Cataract and RLE


If you have been told that you have a cataract, this means that all or part of your natural human lens has become cloudy. Commonly, people complain of increasing glare (especially driving at night), a rapidly shifting glasses prescription and deteriorating vision. There are no proven medications or eye drops to treat cataracts. The only treatment available is cataract surgery.

Modern day cataract surgery is the commonest elective operation performed in the world and has the best safety profile of all operations performed in the world. It is low risk (less than 1% complication rate), relatively fast (a day procedure meaning you go home the day of the surgery) and highly effective at improving vision.

The operation itself is keyhole surgery that replaces the cloudy human lens with a clear plastic intraocular lens (IOL) that is biocompatible with the human body. This means you will only need the one operation to last you for life. The operation is mostly performed under local anaesthetic, but can be performed under general anaesthetic if needed.  Aftercare is simple (just drops 4x per day) and there are few restrictions on activity.

Refractive Lens Exchange

When a cataract operation is performed on a clear lens with the aim of helping reduce a need for glasses rather than remove a cataract, this is known as Refractive Lens Exchange (RLE) surgery. Sophisticated measuring techniques are available to guide the choice in IOL selection to minimise your glasses dependence after surgery. This technique is commonly used as an alternative to laser eye surgery for select patients.

IOL selection

A variety of IOL options are available, including multifocal and astigmatism correcting lenses, and IOL selection strategies are available to give you greater freedom from glasses. There are no perfect IOLs and every lens choice involves some level of compromise. In general, there are three types of IOLs to consider:

Spherical IOLs

This IOL gives excellent vision for distance and most patients do not need glasses for driving. However, for all vision nearer than arms length, glasses are needed.

Toric IOLs

Toric IOLs were specifically designed for patients with astigmatism and represents the next generation of IOLs above spherical lenses. This means that patients with astigmatism often do not need glasses for distance vision, but will need reading glasses for seeing near objects.

Multifocal IOLs

Multifocal IOLs are the newest generation of IOLs on the market. This IOL choice maximises your glasses independence with studies showing that over 80% of people who have this type of IOL inserted are glasses free for their everyday activities. As well as correcting for distance and near vision, they also correct for astigmatism. The IOL works by creating multiple images simultaneously on your retina. You have to train your brain to focus on the image you want to see and this usually takes about 3-6 months. What this means is that for the period of adaptation, it is common to see a small amount of halos around brightly lit objects (such as headlights at night). Once adaptation is complete most people no longer notice these changes. With this lens choice, most people are glasses free for their activities of daily living.