Refractive Lens Exchange

Video Transcription:

Speaker:
When we get to the point where we can have merch

Dr. Cha:
. Merch ,

Speaker:
Merch,

Dr. Cha:
Merch. That’d be crazy. Did we get a cut? ’cause we’re the stars?

Speaker:
Nah.

Dr. Cha:
What

Dr. King:
. Yeah. This is my retirement plan man. . I’m gonna be working until I’m 80. I forgot. We might be doing this. So there’s no product in my hair.

Dr. Cha:
That’s okay. My hair’s a little messy.

Dr. King:
What’s this show called?
Dr. Cha:
.

Dr. King:
Oh yeah. Hi. Welcome to the Days of Our Eyes. I’m Dr. King.

Dr. Cha:
And I’m Dr. Cha.

Speaker:
Today we’re gonna be talking about refractive lens exchange. That’s a big, long word, isn’t it? What is it? Who’s it good for? Why would you do it? Stick around. We’ll let you know.

Speaker:
All right, so first question, what is RLE?

Dr. King:
You wanna handle “What is RLE?”

Dr. Cha:
Sure.

Dr. King:
Make you talk.

Dr. Cha:
Yeah. RLE. Uh, the initials for refractive lens exchange. Some people call it “clear lens exchange.” It boils down to cataract surgery without having the actual cataract. I don’t know how you talk about it with patients in the rooms, but I bust out the, the camera Analogy.

Dr. King:
Camera, yeah.

Dr. Cha:
Right.

Dr. King:
Yeah, I do, I do the camera quite a bit.

Dr. Cha:
Yeah. When you look at a camera, you know that front, um, that front, um, lens. Lens, I guess you could call it . And so our eyes have a couple different lenses in the front. The front part being the cornea. We talked about that in the past. Uh, this is where contact lenses go. Uh, this is where LASIK, PRK, those kinds of corneal refractive surgeries are done. Mm-hmm. Right behind it, behind the color part of your eye, which is called the iris, is a lens, an actual lens. That’s where I, I guess every other lens gets its name. . Mm-hmm. . Uh, it’s called the crystalline lens. When you get, uh, glasses or contacts, traditionally we set you out so that your vision is, um, you know, clear and comfortable out in the distance. And then that lens changes shape so that you can see closer and closer and closer. That’s our accommodative system. Or, uh, for focusing ability. When we talk about refractive lens exchange, we’re actually removing that lens and replacing it, uh, with, uh, a brand new lens. Right?

Dr. King:
I mean, that’s, that’s the basic of what an RLE is, is we are literally exchanging your natural lens for a manmade lens. Why would we do that? Who, who needs that? So, a lot of us have spent our life wearing contacts and stuff, couldn’t quite get up the money for LASIK, you know, wanted to correct it. But we’ve been working, we’re more successful now. We’re later on in our career. Now we’re needing bifocals. Our lens can no longer help us focus up close. That’s when it’s time to start talking about refractive lens exchange. Because in the other procedures, we can only do monovision, one eye distance, one eye near, because nothing’s flexible. Not everybody’s brain can adapt to that. My brain can’t adapt to that. It is just not happening. I’ve tried mm-hmm. . So it’s folks that are further along in life. Mm-hmm. , we like you to be, you know, around age 50 or so. Mm-hmm. . Now the lens is a little softer. It’s a little less struggle in the eye to get that lens out.

Dr. Cha:
When the lens goes in our eye does it move like the natural lens that we have already?

Dr. King:
No. They tried some of those so far, they haven’t found one of those that works. Right. These lenses use a couple different things. Um, we have what’s called a true multifocal lens that has zones or rings of vision, and it’s a simultaneous vision design. What that means is that it’s focusing the distance and the near. It divides the light up and your brain neuro adapts. It learns to tune in for distance and intermediate. And near that particular lens gives us the most near vision that we can have. So that’s a great option for folks that spend a lot of day up close folks who do a lot of crafts and things like that.

Video:
When I get nervous, I do embroidery.

Dr. King:
Mind you, these are manmade lens. Mm-hmm. , they’re not perfect. Mm-hmm. , but they’re better than, you know, when you’re stuck and you can’t see anything and having to put on glasses for everything. Right. The other way of doing it is using a lens that has extended depth of focus. It has a range of vision. It, it uses some optic magic. I call it. It’s aspheric optics. Mm-hmm. that lens we can actually put in the eye, then fine tune it with a light delivery device and create a range of vision. And we can take the two eyes and set them so that it’s blended. So one eye sees a little further out, but one eye sees a little closer up and it creates a, a binocular range of vision that is pretty great. Doesn’t get you quite as close as the multifocal, but it gives you fantastic optics, great night vision, fantastic computer. And you can still read a text on your phone. Mm-hmm. . So those lenses work great for a lot of our digital people, you know, because it gives you this fantastic, uh, range and clarity. Mm-hmm. . So if you’re really picky, that’s a nice lens. . Mm-hmm.

Dr. Cha:
. Right, right.

Dr. King:
I’ve babbled a lot.

Dr. Cha:
No, that was good. I mean, since this is kind of the one time in your life where you could kind of cash all your chips in to really set your vision. We also, you know, like with any refractive surgery, we make sure that the eye is healthy from, you know, right

Dr. King:
Front to back.

Dr. Cha:
Yeah. Tip to tail is what they call it.

Dr. King:
Yep.

Dr. Cha:
Yeah.

Speaker:
So can people still, they can’t develop cataracts once the lens is gone? Like the lens doesn’t grow back, does it?

Dr. King:
No, the lens does not grow back. We’ve removed it as with any lens surgery though. Um, when we, when we do this, it’s like cataract surgery. The, your natural lens is held in a bag called the capsule. Mm-hmm. . We use a laser and cut a hole in the front of the capsule, clean your lens out, put the new lens in there, and it of shrink wraps and holds it in place. The backside of that capsule’s still intact. That can fibrose over time. And if that happens, it’ll fuzz the vision up. That’s when we can take a laser called a YAG laser and just clear that off. That’s a one-time deal. We just clean that off so you can see straight through again. Um, and that won’t come back after that.

Speaker:
Do the lenses expire ? Like do they, do they wear out? Do they like wear out or like, is it like, you know,

Dr. King:
People, you know, you wonder, I mean, this is going in my eye at 50. Is it gonna still be okay when I’m 90? ’cause we’re living longer these days.

Dr. Cha:
Mm-hmm. .

Dr. King:
So you wanna?

Dr. Cha:
Sure. I mean, I think I’ve heard like certain implants, like even like titanium implants or something, they can like, wear down, like from movement, you know, from maybe the body, you know, maybe reacting to um, certain materials, you know, lenses are made out of different things. Usually silicone, PMMA, acrylic, you know, they’re pretty inert, which means they don’t really react with much, especially inside the body. And also the eye is a very specialized organ. It’s immuno-privileged, which means it almost acts separately from the rest of the body and how it reacts to certain things.

Dr. King:
It’s true. I’ve, ’cause I always thought the eye is part of the body and it is, however, in terms of immune response. Yeah. Your body, we don’t have to worry about the, your body rejecting these lenses or eating at ’em or anything like that.

Dr. Cha:
Mm-hmm. . Yeah. They’re very stable.

Dr. King:
And these lenses don’t wear out. They’re there forever. Um, as long as the rest of the eye stays healthy, your vision’s pretty stable. Yeah. But don’t let it dry out. Right. Make sure you still get checked for glaucoma and all that other stuff that can happen. It doesn’t get you out of having your eyes checked.

Dr. Cha:
Mm-hmm.

Dr. King:
Just gets you outta being so dependent on eyewear.

Dr. Cha:
Right.

Dr. Cha:
I heard a joke. Right?

Speaker:
Oh no, he’s gonna tell a dad joke.

Dr. Cha:
I don’t know if that, maybe it was a dad joke. Is it a joke? Did I say a joke? You know, they said like, in a thousand years when they find our bodies, they’re gonna find these little plastic pieces where their eye socket are. That’s how they’re not going anywhere.

Dr. King:
. Yeah. The lens won’t break down. . It’ll outlast you. Yeah.

Speaker:
We’ll be there with Wall-E

Dr. King:
Yeah.

Speaker:
So my last question is like, what’s the recovery like? It’s, I know it’s a little bit different than, um, corneal procedures.

Dr. King:
Mm-hmm. .

Dr. Cha:
Mm-hmm. .

Speaker:
So drops, don’t touch your eyes. Like what’s the recovery?

Dr. King:
Don’t touch your eyes. It’s, it’s a little more like a cataract surgery recovery. Okay. You’re going to use a multi-drop. It’s, it’s got three drugs in one. Uh, an antibiotic, a steroid, and a nonsteroidal anti-inflammatory drop. Use ’em four times a day for a week, then three times a day for a week, twice a day. Once a day. You just taper it down. Um, and the restrictions are pretty similar. You, uh, no water in the eye for a week. You’re gonna sleep with a shield over your eye at night, not during the day. A lot of folks think they have to wear goggles all day. You don’t. Um, we just don’t want you rolling over in the middle of the night or waking up in the morning, sleepy and rubbing your eyes. Something like that. You know what we talk about, Eye rubbing? Stop it. Yeah. And, uh, no lifting over 20 pounds for a week, bending and lifting particularly. Um, because that raises pressure in the head. We don’t want that for the first week after a week. There are no restrictions. Vision, recovery, pretty quick. Mm-hmm. , you know, you’re seeing that day, but it’s going to, it’s gonna improve over the first week. Vision recovery on an RLE over a cataract surgery is usually fairly quick. ’cause we don’t have to use as much energy to break up when a lens is cataract “cataract-us” . Right? That’s a word.

Dr. Cha:
I, I like it.

Dr. King:
It’s, it’s harder. So you have to use more energy. So we, there’s more swelling when it’s a clear lens. Um, it breaks up a little easier and the, the surgeon can get it out with a little less swelling. So the vision recovery’s pretty darn quick.

Speaker:
Well, y’all are in closing. Already.

Dr. King:
Well, no.

Speaker:
Hecking, speedsters

Dr. King:
What are we doing here? We’re in closing. . Well, I haven’t even drank a whole cup of coffee yet now. We haven’t talked enough . So that’s all we know about RLE. We hope we answered some questions for you. We hope you have a better understanding of what the concept is. If you have any questions about what you heard today, just drop ’em in the Dropbox. Of course. If you like what you heard, subscribe, please subscribe. Otherwise, we’ll be seeing you next time. I’m Dr. King.

Dr. Cha:
And I’m Dr. Cha.

Dr. King:
Catch you around.