedation medicine, this makes driving illegal right after surgery, and so make sure someone can take you home safely.
- We’ll give you instructions and eye drops. These help your eye heal and prevent infection. It’s important to use them exactly as directed. I strongly recommend that you use the postop medical eye drops at least 4 more times before you go to bed that night.
- Expect blurry or hazy vision at first. That’s totally normal. You will often see halos, blurrier peripheral vision, jiggling of the lens as you move your eyes, and flashes of bright or dark arcs, all of this is expected in the first couple of days to weeks as the lens heals into the surrounding tissue. Most people notice clearer vision within a few days. For RLE surgery, the distance vision is generally good by the following day after dilation has worn off, and the near vision will get clearer over the first week or so if you have chosen a multifocal lens. For cataract surgery, the healing times are slower. We all heal at different rates, some patients will be slower to heal, and others heal very quickly.
- You’ll come back the next day for a quick check-up to make sure your eye is healing well.
Having previous eye surgery doesn’t necessarily mean you can’t have great vision again. In fact, many people who’ve had earlier surgeries can still benefit from modern procedures like RLE or other vision correction options.
The results depend on:
What type of surgery you had before
- It is a very good choice to do RLE when your lasik results are starting to “wear off”, and this will permanently correct your vision so you can resume living life without glasses.
- For RK, it will be life-changing for you to do RLE with the LAL.
The current health and condition of your eyes
- As we age, we can develop other eye conditions and we must assess your eyes to determine if RLE will improve your vision or if the root cause of your vision problems is not lens dysfunction or cataract.
Your vision goals
- While we can improve almost everyone’s vision with RLE, we must be realistic about the amount of improvement achievable. For example, we may not be able to significantly improve upon a 40 year old’s vision when they are seeing great in the distance and infrequently using reading glasses.
In many cases, we can still help significantly reduce your need for glasses. We’ll carefully evaluate your eyes and talk through realistic expectations. Even if we can’t promise you’ll never wear glasses again, we usually can improve your vision a lot.
We’ll make sure you clearly understand what’s possible, and I’ll guide you every step of the way.
- Your eye might feel a little scratchy or watery. Some describe it as a hair or sand in the eye. This is expected. It is rarely painful.
- Vision will be blurry or cloudy. You will see halos, blurrier peripheral vision, jiggling of the lens as you move your eyes, and flashes of bright or dark arcs, all of this is expected in the first couple of days to weeks as the lens heals into the surrounding tissue. Most people notice clearer vision within a few days.
- Vision usually starts to clear up. Distance vision usually clears first, followed in a few days by near vision if you have chosen a multifocal lens.
- You might notice brighter colors and better focus if you had cataract removal, but sometimes this is noticeable for RLE patients as well.
- Your eye might still be a little sensitive to light. This is normal.
- If you notice that your vision is fluctuates, this is also normal and usually due to temporary dry eye after surgery. The medical eye drops have a side effect of producing mild dry and irritated eyes temporarily. The drops will sting and this is normal.
- For light adjustable lenses, you will have good distance vision at first, and you will not have good near vision until the adjustments are underway (this process starts 1 month after implantation of the lenses).
- Most people feel more comfortable by now.
- Keep using your eye drops as told. At this point it is usually 3 times per day spaced out.
- Avoid rubbing your eye, hot tubs, swimming and applying eye liner or any eye lash makeup over the first 10 days.
- Vision should keep getting better but at a slower rate.
- All normal activities are okay now.
- Final results are usually in for fixed lenses (monofocal, toric, multifocal lenses)
- Light adjustable lenses will start to be adjusted at this point and adjustments will take approximately 1 month to complete.
- You’ll likely have a follow-up to check your vision.
- For those who chose monofocal lenses, you will be prescribed glasses for your distance and upclose vision at this time.
During cataract or refractive lens exchange (RLE) surgery, we typically use local anesthesia. This means you’ll get special numbing eye drops that keep your eye comfortable and pain-free throughout the procedure.
You’ll stay awake during surgery, but you’ll be relaxed and won’t feel pain. We also give you a gentle calming medicine that melts under your tongue help you feel relaxed and less nervous. It is called an MKO melt and stands for a combination of Midalozam (sedation), Ketamine (sedation and anesthetic) and Ondansetron (antinausea). You may be glad to know that IV’s and needles are not used and unnecessary for this procedure.
Most people are surprised by how quick and painless the procedure is, and you’ll be able to go home immediately afterward, feeling comfortable and safe.
I will be guiding you throughout the procedure and will let you know what we are doing and any sensations to anticipate such as “bright light”, “light pressure”, and “background noises” from my machines that convey surgery settings to me. There will be no surprises and you will stay informed throughout the 5-10 minute procedure.
No medications are needed to be stopped before your RLE procedure. Commonly, patients ask if these following medicines are to be stopped and the answer is NO, please continue to take them as instructed by your other doctors:
Blood thinners (like aspirin, warfarin, or other anticoagulants) do not need to be paused.
Eye medications (drops or ointments) should be continued, this is especially true if you use glaucoma eye drops.
You can be confident that vitamins, herbal supplements, or prescription medications—are all safe to continue taking before, during and after surgery day.
In summary, no medications, supplements, eye drops or even contact lenses need to be stopped prior to surgery.
Cataract or RLE surgery itself doesn’t usually cause long-term dry eyes, but your eyes might feel a little drier than normal for a few weeks afterward. This temporary dryness happens because the surgery can briefly change the surface of your eye, making it feel scratchy, irritated, or dry.
The good news is, it’s usually mild and gets better quickly. We recommend using artificial tears (eye drops) after surgery to help keep your eyes comfortable. Most patients return to normal within a month or two, but if dryness continues longer, we have plenty of ways to help you feel comfortable again and my team will help you get through this period of discomfort.
*It is also worthwhile to note that dry eye not only causes some discomfort but that it also causes the symptom of intermittent or fluctuating blurry vision. Dry eye is the most common culprit if you have blurry vision that occurs at specific times of the day or intermittently throughout the day or with specific activities such as driving, or reading, or watching TV.
You’ll stay awake during surgery, but you’ll be relaxed and won’t feel pain. We also give you a gentle calming medicine that melts under your tongue help you feel relaxed and less nervous. IV’s and needles are rarely used and unnecessary for this procedure, and you will find these mostly at the hospital setting.
During cataract or refractive lens exchange (RLE) surgery, we typically use local anesthesia. This means you’ll get special numbing eye drops that keep your eye comfortable and pain-free throughout the procedure.
Most people are surprised by how quick and painless the procedure is, and you’ll be able to go home immediately afterward, feeling comfortable and safe.
We sometimes ask you to complete a short personality or lifestyle questionnaire before RLE surgery to help us better understand your expectations, visual needs, and personality. The reason is simple:
To ensure you’re satisfied: It helps us match your vision goals with the right type of lens.
To set realistic expectations: Some people have personalities or lifestyles that make them happier with certain lens choices over others. It also helps us determine if surgery should be avoided if goals and expectations are unrealistic (for example: expecting RLE or premium cataract surgery to be a solution for a vision limiting eye condition that is not cataract). For RLE (in the absence of a cataract), it is a good rule of thumb to expect unaided vision to be roughly the same as with your glasses, but realize a perfect lens does not exist and all current lens technologies have limitations as compared to a young human lens that can seamlessly adapt its focus by changing shape.
To identify potential challenges early: If you’re more likely to notice small imperfections (like halos or glare), we can discuss this beforehand, so you’re well-prepared and comfortable.
It’s just another way we make sure you get the best results and a high level of satisfaction from your surgery.
Informed Consent Guide
Risks and Benefits Questions
5:42
15:57
11:33
11:33
5:09
5:10
3:44
11:22
6:55
5:42
5:52
Common
15:57
15:57
15:57
3:27
5:06
6:40
4:19
3:46
6:40
4:18
3:50
3:14
3:12
9:44
2:36
2:31
3:58
Lower Yield
1:47
3:22
3:34
4:18
1:52
Yes, RLE (Refractive Lens Exchange) is very safe. It’s basically the same procedure as cataract surgery, which is one of the safest and most common surgeries performed around the world. Millions of these surgeries happen every year, and complications are rare.
We take careful steps to ensure safety:
We use numbing eye drops, so you won’t feel pain.
We use very precise, gentle techniques.
We closely monitor you during and after surgery to avoid problems.
Most people have excellent results and a smooth recovery. While no surgery is completely risk-free, serious problems are extremely rare.
You’re in experienced hands, and we’ll take great care of you at every step.
- Infection (very rare, less than 1 in 10 thousand)
- Swelling in the eye is actually very normal and expected temporarily, but sometimes it can be prolonged.
- Increased eye pressure, this is more common in patients with glaucoma and is managed with eye drops but also observed with healthy eyes. It is usually short lived and limited to the first day to first week. Your eye pressure will be checked at every followup visit.
- Lens not centered properly, this is very rare and may need a surgical adjustment. Maybe once per every thousand surgeries do we see a malrotated or decentered lens, it is usually an easy adjustment to further improve your vision.
- Retinal detachment (rare, but can be associated with long eyes as measured from the surface of the eye to the retina in the back of the eye, patients with longer eyes are often nearsighted. In my own experienced after performing 5000 lens based surgeries – I have not observed retinal detachment and a significant portion of my patients have long eyes.
Our goal is is to help you obtain freedom from glasses for near and for far, this is almost always achievable if your eyes are healthy.
If your vision is limited by an eye condition, for example, moderate dry eye or or extra retinal membrane, you’ll probably be out of glasses for everything but there’s a chance you may be relying on glasses occasionally or or in some situations. We try to select our patients well, if we’re not going to get you out of glasses we’re very upfront about that and we will set realistic expectations with you so you are not surprised or disappointed after surgery. If you cannot accept the realistic goals we present then it may be best to wait until your vision is worse or more significant improvements in technology before undergoing this surgery.
There are some RLE candidates who have lofty expectations (for example “to be able to see like the craters on the moon and be able to read like from the tip of my nose”). If you can’t see all that with your glasses, it is also unlikely with RLE. So just have the right expectations that this basically replaces your glasses for distance and near. If you have any degree of cataract you’re going to be so happy because your vision will actually improve after surgery since this not only is it going to address the cataract it also addresses not needing glasses for the rest of your life.
More in depth discussions on Multifocal and Light Adjustable lenses in a separate video.
Will I still need glasses after getting an IOL?
- Monofocal IOLs give you good vision at one distance (usually far), but it will not be as good as it can be due to not correcting astigmatism, and you’ll still need glasses for computers and reading (or close-up work).
- Multifocal or extended depth-of-focus (EDOF) IOLs can help you see both near and far, reducing your need for glasses—but some people still prefer readers for tiny print. Multifocal lenses get ~100% of healthy eyes out of glasses for everyday tasks. EDOF lenses do the same but use the concept called blended vision as described in the deep dive video. The light adjustable lens is a special variant of the EDOF lens, and allows us to refine your vision and further customize the lenses to your liking.
- Toric IOLs describe an additional function of IOLs that corrects for astigmatism to reduce your dependence on glasses. Monofocal, multifocal and EDOF lenses can be customized to have toric capabilities.
Our goal is is to help you obtain freedom from glasses for near and for far, this is almost always achievable if your eyes are healthy.
If your vision is limited by an eye condition, for example, moderate dry eye or or extra retinal membrane, you’ll probably be out of glasses for everything but there’s a chance you may be relying on glasses occasionally or or in some situations. We try to select our patients well, if we’re not going to get you out of glasses we’re very upfront about that and we will set realistic expectations with you so you are not surprised or disappointed after surgery. If you cannot accept the reality we present then it may be best to wait until your vision is worse before undergoing this surgery.
There are some RLE candidates who have lofty expectations (for example “to be able to see like the craters on the moon and be able to read like from the tip of my nose”). If you can’t see all that with your glasses, it is also unlikely with RLE. So just have the right expectations that this basically replaces your glasses for distance and near. If you have any degree of cataract you’re going to be so happy because your vision will actually improve after surgery since this not only is it going to address the cataract it also addresses not needing glasses for the rest of your life.
More in depth discussions on Multifocal and Light Adjustable lenses in a separate video.
If you’re not sure about refractive lens exchange (RLE), here are some other options we can consider:
1. Glasses or Contact Lenses
The simplest option to correct vision without surgery.
2. LASIK or PRK (Laser Vision Correction)
Uses a laser to reshape the front surface of your eye to improve vision.
Good if your prescription isn’t very high and your eyes are healthy.
- Is not permanent, your natural lens will keep changing as you age and this will lead to reliance on glasses with due time.
3. Implantable Contact Lens (ICL)
A thin lens placed inside your eye to correct your vision, without removing your natural lens.
Great for higher prescriptions and younger patients.
- But also is not permanent, your natural lens will keep changing as you age and this will lead to reliance on glasses with due time.
4. Waiting (No Surgery)
If your vision isn’t too bothersome, you might choose to wait and monitor it.
Each option has pros and cons. What’s best for your eyes is a very personal choice and we will discuss your vision needs, and your lifestyle, to determine what is most valuable to you.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Refractive Lens Exchange (RLE) surgery is generally permanent, because your natural lens is removed and replaced with an artificial lens (IOL). It can’t simply be undone.
However, in the rare case that you aren’t satisfied or have significant issues, there are still good options:
Lens exchange:
The artificial lens can sometimes be replaced with another type.Additional vision correction:
Procedures like Lasik surgery or corrective lenses (glasses or contacts) can further improve vision if needed.
That’s why we spend extra time before surgery choosing the best lens and making sure you’re comfortable with the decision. Our goal is always to help you get it right the first time.
- Usually improves in a few days. This is related to swelling of the cornea which is common after any eye procedure.
- We will check your eye closely during follow-ups to make sure your vision clears as expected.
- Normal for the first few days.
- Eye drops and artificial tears can help soothe your eye. We will guide you on exactly which drops to use.
- Very common and usually improves within a few days to weeks.
- Wearing sunglasses can help until it gets better.
- Usually goes away within days.
- We can prescribe anti-inflammatory drops to speed healing if needed.
- Common after surgery, often improves in a few weeks.
- Artificial tears are helpful, and we can provide additional treatments if dryness continues.
After cataract or RLE surgery, your vision might become a little blurry again over time. This is usually because of something called Posterior Capsular Opacification (PCO), sometimes called a “secondary cataract.” It’s not a real cataract coming back; instead, it’s just a thin film or cloudiness forming behind your new lens.
The good news is, fixing it is very simple and quick. We use a procedure called a YAG laser capsulotomy, where a gentle laser creates a small opening in that cloudy film. It’s painless, takes only a few minutes, and quickly restores your clear vision. There’s no cutting, no stitches, and recovery is usually very fast. PCO is very common, easy to treat, and rarely comes back again afterward.
During cataract or refractive lens exchange (RLE) surgery, we typically use local anesthesia. This means you’ll get special numbing eye drops that keep your eye comfortable and pain-free throughout the procedure.
You’ll stay awake during surgery, but you’ll be relaxed and won’t feel pain. We also give you a gentle calming medicine that melts under your tongue help you feel relaxed and less nervous. It is called an MKO melt and stands for a combination of Midalozam (sedation), Ketamine (sedation and anesthetic) and Ondansetron (antinausea). You may be glad to know that IV’s and needles are not used and unnecessary for this procedure.
Most people are surprised by how quick and painless the procedure is, and you’ll be able to go home immediately afterward, feeling comfortable and safe.
I will be guiding you throughout the procedure and will let you know what we are doing and any sensations to anticipate such as “bright light”, “light pressure”, and “background noises” from my machines that convey surgery settings to me. There will be no surprises and you will stay informed throughout the 5-10 minute procedure.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Having previous eye surgery doesn’t necessarily mean you can’t have great vision again. In fact, many people who’ve had earlier surgeries can still benefit from modern procedures like RLE or other vision correction options.
The results depend on:
What type of surgery you had before
- It is a very good choice to do RLE when your lasik results are starting to “wear off”, and this will permanently correct your vision so you can resume living life without glasses.
- For RK, it will be life-changing for you to do RLE with the LAL.
The current health and condition of your eyes
- As we age, we can develop other eye conditions and we must assess your eyes to determine if RLE will improve your vision or if the root cause of your vision problems is not lens dysfunction or cataract.
Your vision goals
- While we can improve almost everyone’s vision with RLE, we must be realistic about the amount of improvement achievable. For example, we may not be able to significantly improve upon a 40 year old’s vision when they are seeing great in the distance and infrequently using reading glasses.
In many cases, we can still help significantly reduce your need for glasses. We’ll carefully evaluate your eyes and talk through realistic expectations. Even if we can’t promise you’ll never wear glasses again, we usually can improve your vision a lot.
We’ll make sure you clearly understand what’s possible, and I’ll guide you every step of the way.
RLE surgery is extremely safe, but like any surgery, very rare complications can happen. The worst thing that can happen is something happens to the surgeon (me), which is extremely unlikely when the surgeon is healthy. I will ensure you will have the safest possible surgery despite any rare intraoperative surprise we encounter. In this surgery, surprises can happen, but rest assured that I am always prepared and ready to handle anything that comes up.
After surgery, the worst things that can happen are:
Infection inside the eye: (endophthalmitis) This is very rare, but serious and can result in some degree of vision loss. We do everything possible to prevent it, including using sterile techniques and antibiotics. We have not see this in any ORs that I work in due to very strict sterile protocols. But we are always on the lookout for signs of infection postoperatively as sometimes the origin of the infection may be from surgery or possibly from post-operative events. Rest assured that this would be a highly unlikely event, and if encountered we will make sure you are diagnosed and treated early so that you have the best chance of vision returning to normal.
Bleeding or severe swelling in the eye: This can temporarily or permanently affect vision, but again, this is very rare and I have not seen this in 5000 surgeries in my career. This was rare even 20+ years ago before advances in surgical technology. I do not know any contemporary surgeons who have encountered pseudophakic bullous keratopathy (swelling), or suprachoroidal hemorrhage (bleeding).
Retinal detachment: Also uncommon, I have not encountered this in 5000 intraocular surgeries during my career, but they are more likely in patients with high nearsightedness (with long eyes). It’s treatable but requires additional surgery with a subspecialist called a retina ophthalmologist.
Severe damage leading to vision loss: Extremely rare, and I have never encountered this, but theoretically possible in any eye surgery.
It’s important to remember these complications are very unlikely. We take careful steps to prevent them, and RLE and cataract surgery remains one of the safest surgeries we perform. Most people have excellent outcomes and significantly improved vision.
You should feel confident about your the success of your surgery with me.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Surgery healing time: cataract versus RLE
Time frame for neuro-adaptation (getting used to) your new vision
I am taking medical and OTC eyedrops, can I do the surgery? Will I need to discontinue?
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
What if I don’t like my lens, can it be replaced with a different one?
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Overview of Surgery Day
Day of Surgery Questions
9:26
3:27
9:26
6:55
14:23
1:16
2:02
1:17
3:47
1:12
2:20
3:50
Common
7:28
7:28
1:31
1:41
5:42
3:47
Lower Yield
2:33
1:57
1:31
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Overview of What to Expect After Surgery
After Surgery Questions
7:28
9:21
3:27
4:20
2:41
7:45
1:47
1:30
4:05
After 24 hours
3:20
4:57
1:23
1:47
After 1-2 weeks
2:12
2:32
1:20
3:04
4:44
5:34
After 1-2 months
3:27
Between 3-12 months
5:14
5:52
Beyond 1 year
3:58
1. How often should I use my eye drops? What happens if I forget a dose?
You’ll typically use your eye drops several times daily in your eye(s) after surgery, following the exact schedule we’ll give you. If you forget a dose, use it as soon as you remember. At some centers, we give a combination eye drop for convenience (a mixture of antibiotic, and two types of anti-inflammatory medicine). At other centers, you may have filled a prescription of post operative eye drops consisting of the three different eye drops in separate eye drop bottles. Please follow the directions provided to you for use by the clinic and please call the clinic if you lose the eye drops or need refills.
2. Why do I feel like there’s something in my eye after surgery?
It’s common after surgery because the eye is healing. The sensation is usually specific to the site of the 2 tiny incision at the outer edge of the eye, although at times you will have a nonspecific discomfort that is thought to be due to the (harsh) antiseptic solutions used to sterilize the eye before surgery. Your eye might feel scratchy or gritty for a few hours to a few days. Artificial tears help ease this sensation, and it usually goes away quickly. You may use artificial tears liberally when you feel this sensation or when your vision fluctuates in blurriness.
3. I see halos after the surgery in some lighting conditions—is this normal?
Yes, this is normal in the early healing phase, due to surgical dilation which lasts 24 hours and combined with swelling on the surface of the eye from surgery. These side effects quickly improve after 24 hours, but if you have a multifocal implant you will expect to see rings around bright lights at night time for several months to a year. This will pass as your brain neuro-adapts to the multifocal lenses.
4. Why is my vision blurry and why am I sensitive to light?
Blurry vision and sensitivity to bright lights are common right after surgery because your eye is dilated. This may take at least 24 hours to a few days to improve. Sunglasses and regular use of prescription eye drops and artificial tears can help you feel more comfortable. For cataract patients, you will have significantly higher light transmission and therefore your vision will be much brighter. This is one of the objectives of cataract surgery and rarely do patients complain about achieving this goal.
5. Why am I seeing the lens flicker as I move my eyes?
This “flickering” sensation is normal during early healing. It’s caused by small reflections or slight lens movements and usually stops as your eye fully heals and adjusts—typically in a few weeks. Some patients worry that this could be the “flashes” symptom that is a warning sign of retinal detachment, an easy way to determine if it is an optical phenomenon or retinal pathology is if by closing your eyes this eliminates the flashes: this would indicate it is just the small reflections of the lens and not symptoms of retina issues.
6. Why do I see flashes of light?
Occasional flashes can occur because your eye is healing and adjusting, due to the slight movements of the lens and light reflected from this movement. As above, a good way to determine if it is the lens is to close your eye, if the symptoms disappear then it is simply the lens and this is normal, if the bright flashes continue even with your eyes closed then contact us right away so we can check your retina.
7. Why is my peripheral vision blurry?
Temporary blurriness in peripheral (side) vision is very normal due to the small incisions from your surgery that are placed at the outer edges of your eye, these areas will be swollen for a few days and this is why your vision is blurrier at the periphery than at the center. This clears within days to a few weeks as the eye heals completely.
8. What should I watch out for?
Watch for sudden vision loss, increasing eye pain and redness, worsening swelling, new floaters, and flashes of light (that persist with the eye closed). Call us immediately if you experience these symptoms.
9. How can I tell if I have an infection?
Signs of infection include increasing redness, increasing eye pain, increasing sensitivity to light, increasing significant swelling, and decreased vision. Usually all of the above simultaneously would warrant a call to us immediately. Individually, these symptoms are normal. Infections are uncommon after the first 5-7 days after surgery and symptoms would arise starting 2-3 days after surgery.
10. When will I notice an improvement in my vision?
Most patients see improvement within the first few days, with vision steadily becoming clearer over a few weeks as your eyes fully heal and adjust. RLE will heal quicker than cataract surgery, and the more advanced the cataract, the longer it may take to fully heal.
11. Will I need special UV glasses after the surgery? (Light Adjustable Lens)
The Light Adjustable Lens requires you to wear special UV glasses provided by us after surgery when you are exposed to sunlight. This is no longer required after your lenses have been fully adjusted and locked in. This topic is explored more thoroughly under the LAL video summary (FAQ and Surgery planning sections).
Why do I feel like there’s something in my eye after surgery?
It’s common after surgery because the eye is healing. The sensation is usually specific to the site of the 2 tiny incision at the outer edge of the eye, although at times you will have a nonspecific discomfort that is thought to be due to the (harsh) antiseptic solutions used to sterilize the eye before surgery. Your eye might feel scratchy or gritty for a few hours to a few days. Artificial tears help ease this sensation, and it usually goes away quickly. You may use artificial tears liberally when you feel this sensation or when your vision fluctuates in blurriness.
I see halos after the surgery in some lighting conditions—is this normal?
Yes, this is normal in the early healing phase, due to surgical dilation which lasts 24 hours and combined with swelling on the surface of the eye from surgery. These side effects quickly improve after 24 hours, but if you have a multifocal implant you will expect to see rings around bright lights at night time for several months to a year. This will pass as your brain neuro-adapts to the multifocal lenses.
Why is my vision blurry and why am I sensitive to light?
Blurry vision and sensitivity to bright lights are common right after surgery because your eye is dilated. This may take at least 24 hours to a few days to improve. Sunglasses and regular use of prescription eye drops and artificial tears can help you feel more comfortable. For cataract patients, you will have significantly higher light transmission and therefore your vision will be much brighter. This is one of the objectives of cataract surgery and rarely do patients complain about achieving this goal.
Why am I seeing the lens flicker as I move my eyes?
This “flickering” sensation is normal during early healing. It’s caused by small reflections or slight lens movements and usually stops as your eye fully heals and adjusts—typically in a few weeks. Some patients worry that this could be the “flashes” symptom that is a warning sign of retinal detachment, an easy way to determine if it is an optical phenomenon or retinal pathology is if by closing your eyes this eliminates the flashes: this would indicate it is just the small reflections of the lens and not symptoms of retina issues.
Why do I see flashes of light?
Occasional flashes can occur because your eye is healing and adjusting, due to the slight movements of the lens and light reflected from this movement. As above, a good way to determine if it is the lens is to close your eye, if the symptoms disappear then it is simply the lens and this is normal, if the bright flashes continue even with your eyes closed then contact us right away so we can check your retina.
7. Why is my peripheral vision blurry?
Temporary blurriness in peripheral (side) vision is very normal due to the small incisions from your surgery that are placed at the outer edges of your eye, these areas will be swollen for a few days and this is why your vision is blurrier at the periphery than at the center. This clears within days to a few weeks as the eye heals completely.
What should I watch out for?
Watch for sudden vision loss, increasing eye pain and redness, worsening swelling, new floaters, and flashes of light (that persist with the eye closed). Call us immediately if you experience these symptoms.
How can I tell if I have an infection?
Signs of infection include increasing redness, increasing eye pain, increasing sensitivity to light, increasing significant swelling, and decreased vision. Usually all of the above simultaneously would warrant a call to us immediately. Individually, these symptoms are normal. Infections are uncommon after the first 5-7 days after surgery and symptoms would arise starting 2-3 days after surgery.
When will I notice an improvement in my vision?
Most patients see improvement within the first few days, with vision steadily becoming clearer over a few weeks as your eyes fully heal and adjust. RLE will heal quicker than cataract surgery, and the more advanced the cataract, the longer it may take to fully heal.
Why do I feel like there’s something in my eye after surgery?
It’s common after surgery because the eye is healing. The sensation is usually specific to the site of the 2 tiny incision at the outer edge of the eye, although at times you will have a nonspecific discomfort that is thought to be due to the (harsh) antiseptic solutions used to sterilize the eye before surgery. Your eye might feel scratchy or gritty for a few hours to a few days. Artificial tears help ease this sensation, and it usually goes away quickly. You may use artificial tears liberally when you feel this sensation or when your vision fluctuates in blurriness.
I see halos after the surgery in some lighting conditions—is this normal?
Yes, this is normal in the early healing phase, due to surgical dilation which lasts 24 hours and combined with swelling on the surface of the eye from surgery. These side effects quickly improve after 24 hours, but if you have a multifocal implant you will expect to see rings around bright lights at night time for several months to a year. This will pass as your brain neuro-adapts to the multifocal lenses.
Why is my vision blurry and why am I sensitive to light?
Blurry vision and sensitivity to bright lights are common right after surgery because your eye is dilated. This may take at least 24 hours to a few days to improve. Sunglasses and regular use of prescription eye drops and artificial tears can help you feel more comfortable. For cataract patients, you will have significantly higher light transmission and therefore your vision will be much brighter. This is one of the objectives of cataract surgery and rarely do patients complain about achieving this goal.
Why am I seeing the lens flicker as I move my eyes?
This “flickering” sensation is normal during early healing. It’s caused by small reflections or slight lens movements and usually stops as your eye fully heals and adjusts—typically in a few weeks. Some patients worry that this could be the “flashes” symptom that is a warning sign of retinal detachment, an easy way to determine if it is an optical phenomenon or retinal pathology is if by closing your eyes this eliminates the flashes: this would indicate it is just the small reflections of the lens and not symptoms of retina issues.
Why do I see flashes of light?
Occasional flashes can occur because your eye is healing and adjusting, due to the slight movements of the lens and light reflected from this movement. As above, a good way to determine if it is the lens is to close your eye, if the symptoms disappear then it is simply the lens and this is normal, if the bright flashes continue even with your eyes closed then contact us right away so we can check your retina.
7. Why is my peripheral vision blurry?
Temporary blurriness in peripheral (side) vision is very normal due to the small incisions from your surgery that are placed at the outer edges of your eye, these areas will be swollen for a few days and this is why your vision is blurrier at the periphery than at the center. This clears within days to a few weeks as the eye heals completely.
What should I watch out for?
Watch for sudden vision loss, increasing eye pain and redness, worsening swelling, new floaters, and flashes of light (that persist with the eye closed). Call us immediately if you experience these symptoms.
How can I tell if I have an infection?
Signs of infection include increasing redness, increasing eye pain, increasing sensitivity to light, increasing significant swelling, and decreased vision. Usually all of the above simultaneously would warrant a call to us immediately. Individually, these symptoms are normal. Infections are uncommon after the first 5-7 days after surgery and symptoms would arise starting 2-3 days after surgery.
When will I notice an improvement in my vision?
Most patients see improvement within the first few days, with vision steadily becoming clearer over a few weeks as your eyes fully heal and adjust. RLE will heal quicker than cataract surgery, and the more advanced the cataract, the longer it may take to fully heal.
Day 1
Week 1-2
Month 1-2
As needed
YAG
Lasik Enhancement (non-LAL)
Day 1
Week 1-2
Month 1-2
As needed
YAG
Lasik Enhancement (non-LAL)
Cataract versus RLE
Standard IOL
Multifocal IOL
LAL
Cataract versus RLE
Standard IOL
Multifocal IOL
LAL
Cataract versus RLE
IOL type
Sometimes clear, sometimes not (Postop Dry Eye)
Adaptation
“Off target”
Other considerations
Cataract versus RLE
Standard IOL
Multifocal IOL
LAL
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Technical and philosophical questions
Miscellaneous Questions
7:22
2:27
1:53
4:00
1:12
8:42
4:16
1:16
3:47
2:16
1:12
8:42
4:20
3:35
2:32
2:05
2:00
1:51
0:53
0:51
My best guess...
2:01
2:01
1:50
2:23
1:05
2:09
Test
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
No.
*I do not use blue blocking lenses. These have fallen out of favor for many years. There is skepticism about permanent blue blockers affecting mood and circadian rhythem.
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
No. They are silicon or plastic (acrylic) or hydrogel (ICL)
Add some content for each one of your videos, like a description, transcript or external links.To add, remove or edit tab names, go to Tabs.
Unfortunately no.
No, but this is not a bad problem to have.
No, these do not exist yet.
No, these do not exist yet.
No, these do not exist yet. There are no electronic components to existing intraocular lenses.
No, these do not exist yet. There are no electronic components to existing intraocular lenses.
No, there are no electronic components to existing intraocular lenses.
Yes and no. You are still human, and perhaps bionic / cyborg.
You cannot give your cataracts to someone else. They will get their own in due time. Cataracts are a form of blindness, and this is not a suitable gift.
Possibly. You may have better quality of life and thus have better mood (temporarily or permanently).
Personality is hard to change beyond your formative years. I do not expect cataract surgery or RLE will be a solution to mood and psychiatric disorders, and you should not do these surgeries for such reasons.
Maybe. Our understanding of dreams is limited. If they represent a process of consolidation of memories (visual and otherwise), then these memories will be enhanced if your vision is improved. And possibly your dreams will be positively affected. I do not know if RLE will prevent nightmares.