Lens Replacement Surgery vs. LASIK: Uses, Benefits, Side Effects and More

Both lens replacement surgery and laser-assisted in situ keratomileusis (LASIK) aim to correct nearsightedness (you have difficulty seeing at a distance), farsightedness (you have trouble seeing at all ranges), and other vision issues so you can be as independent of glasses and contact lenses as possible. The difference is in how these make this happen.

With lens replacement surgery, also known as refractive lens exchange or clear lens extraction, as the name suggests, it's all about the lens.

The lens is the part of the eye that refracts light onto the light-sensing retina at the back of the eye. When the light does not land in quite the right place with your lens, one strategy is to replace this lens with an artificial lens that can fix the issue.

Meanwhile, with LASIK, the idea is to reshape the cornea (the clear dome of the eye) so that the light rays land on the retina.

As part of this article, we will highlight how each of these treatments works, consider which is best for you, when these might be used together and how to cope with side effects.

What to Know About Lens Replacement Surgery

Like LASIK, lens replacement surgery is considered a refractive procedure done to improve vision.

How Does It Work?

With lens replacement surgery, the idea is to enhance your vision by removing the natural lens and replacing this with a premium artificial one that can offer sharp vision at needed distances.

Clear lens extraction may interest the same people who typically undergo elective refractive surgery such as LASIK.

People who undergo lens replacement surgery have been told their needed refractive correction is too great for LASIK, where reshaping the cornea would take too much tissue, such as someone who is very nearsighted.

Lens Replacement Surgery Delivery

The surgery is very similar to traditional cataract surgery. There is one difference, however. That is that there is no cataract clouding the lens in this case. The only reason for the clear lens extraction is the desire to improve the sharpness of the vision with less dependence on glasses or contact lenses.

Once the natural crystalline lens is removed, it is replaced by an artificial one. Most of the time, the artificial lens is what's known as a premium lens. Such lenses can not only enable you to see sharply at a distance but also:

• Let you see up close or intermediate distances with multifocal or accommodating lenses.
• Allow you to see clearly with astigmatism with the aid of toric lenses.

With astigmatism, vision is blurry because the clear dome of the eye, the cornea, is misshapen. The toric lens is designed to compensate for this.

Side Effects

While refractive lens exchange can offer many benefits, there can at times also be potential complications to be aware of, such as the possibility of:

• Retinal detachment: The retina, which is the eye's light-sensing layer, loosens from the back of the eye
• Infection
• Swelling of the macula (the central part of the light-sensitive retina)
• Mistake in lens power

Prices and Where to Get It

The cost of refractive lens exchange is usually not covered by insurance. It also tends to be about double that of LASIK.

Refractive lens exchange is typically done at private clinics and university centers.

What to Know About LASIK

The idea behind LASIK is to use the laser to reshape the cornea so that vision is sharp without relying on glasses or contact lenses.

Laser stands for light amplification by stimulated emission of radiation. A laser device produces light at a specific wavelength and amplifies it. The narrow light beam produced is coherent, meaning the peaks and valleys of the light waves are lined up.

How Does It Work?

With the LASIK procedure, your ophthalmologist (eye doctor) makes a flap in the cornea and temporarily lays this back out of the way. The ophthalmologist then aims the excimer laser at the eye to reshape the cornea. The laser removes tiny amounts of tissue, unique to each eye.

Once the procedure is done, the flap is then put back in place. Then, if the other eye needs to be treated, this can be done as well.

While this can effectively treat nearsightedness, farsightedness, and astigmatism, if the correction needed is too great, this will not be possible since too much tissue must be removed.

If you are over age 40 and have presbyopia, where the lens of your eye no longer focuses well up close, you are unlikely to be a great candidate for LASIK. Even if LASIK corrects your distance vision, you may need to wear glasses for reading. Some people with presbyopia consider monovision LASIK, where one eye is corrected for distance and the other for near vision.

LASIK is usually suited for those who:

• Are at least over age 18
• Have a stable prescription that hasn't changed in the past 12 months
• Need a mild to moderate correction with a cornea that has enough corneal tissue to accomplish this
• Understand what LASIK can and can't do for them

Remember that about 90% of those with LASIK attain vision between 20/20 and 20/40 without using glasses or contact lenses.

LASIK Delivery

Your ophthalmologist will help you decide if LASIK is right for you. If you do decide to undergo LASIK, here's what you can expect:

• Your eyes will be numbed. You'll be given a sedative to help you relax.
• A device will be put in your eye to keep the lids open
• The ophthalmologist will put a suction ring on your eye to keep your eye in place. Don't be surprised if you feel a little pressure and your vision dims somewhat.
• The ophthalmologist will then make a thin flap of corneal tissue using either a microkeratome or a femtosecond laser device. Then, temporarily, the flap will be lifted out of the way.
• Using the excimer laser, the ophthalmologist will begin reshaping your cornea as you focus on a light. While the laser is being used, you will hear a clicking sound.
• Once the reshaping is done, the ophthalmologist will lay the flap back down and allow this to heal in place over the next couple of minutes.

Prices and Where to Get It

LASIK typically runs anywhere from $1,000 to $4,000 per eye. This may vary based on where you get the procedure done and the amount of correction you need. Often, the procedure is deemed elective and not covered by insurance. However, some vision care insurance may cover part of the procedure.

You can expect to find LASIK available at individual surgery facilities and university centers.

Side Effects

While about 90% of people are satisfied with their LASIK outcomes, like any procedure, there can be side effects. Some side effects that are often temporary, but in some cases may be permanent include:

• Seeing circles or starbursts around lights at night
• Night driving issues
• Blurry vision
• Sensitivity to light (photophobia)
• Eye pain
• Subconjunctival hemorrhage with reddish areas in the whites of the eyes.

What Treatment Is Best for You?

When deciding whether to undergo LASIK or refractive lens exchange, you must consider how much correction you need. If the required correction is too great, you will not be able to undergo LASIK.

Also, if you are around age 40 or over, keep in mind that you will have more difficulty focusing up close due to presbyopia. With refractive lens exchange, you can get a premium lens that can correct this.

In addition, if you have even the beginnings of a cataract, you may want to opt for refractive lens exchange since this will have to be removed anyway in the not too distant future.

If cost is also a factor and you are a good LASIK candidate, then the fact that this is far less expensive needs to be considered.

In the end, you need to discuss with your ophthalmologist which approach is right for your unique situation.

Can Refractive Lens Exchange and LASIK be Used Together?

Opting for one of these procedures will not necessarily keep you from later undergoing the other.

So, if you have refractive lens exchange and the lens power is slightly off, your ophthalmologist may suggest enhancing the result with LASIK, a less invasive procedure. If, after LASIK, you begin to experience near vision issues with signs of an early cataract, you may wish to consider refractive lens exchange.

Coping With the Side Effects

Side effects following either refractive lens exchange or LASIK will often subside on their own as the eye heals. But, if side effects persist or are not temporary, there are things you can do such as:

• Reach out to your ophthalmologist and undergo prompt treatment for potentially sight-threatening issues such as retinal detachment or infection.
• Undergo an enhancement procedure for a lens power that is slightly off or to touch up LASIK results that are less than 20/20.
• Wear glasses with special coatings to compensate for glare or use drops to shrink your pupil to diminish nighttime driving problems.
• Wear glasses with tinted lenses to tamp down on light sensitivity.

Summary

Refractive lens exchange and LASIK offer the opportunity to improve vision with the possibility of seeing clearly without glasses. Refractive lens exchange improves vision by replacing the natural lens with an artificial one that can correct for problems such as nearsightedness, farsightedness, and astigmatism.

With LASIK, the cornea is reshaped with an excimer laser to ensure that the light rays land on the light-sensitive retina for clear vision. Deciding between the two depends on factors such as your prescription, age, and other visual issues.

A Word From Verywell

Determining whether to opt for refractive lens exchange or LASIK as a way of improving vision means weighing a lot of factors. In some cases, the answer may be clear from the start, but in others, this may be a nuanced choice for which there is no right answer. Then, it may be entirely up to you to decide which option feels right.