Assess night driving, work habits when considering refractive lens exchange candidates
Key takeaways:
- Patients with hyperopia tend to be the happiest with refractive lens exchange.
- Trial monovision in patients with myopia.
KOLOA, Hawaii — Refractive lens exchange is becoming more popular as lens technology progresses, according to a speaker at Hawaiian Eye 2025.
Dagny Zhu, MD, said refractive lens exchange (RLE) can carry higher stakes than other surgeries because patients have high expectations.
Zhu asks every patient who is interested in RLE three questions: How much do you drive at night, what do you do for a living and what are your hobbies, and how often do you wear glasses?
For patients with hyperopia, Zhu said she avoids laser vision correction because of the possibility for regression and the potential for higher-order aberrations. In addition, these patients usually do not tolerate monovision.
In these cases, she considers RLE with a bilateral full range vision IOL, a mix-and-match strategy or a bilateral extended depth of focus (EDOF)/monofocal IOL.
“Hyperopes will be your happiest RLE patients,” Zhu said. “That’s definitely the population I would start with.”
In patients with myopia, Zhu will often have them try monovision to see if they can tolerate it. If they can, she will push for laser vision correction or an ICL (STAAR Surgical) to avoid retinal complications. If the patient decides to pursue RLE, Zhu will consider a bilateral full range vision IOL or an EDOF/monofocal IOL. However, she always refers these patients to a retina specialist first to assess peripheral retinal pathology and posterior vitreous detachment.
For patients with emmetropic presbyopia, Zhu will not consider RLE unless they fit a specific profile.
“This patient has to have lost all of their accommodation, have really high demands for near because of their work, not drive much at night and have very realistic expectations,” she said. “That’s the only scenario where I’ve considered a full range of vision lens only in their nondominant eye. Oftentimes, that’s enough.”
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Zhu D. Refractive lens exchange: The next frontier. Presented at: Hawaiian Eye 2025; Jan. 18-24, 2025; Koloa, Hawaii.
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