Eyeworld

66 | EYEWORLD | SEPTEMBER 2021 R EFRACTIVE by Liz Hillman Editorial Co-Director About the physicians Sarah Nehls, MD Chief, Cornea and Anterior Segment Service Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison, Wisconsin Blake Williamson Williamson Eye Center Baton Rouge, Louisiana R efractive lens exchange (RLE), clear lens extraction, custom lens replace- ment—the removal of a dysfunctional crystalline lens that doesn't have a visually significant cataract goes by different names, depending on who you talk to. Regardless of what the procedure is called, improvements in IOL technologies have in- creased interest in these procedures, and there is more confidence among surgeons in its ability to deliver expected outcomes. Blake Williamson, MD, said he does this procedure routinely each week. Thanks to a lo- cal marketing campaign in his area, Dr. William- son said he has patients coming in asking for a procedure that can address presbyopia. "They walk in saying 'I'm 45 years old and I hate my reading glasses, what can I do?'" he said. "If someone does come in for LASIK, if they're hyperopic and 45 or above, they're automatically getting switched to a [custom lens replacement] evaluation instead of a LASIK evaluation." Sarah Nehls, MD, said she often has patients in their 50s and 60s coming in for a LASIK consult that she usually ends up shifting to a lens-based discussion. Dr. Nehls said the most common patient is someone who has had great vision most of their life, but as they aged, they experienced a hyperopic shift along with presbyopia. Sometimes they also have early lenticular changes. Patients in this age group, she said, are go- ing to benefit from correction of their distance vision and presbyopia. In addition, it's a one- time procedure; they won't develop cataracts. "To be able to use lenses to capture the dis- tance and reading vision is amazing," Dr. Nehls said. "I tell patients that this lens is going to last your lifetime. … There are things that can happen as you age that might affect your vision like glaucoma or macular degeneration. … You still need to get regular eye health checkups, but the lens is going to correct your vision most permanently." Recent improvements in presbyopia-cor- recting IOLs, in general, are generating a lot of excitement in Dr. Nehls' practice. She described one patient who was referred to her by a prior happy RLE patient who had received Vivity The who, what, when of refractive lens exchange

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