There are instances when your refractive error is too high, or your cornea is too thin, that laser refractive surgery isn't a good choice. Individuals who do not qualify for refractive surgery and are intolerant of eyeglasses or contact lenses may benefit from Refractive Lens Exchange (RLE). This is also known as Clear Lens Extraction And Replacement (CLEAR). RLE/CLEAR is basically the same procedure as cataract surgery in an individual without cataracts, and possessing a high refractive error, with a desire to be spectacle independent. All the machines, and procedures used in cataract surgery are utilized and performed in RLE/CLEAR.

The lens is the part of the eye that helps focus light on the retina. The retina is the eye's light-sensitive layer that sends visual signals to the brain. Light passes through the lens and gets focused on the retina in a normal eye. To help produce a sharp image, the lens must remain clear.

For an early cataract, vision may improve by using different eyeglasses, magnifying lenses, or stronger lighting. If these measures don't help, surgery is the only effective treatment. This treatment involves removing and replacing the cloudy lens with a substitute lens.

A cataract needs to be removed only when vision loss interferes with your everyday activities, such as driving, reading, or watching TV. You and your eye care professional can make that decision together. In most cases, waiting until you are ready to have cataract surgery will not harm your eye. If you decide on surgery, your eye care professional may refer you to a cataract surgeon to remove the cataract. If you have cataracts in both eyes, you may have them removed separately or simultaneously, depending on your requirements and condition.

Sometimes, a cataract should be removed even if it doesn't cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy.

Lens removal is one of the most common operations performed in the world today. It is also one of the safest and most effective. In about 90 percent of cases, people who have lens surgery have better vision afterward.

There are two primary ways to remove a lens. Your doctor can explain the differences and help determine which is best for you:

Phacoemulsification, or phaco. Phacoemulsification is an advanced technique of lens extraction. It is also known as small-incision lens surgery. Others call it the "no-needle, no-stitch" technique. After applying a local anesthetic, your doctor makes a small incision on the side of the cornea, the clear, dome-shaped surface covering the front of the eye. The doctor then inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the center of the lens so it can be removed by suction. Most lens surgery today is done by phaco.

Extracapsular surgery. Your doctor makes a slightly longer incision on the cornea's side and removes the lens's hard center. The remainder of the lens is then removed by suction.

After placing topical anesthesia, clear corneal incision is made with a crystal/diamond keratome. This is usually only 2.2 mm in size. This is a self-sealing incision that allows a sutureless procedure.

Arguably, one of the more delicate steps in the procedure of lens removal, continuous curvilinear capsulorhexis (CCC), is the careful creation of a well-controlled tear in the anterior capsule of the lens.

Ultrasonic vibrations (phacoemulsification) are now created to crush the lens into manageable particles, which are then aspirated into a port using the same tip (handpiece).

The conventional way of approaching the removal of a lens is by the "divide and conquer" method. The lens is rotated, and grooving is continued to create manageable pie-shaped segments.

This provides a side view of the actual inclination of the phaco tip (handpiece) as it proceeds with phacoemulsification of the lens.

After removal of the nuclear component, the softer cortical material is then aspirated with an irrigation/aspiration (I/A) handpiece. Complete lens removal lessens the likelihood of developing a posterior capsular opacification necessitating a YAG laser capsulotomy post-operatively.

After injection of viscoelastic material into the capsular bag and the anterior chamber, a foldable intraocular lens is then inserted and unfolded into the eye.

The intraocular lens is then dialed into place. The remaining viscoelastic material is removed. The eye is then checked for leaks.

In most lens surgeries, the removed lens is replaced by an intraocular lens (IOL). An IOL is a clear, artificial lens that requires no care and becomes a permanent part of your eye. With an IOL, you'll have improved vision because light can pass through it to the retina. Also, you won't feel or see the new lens. The self-sealing corneal incision precludes the need for stitches. However, one may receive one or several stitches in some instances.

Some people cannot have an IOL. They may have problems during surgery, or maybe they have another eye disease. For these people, a soft contact lens may be suggested. For others, glasses that provide powerful magnification may be better.

A week or two before surgery, your eye care professional will do some tests. These may include tests to measure the cornea's curvature and the size and shape of the eye. For patients who will receive an IOL, this information helps your doctor choose the right type of IOL. Also, doctors may ask you not to eat or drink anything after midnight the morning of your surgery.

When you enter the hospital or clinic, you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed.

The operation usually lasts less than 30 minutes and is almost painless. Many people choose to stay awake during surgery, while others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye.

After the operation, a patch will be placed over your eye, and you will rest for a while. Your medical team will watch you see if there are any problems, such as bleeding. Most people who have cataract surgery can go home the same day. Since you will not be able to drive, make arrangements for a ride.

It's normal to feel itching and mild discomfort for a while after lens surgery. Some fluid discharge is common, and your eye may be sensitive to light and touch. If you have discomfort, your eye care professional may suggest a pain reliever every 4-6 hours. After 1-2 days, even moderate discomfort should disappear. In most cases, healing will take about six weeks.

After surgery, your doctor will schedule exams to check on your progress. You may take eye drops or pills for a few days after surgery to promote healing and control the pressure inside your eye. Ask your doctor how to use your medications, when to take them, and what effects they can have. You will also need to wear an eye shield or eyeglasses to help protect the eye. Avoid rubbing or pressing on your eye.

Problems after surgery are rare, but they can occur. These can include infection, bleeding, inflammation (pain, redness, swelling), vision loss, or light flashes. With prompt medical attention, these problems can usually be treated successfully.

Try not to bend or lift heavy objects when you are home. Bending increases pressure in the eye. You can walk, climb stairs, and do light household chores.

You can quickly return to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust to focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.

If you just received an IOL, you may notice that colors are very bright or have a blue tinge. Also, if you've been in bright sunlight, everything may be reddish for a few hours. If you see these color tinges, it is because your lens is clear and no longer cloudy. Within a few months after receiving an IOL, these colors should disappear. And when you have healed, you may enjoy your enhanced vision.

If you chose a monofocal IOL, you would always need reading glasses. If you chose a multifocal IOL, you would be able to read without eyeglasses, provided you have adequate lighting conditions. Astigmatism correcting IOLs decreases your requirement for prescription glasses after cataract surgery.

Sometimes, a part of the natural lens that is not removed during lens surgery becomes cloudy and may blur your vision. This is called an posterior capsule opacification (PCO). A PCO can develop months or years later. Unlike a lensectomy, a PCO is treated with a laser. With YAG laser capsulotomy, your doctor uses a laser beam to make a tiny hole in the lens to let light pass through. This is a painless outpatient procedure.