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‡ Clear lens extraction (CLE), also called
refractive lens exchange (RLE)

‡ is the removal of a noncataractous natural

lens of the eye with or without intraocular
lens placement as a refractive procedure.
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‡ Myopia is due to an axial length longer

than the focal point of the refracting
system of the eye or an overly powerful
refracting system, a thick cornea, or a
thick lens, or a combination of any or all of
the above.
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‡ Myopia usually develops in early or mid

teens and stabilizes in early adulthood. It
presents as blurry distant vision.
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‡ Optical or refractive indications for lens
surgery are ametropia (ie, myopia,
hyperopia, astigmatism), anisometropia,
and presbyopia. These include all classic
refractive states of the healthy adult eye,
which is why this new indication for lens
surgery is controversial; no true
histopathology may exist in most of these
eyes.
‡ Some eyes, as in those with extreme axial
myopia, may be at risk for true pathology
following surgical intervention.
‡ Historical development of spectacles and
contact lenses antedates the development of
modern lens surgery. For these reasons, a
mind-set has been created among academics
that inborn errors of refraction are not diseases;
therefore, they are not conditions to be treated
by medicine or surgery, especially if such
treatment might unnecessarily endanger an eye
or expose an otherwise healthy eye to undue
risk.
‡ The basic needs of refractive surgery are
accuracy, stability, safety, and quality of
vision.
‡ Regarding accuracy, ideally, a standard
deviation of less than 0.25 D is wanted,
yielding 20/25 (or better) uncorrected
acuity in 95% of patients for all amounts of
myopia, hyperopia, and astigmatism.
‡ For stability, CLE is probably the most
stable refractive procedure available, with
± 0.02 D per year reported over a 9-year
observation period. PRK has a
significantly higher risk of regression or
progression, and, in addition, LASIK
carries a risk of corneal ectasia.
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‡ Contraindications include retinal disease.
With high myopia, a higher rate of retinal
detachment exists than with other types of
refractive errors.