Why Refractive lens replacement/exchange in London?

Refractive Lens Exchange (RLE) is also known as refractive lens replacement surgery or clear lens extraction.

RLE is a life-changing treatment that enables you to see well for most distances without spectacles or contact lenses. The aim is to minimise your dependence on spectacles, to improve your independence and quality of life.

It is ideal for individuals who are 50 years of age or older, who wish to avoid wearing glasses or contact lenses.

It may be a better option than laser vision correction, such as LASIK, because refractive lens exchange enables implantation of ‘multifocal’ lens types. This means the eye can see well for more than one distance (e.g. far and close), unlike laser vision correction, which is more often used to give good vision for one distance (e.g. far) in each eye.

Refractive lens exchange is commonly used to correct refractive errors, such as myopia (near-sightedness), hyperopia (far-sightedness), and astigmatism. It can also address presbyopia, which is the age-related loss of near vision.

What is Refractive Lens Exchange?

Refractive Lens Exchange (RLE) is a procedure that involves replacement of the eye’s natural lens with a premium artificial lens implant.

RLE surgery is almost identical to cataract surgery. The term RLE is used when the natural crystalline lens in your eye is still clear (i.e. not cloudy). Like cataract surgery, RLE is one of the safest and most commonly performed surgical procedures worldwide. It’s typically recommended when glasses or contact lenses are no longer a suitable solution for vision correction or when one wishes to decrease dependence on them.

Do you use specific lens implants for cataract surgery?


At Harley Vision, we choose the lens implant that matches your lifestyle needs. Lens implants we offer range from simple monofocal lenses to premium and toric multifocal lenses. We use the best lens implants and laser technology in the industry. These will be explained in more detail at your consultation.
The UK is one of the best possible places in the world to have the latest technology in eye surgery, because we have more laser and lens implant choices than many other countries around the world.


We do not have any special deals with any companies forcing us to use lasers and implants from one company. Although this means this is more expensive for us, because we do not benefit from economies of scale like many other clinics, we simply do not care. What we do care about is having the flexibility to use whatever lens implant or laser technology we think is best for the patient.

Rest assured that at Harley Vision, we will offer you what we believe is the best choice for your eyes, rather than what we ‘must’ use.

Refractive Lens Replacement Vs Lasik in London

Lasik or Laser-Assisted In situ Keratomileusis is a surgical procedure involving refractive error correction by reshaping the cornea of the eye. Refractive Lens Replacement involves correcting refractive errors by replacing the natural lens of the eye with a lens implant through lens replacement surgery. Both procedures are aimed at reducing the use of spectacles and contact lens. Additionally, both procedures are simple, safe and effective. Lasik is possible if your corneas are found to be suitable for LASIK surgery. Refractive Lens Replacement is opted for patients with certain eye prescriptions or those who would like to see well in more than one distance (e.g. with use of multifocal lens implants).

Refractive Lens Replacement Procedure - What's involved in Treatment

Various types of intraocular lens implants (IOLs) are used in a Refractive Lens Replacement procedure. They can be either Monofocal lenses, extended depth of focus lenses, toric lenses or multifocal lenses. Monofocal IOLs provide clear vision but only for a particular distance i.e. distance, intermediate or near. Multifocal lenses give clear vision for more distances, i.e. distance, intermediate and near.

Monofocal lens implants and extended depth of focus (EDOF) implants provide better contrast sensitivity and reduced glare effects, but you are more likely to need glasses after surgery for reading and using computers. Multifocal IOLs provide better vision for all distance, intermediate and near zones but are associated with glares and halos as side effects.

The treatment modalities for each procedure may vary depending on the clinic you choose in London and the modalities they have for such types of the refractive lens replacement procedure. At Harley Vision, London, we have the best modalities to make your treatment a hassle-free affair.

Benefits of Refractive Lens Replacement

Refractive lens replacement provides a permanent solution for refractive error in the long run in comparison to other modes of refractive error correction. You do not need to be bothered about the yearly changing of your glasses or contacts and can happily stay without glasses for life. And its recovery period is short, meaning you can get back to your normal life in a very short time post-surgery.

Additionally, it is a welcome solution for people who have high refractive errors or conditions like thin or deformed cornea where LASIK is not possible. Additionally, by removing the natural lenses in your eyes, you are relieved of the possibility of getting a Cataract in the future. Refractive lens replacement may be the only surgical solution to enable you to become spectacles or contact lens free. You can get in touch with an expert ophthalmologist in Harley Vision, London, for more information.

Are you a Candidate for Refractive Lens Replacement Surgery in London?

Ideal candidates for the procedure are people who are 50 years of age or older, who cannot see well for far or near without glasses or contact lenses. Younger candidates having better accommodation are not deemed ideal for this refractive lens replacement procedure. Additionally, candidates with high refractive errors or thin cornea deemed ineligible for LASIK may be eligible for LASIK

If you want to correct your vision due to presbyopic and refractive error, not ready to depend on spectacles or contact lenses, refractive lens replacement surgery may be your ideal solution. In this regard, Harley Vision, London, is an excellent clinic to find highly experienced eye surgeons for refractive lens replacement surgery.

Frequent asked questions (FAQs):

AI has an important and evolving role to play in improving outcomes of cataract/RLE surgery. Accurate lens selection is the key determinant of clarity of vision for a non-complicated operation. The first step at the Harley Vision is for the patient to have a discussion with the surgeon about their desired visual outcome. The lens selection is based on AI methods, as well as the surgeon’s experience. The surgery itself is performed by the surgeon. The enables achievement of the best possible visual outcome for the patient.
In the hands of an experienced surgeon, the operation takes 10-15 min. The patient can go home immediately after routine surgery, and vision usually improves significantly within a few days.

NICE guidelines (adopted by Royal College of Ophthalmologists) state: ‘having a PCR rate of approximately 2% or less is widely regarded as an indicator of surgical competence’. (NICE cataract surgery guidelines 2017).

Mukhtar Bizrah has extensive experience in complex cataract surgery, as well as cataract surgery combined with corneal transplantation. Despite managing complex cases, his posterior capsule rupture (PCR) rate is 0.6%, which is one of the lowest nationally.

Refractive lens exchange enjoys a high safety profile. Risk of needing another operation is 1 in 100, and risk of permanent loss of vision (due to severe infection or bleeding) is approximately 1 in 1000. About 20% of patients may develop clouding behind the implanted lens, which may require treatment with laser. The laser treatment usually takes a few minutes and recurrence of the problem is very rare.

You vision will depend on the type of artificial lens that you choose to be implanted inside the eye during the surgery. Options include:

The natural lens of your eye is replaced with an artificial lens called an intraocular lens (IOL) during refractive lens exchange. IOLs come in different types and materials, each having their own advantages and potential disadvantages. Here are the major types:

  1. Monofocal IOLs: These provide high-quality vision at a single focal point (e.g. distance OR near, not both). For example, if you monofocal lenses are implanted with the aim of giving you good distance vision, then reading glasses are typically needed for intermediate and near vision, such as for wearing eye make up, using a computer or mobile device, looking at your car’s dashboard, reading a book or restaurant menu. The cost of monofocal lenses is usually covered by insurance companies, and these are the most commonly used lenses in the NHS.
  2. Premium Monofocal IOLs: These are designed to give excellent distance vision, whilst enhancing vision for intermediate activities (e.g. computer use). You are likely to need glasses to read small print at a short distance (e.g. reading a newspaper).
  3. Extended Depth of Focus IOLs: These lenses provide a continuous range of high-quality vision for far and intermediate distances, and for some people, near distances as well. They usually cause less glare and halos than multifocal IOLs.
  4. Multifocal IOLs: These lenses provide vision at multiple distances, reducing dependency on glasses. However, they tend to cause more unwanted visual symptoms such as glare/halos/starbursts than standard monofocal lenses. Most people adapt to these symptoms with time, but this is not guaranteed.
  5. Accommodative IOLs: These lenses can shift from near to far vision in response to movements of the ciliary muscles in your eye, somewhat like the natural lens does. This type of lens flexes to provide focus at multiple distances.
  6. Toric IOLs: These lenses are designed for people with astigmatism. They correct the irregular corneal shape caused by astigmatism, providing clearer overall vision. Most of the IOLs listed above (e.g. multifocals), have toric versions which reduce astigmatism.
  7. Monovision: This means implanting a monofocal lens to enable distance vision in one eye, and a monofocal lens for near or intermediate vision in the other eye. While the idea sounds complex, a surprising number of patients opt for this and are pleased with the outcomes.

Choice of the lens is based around your preference and lifestyle, as well as the presence of other eye conditions. The above provides a blueprint, and more detailed discussion with an experienced surgeon will help you make the decision that is right for you.

Monovision, also known as blended vision, is a technique typically used to address presbyopia, the age-related condition where the eye has difficulty focusing on near objects.

The monovision approach involves correcting one eye (typically the dominant one, but not necessarily) for distance vision, and the other eye for near vision. This allows the individual to see clearly at both distances, hence minimising the need for bifocals or reading glasses. The brain usually adapts to this difference and learns to choose the eye that provides the best focus for a particular distance, thereby “blending” the two images into one clear picture in the mind. This process is called neuro-adaptation, and can take up to several months.

Monovision has been implemented successfully in contact lens wear, laser eye surgery, lens replacement surgery (also known as refractive lens exchange) and cataract surgery.

It is important to note that monovision may not be suitable for everyone. Some individuals might have trouble adapting to the difference in prescription between their two eyes, leading to issues with depth perception, visual discomfort or unwanted visual symptoms (e.g. glare). If you decide to have monovision, and your eyes do not adapt, you may need to undergo further treatment.

At Harley Vision, we utilise 3 key elements in our management of patients:

1. Patient choice
2. Clinical and surgical expertise
3. Evidence-based treatments and artificial intelligence (AI)

Large clinical trials have not shown laser-assisted cataract/RLE surgery to improve patient outcomes nor safety of surgery. At Harley Vision, we offer the option to have femtolaser-assisted refractive lens exchange. We do not routinely encourage it because we cannot ethically justify the increased cost to you.

Previous laser eye surgery does not affect your ability to have refractive lens exchange. The main challenge in such cases is choosing the correct lens to be implanted inside the eye. Previous laser eye surgery affects accuracy of eye measurements, which in turn affects choice of lens to be implanted inside the eye.

Mukhtar Bizrah trained in one of the highest volume cataract and RLE surgery clinics in North America for patients with previous laser eye surgery (e.g. LASIK or PRK). Using his vast experience in this field, he is able to optimise visual outcomes and minimise risks of unexpected surgical results following cataract surgery and refractive lens exchange.

Yes, at the Harley Vision, refractive lens exchange surgery is frequently performed on both eyes on the same day.
Cataract cannot possible occur after refractive lens replacement surgery. In other words, refractive lens exchange or replacement surgery means you will never need cataract surgery as your natural lens has been replaced with an artificial clear lens.
Like every surgical procedure, refractive lens replacement comes with a set of potential complications and other things that could go wrong. But if you are getting operated by an experienced surgeon in London using the correct IOL for you along with taking care of other safety parameters, then the chance of complications is small. You can talk to an expert in Harley Vision, London, for more information.
Refractive lens replacement/exchange is not painful because of the local anaesthesia administered before the surgery. The surgery can be done under local anaesthetic (most common), sedation, or rarely general anaesthesia. After the refractive lens exchange surgery, it is common to feel occasional mild discomfort or foreign body sensation. This resolves with time. At Harley Vision in London, the keyhole incisions (usually 2.2mm) and advanced technology mean that most patients do not feel any pain and recover remarkably fast. You can expect to get discharged on the same day. At Harley Vision, we make the whole refractive lens replacement process painless and hassle-free for you.

It is advisable not to drive on the day of your refractive lens exchange surgery. It’s better to ask someone to pick you up after refractive lens exchange surgery and drive you home safely. The vision usually improves within 24 hours of refractive lens replacement surgery. While legally, nothing is stopping you from moving as soon as your vision is within legal limits for driving, it is advisable to give yourself time to adjust to your change in vision.

You can walk immediately after the surgery. It is advised to refrain from any heavy exercise for at least a week after the refractive lens exchange. If you have had a premium toric intraocular lens implanted, it is advisable to avoid heavy exercise for 3-4 weeks to avoid rotation of the lens. A toric intraocular lens is aligned at a particular axis (0-360 degrees) to correct astigmatism and can result in marvellous vision after refractive lens replacement surgery. However, even mild rotation of an intraocular lens can lead to a suboptimal visual correction.

Refractive lens exchange is a microsurgical procedure that involves making small keyhole incisions in the eye. The natural crystalline lens is then removed and replaced with an artificial lens, known as an intraocular lens (IOL).

Modern day refractive lens replacement surgery is typically performed using a high-frequency ultrasound device that breaks up the cloudy lens into small pieces, a process known as phacoemulsification. These pieces are then gently suctioned out of the eye. The back membrane of the lens (the posterior capsule) is left in place to serve as a place for the IOL to rest.

Once the natural lens has been removed, the IOL is folded and inserted into the empty capsule. Once in the eye, the folded IOL unfolds, filling the empty capsule. The incision is then closed, usually requiring no stitches as it seals itself due to the eye’s natural pressure.

The procedure is typically performed under local anaesthesia and on an outpatient basis, which means you can go home the same day. The procedure is usually pain-free. In some cases, sedation or general anaesthesia (rare) may be required. The surgery usually takes less than an hour, but you should plan to spend 2-3 hours at the surgical facility to allow time for pre-surgery preparation and post-surgery recovery.

Refractive lens replacement is deemed an elective procedure and therefore not generally covered by any insurance company in London. We offer 0% finance options to help you cover the cost of surgery.
Yes, refractive lens replacement is permanent and is not a reversible procedure. Unlike natural lenses, IOL has a warranty of 100 years. So, you need not look for any other ocular surgeries in London to exchange or replace the lens. The lens in itself is designed to provide a permanent eye care solution.
To prepare for a refractive lens replacement surgery, first, you have to discuss your eligibility with your ophthalmologist in London. Once on the road to surgery, advanced state-of-the-art scans will be performed on your eye to determine the health of your eye with the power of the lens required for your eye. Certain medications you are on may be stopped before the surgery to prevent complications, and you will be advised to stop contact lens wear a few days before the surgery.