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    RLE choice factors in benefits, risks, alternatives


    Based on that information, Dr. Wiley suggested that when performing RLE, surgeons should select an IOL that is associated with a relatively low rate of posterior capsule opacification.

    Discussing specific patient scenarios, Dr. Wiley suggested that although LASIK may be considered an option for treating myopia and hyperopia in patients aged 18 to 60 years, RLE may be considered a “slam dunk” for a 60-year-old with high hyperopia because of its favorable benefit:risk ratio.

    “Corneal refractive surgery is not a great option for treating a high hyperopic error, and with RLE, it is possible to solve multiple problems,” he said.

    “Often these patients have crowded angles and so are at risk for glaucoma,” Dr. Wiley said. “Removing the lens may cure these narrow-angle concerns, and these eyes also have a relatively low risk of retinal detachment.”

    However, Dr. Wiley cautioned surgeons to watch for choroidal effusion because there is an increased risk for it to occur in very short eyes.

    Discussing the refractive surgery decision for a 58-year-old high myope (-12.0 D), Dr. Wiley said that while phakic IOL implantation is a possibility, it may not be the best choice considering evidence that it can particularly induce cataract in people over age 45.

    “RLE can be perfect in such a patient,” he said. “Here it also solves two problems with one procedure, correcting the refraction and eliminating the potential issue of cataract. Furthermore, with new IOLs, RLE can also treat presbyopia.”

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