Medically reviewed by Krishna Surapaneni, MD, board-certified ophthalmologist and cataract, cornea, and refractive surgeon at SuraVision in Houston.
If glasses or contacts are holding you back and LASIK is not the right fit, two lens-based procedures can take their place: the EVO ICL and refractive lens exchange (RLE). They solve the same problem in different ways. One adds a lens to your eye. The other replaces the lens you were born with.
Here is how the two compare, and how to tell which one belongs in your conversation with Dr. Sura.
What the EVO ICL Does
The EVO ICL in Houston is a small, flexible lens placed inside the eye, just in front of your natural lens. Your own lens stays exactly where it is. Nothing is removed, and the ICL can be taken out or replaced if your needs ever change.
The EVO ICL is FDA approved for nearsighted adults ages 21 to 45, correcting prescriptions from -3.00 up to -20.00 diopters, and a toric version corrects astigmatism during the same procedure. You can read more about this lens category in the FDA’s patient guide to phakic intraocular lenses.
What Refractive Lens Exchange Does
Refractive lens exchange in Houston replaces your natural lens with an artificial lens, using the same proven technique as cataract surgery. The procedure typically takes about 15 minutes per eye, and you choose from lens options that include monofocal, PanOptix, Vivity and the light-adjustable lens.
Because the new lens can be chosen to restore a full range of vision, RLE is the stronger answer when reading glasses have entered the picture. The strongest candidates are over 40 with presbyopia, high prescriptions, or corneas that rule out LASIK.
The Main Differences
- Your natural lens. The EVO ICL works alongside it. RLE replaces it.
- Age. The EVO ICL is FDA approved for ages 21 to 45. RLE usually makes sense after 40, when the natural lens has begun to stiffen.
- What gets corrected. The EVO ICL treats nearsightedness, with or without astigmatism. RLE can address nearsightedness, farsightedness, astigmatism and the need for readers, depending on the lens you choose.
- Reversibility. The EVO ICL is removable. RLE is permanent, because the natural lens does not grow back.
- Cataracts later in life. The EVO ICL leaves your natural lens in place, so that lens still ages normally. After RLE, the natural lens is gone, which changes the cataract question entirely. Our article on cataracts after RLE walks through it.
How to Choose
Age and the state of your natural lens do most of the deciding. A 28-year-old with strong nearsightedness and healthy eyes usually points to the EVO ICL. A 52-year-old juggling distance glasses and readers usually points to RLE. In between, the right answer depends on your prescription, your corneas and how your natural lens is aging, which is exactly what the scans at your consultation measure.
Most patients have both eyes treated with either procedure. Dr. Sura performs your evaluation, your surgery and every follow-up himself, and he will tell you plainly if neither procedure is the right fit.
Frequently Asked Questions
Can I get the EVO ICL now and RLE later?
Yes. The EVO ICL does not change your natural lens, so lens replacement surgery remains available decades later if your eyes need it.
Is one procedure better than the other?
Neither is better for every eye. They serve different ages and different prescriptions, and your consultation determines which one fits yours.
Do these procedures hurt?
Numbing drops keep you comfortable during the EVO ICL procedure, and you are given medication to keep you comfortable during RLE. Both are brief outpatient procedures.
Does insurance cover the EVO ICL or RLE?
Both are elective procedures, so insurance does not cover them, but you can use HSA or FSA funds, and financing is available for qualified patients.
Ready to take the next step toward clearer vision? Schedule a consultation with SuraVision today to discuss your options and learn more about the EVO ICL and refractive lens exchange. Call us at 713-730-2020 or book your appointment online!