PRELEX (Presbyopic Lens Exchange) is the name now given to the surgical procedure to replace the natural lens of your eye, which is no longer focusing correctly for near targets, with a multi-focal or pseudo-accommodative intra-ocular lens implant (IOL).

Whilst the application of the technology is new, the surgical techniques employed have been proven successful over many years of use. This is because the procedure itself is similar to that used to treat cataract patients. The most significant difference between a cataract patient and a PRELEX patient is the clarity of the lens prior to surgery.

Face & Eye surgeons are amongst a small and progressive group of international ophthalmologists to offer PRELEX. Their patients are now able to have clear vision and to reduce or eliminate their need for glasses. They will also never need treatment for cataracts. Face & Eye surgeons also have the advantage of being able to offer the use of the femtosecond laser for this surgery, thereby carrying out the surgery with bladeless techniques.

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The operation is similar to that performed on cataract patients. On the day of surgery you will be given eye drops to dilate the pupil. The area around your eye will be washed and cleansed. The operation usually lasts about 15 minutes and is almost painless as it is generally performed under a local or topical anaesthetic. If you have astigmatism the surgeon may correct it with specifically-placed miniature incisions around the edge of the cornea. (This is now more accurate with the use of the femtosecond laser).

The technology used is a machine called a phacoemulsifier (phaco). The surgeon makes a micro-incision on the side of the cornea, no more than 3.0mm and inserts a tiny probe into the eye. This ‘phaco’ device emits ultrasound waves that break up the lens and the same probe removes the lens material by suction. Once removed the original lens matter is replaced by the lens implant which is folded, and inserted through the tiny incision. It then unfolds once in place in the eye. There are often no stitches, you can return home to relax the same day and look forward to a rapid and pain-free recovery.

Many patients remark on the immediate improvement in their vision. This is important for the surgeon to monitor so he can determine what focal power to aim for in the second eye. You can return to work or many of your usual activities within a few days but will return to hospital to have the second eye done within a couple of weeks.

The true benefit of PRELEX is not evident until both eyes have been done and the brain has had time to adjust to its new visual system.


How long will the surgery take?

The operation itself will take about 15 minutes, however you will need to allow for about 3 hours. You will need someone to collect you.

How safe is the procedure?

PRELEX uses new technology in the form of the multi-focal lens or pseudo-accommodative lens, combined with a well proven surgical procedure. Every year in the UK alone almost a quarter of million people undergo cataract surgery, in which the lens is replaced with a lens implant using the same surgical techniques required for PRELEX.

At Face & Eye your surgeon is highly skilled and trained in both the procedure itself and the new technology.

As with all surgery there are risks, even though cataract surgery is now considered one of the quickest and safest surgical interventions available. PRELEX is the same surgical procedure but in a non-cataract patient. Although the vast majority of patients achieve excellent results without complications, it should not be forgotten that PRELEX is a surgical procedure. As with all forms of eye surgery, PRELEX has risks and whilst we make every effort to minimize them, they cannot be totally eliminated. You can discuss these risks further with your surgeon, but in the end, only you can determine if the benefits of having PRELEX are worth it for you. As an elective procedure, there always exists the alternative of wearing reading glasses, bifocals or contact lenses.

Although the vast majority of patients achieve excellent results without complications, it should not be forgotten that PRELEX is a surgical procedure. As with all forms of eye surgery, PRELEX has risks and whilst we make every effort to minimize them they cannot be totally eliminated.

What are the common risks of PRELEX?

Although the vast majority of patients achieve excellent results without complications, it should not be forgotten that PRELEX is a surgical procedure. As with all forms of eye surgery, PRELEX has risks and whilst we make every effort to minimize them they cannot be totally eliminated:

  • Retinal Detachment – occurs when the retina detaches from its normal position and can result in severe loss of vision if surgical correction is not successful. The approximate risk of a retinal detachment in the general population is 0.01 % per year. Someone who is hyperopic has a smaller risk than this, whereas a myopic patient has a slightly higher risk than this.
  • Infection - every time there is an incision made in an eye for any reason it is possible to get an infection inside the eye which has the potential to cause severe visual loss. This problem is extremely rare and our rate of endophthalmitis is less than 0.03%. After the PRELEX operation, to help protect against infection eye-drops are prescribed which must be used as directed.
  • Bleeding – there is a small risk of a serious peri-operative bleed either in the orbit, or within the eye
  • Macular oedema – is an accumulation of fluid at the central retina which can cause temporary or permanent reduction in vision after surgery. The postoperative eye-drops also help to reduce this risk.
  • Floaters – are often noticeable immediately after surgery but usually become less noticeable with time.
  • Posterior capsular opacification (PCO) – is thickening of the residual lens membrane which supports the lens implant. Approximately 25% of patients will, at some stage, notice a reduction in their vision due to PCO.. This incidence increases markedly for patients having the pseudo-accommodative lens implant. It may occur months or even years after surgery and is readily and quickly dealt with by outpatient laser treatment.
  • Glare/Haloes/Dazzle – some types of multifocal lenses may cause these symptoms, especially in dim-lighting conditions, such as night-time driving
  • Other possible complications include tearing of the lens capsule (<1%) which could mean that it is more difficult to implant an intraocular lens. There are other extremely rare complications which your surgeon will discuss with you prior to surgery.

Am I a candidate for PRELEX?

There are many factors that contribute to the 'ideal' PRELEX candidate. Your particular circumstances, lifestyle, glasses prescription and pupil size can all affect the possible outcome. All these factors are best discussed with the Consultant Surgeon. Having a multi-focal IOL or accommodating lens is the same as having a new visual system fitted. It will take some time for your brain to adjust and adapt to the new images it is seeing.

How long does PRELEX last?

The lens implants we use are left in place for life. A cataract cannot grow after PRELEX, but some patients develop thickening of the residual lens tissue left in place to support the lens. Should this occur it is easily dealt with by an outpatient laser procedure known as a YAG laser capsulotomy.

Why should I choose Face & Eye for my PRELEX?

Our consultant ophthalmic surgeons, have each performed thousands of cataract procedures and so are highly skilled in the removal of the natural lens using the latest micro-incision phaco technology.

They have been using foldable IOLs and multi-focal lenses for many years. When using a multi-focal or accommodative lens, particularly in the PRELEX patient, accurate biometry is crucial to select the right power for your eyes. At Face & Eye we have the latest biometry technology available for the most accurate readings.

At Face & Eye we use the latest technology to measure all aspects of the eye enabling us to achieve the best visual outcome thereby eliminating or reducing your dependence on glasses.

At Face & Eye we are uniquely able to offer our patients Bladeless Femtolaser PRELEX.

Click here for downloadable PDF providing information about package prices for this procedure.

What our patients say

To all the staff of Face and Eye Clinic, my daughter got married on the 9th June. It was a marvellously happy occasion. My surgery made all the difference to how I felt I was able to be on the day. I have enjoyed using eye make up again and it has felt as though I have been given a new confidence in myself. It has made an enormous difference - worth every penny! Read RC's comments