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Dysfunctional Lens Syndrome

Over 40’s Eye Condition

Did you ever wake up one day and noticed that you could not see anything close to you? If you run into this situation welcome to the 40’s! What you have is a condition called presbyopia. When you are young your lens can focus in and out like the lens in the camera, allowing you to see up close as well as far away. When you reach a certain age, usually 40 years old, the lens inside your eye can no longer focus because of the aging process. This change causes you to lose the ability to focus on anything up close. People who have farsightedness may develop this condition sooner than those who have nearsightedness and will lose the ability to see up close at even an earlier age.


Cataract is a condition in which the lens becomes cloudy. This condition is part of the aging process. There are many types of cataract but usually the lens may turn yellow for some time before the opacification takes place. When this change in color occurs you may notice everything around you turn yellowish. When the central part of the lens becomes opaque your vision will be affected. You may experience glare when you are exposed to the sun or intense light. Your vision may also decrease with cataract over time.

Randal Pham, MD.

Dysfunctional Lens Syndrome

Dysfunctional Lens Syndrome (DLS) is a continuum between presbyopia and cataract. As you age the lens will undergo gradual changes and you may go from not being able to see up close to not being able to see at all. In between these two extreme conditions is a range of dysfunctions that you may experience. You will notice that you need to change glasses more often in order to see up close; usually reading glasses and bifocals help. When you develop a cataract you may find that even with your new prescription glasses your vision is no longer clear. Your vision will continue to deteriorate over time until you will no longer able to see anything, as with the case of a very mature cataract.

Refractive Lens Exchange

Refractive lens exchange (RLE) is a procedure that replaces the natural lens with an artificial man-made lens. The natural lens can be removed by suction, ultrasound or laser depending on the lens condition and the surgeon’s preferences. The artificial lens is usually placed inside the container of the natural lens and is to stay there permanently. The artificial lens is made out of various materials and the choice of materials depends on the patient’s condition and the surgeon’s preferences. Some artificial lens can help decrease dependency on glasses, allowing you to see far, intermediate and near distances without glasses. RLE can also be used to treat nearsightedness, farsightedness and astigmatism.

Randal Pham, MD.

Non-surgical Alternatives to RLE

Glasses and contact lens are non-surgical alternatives to RLE. Glasses have little risk and should be the first line of defense against dysfunctional lens syndrome. However, glasses that are used to treat severe farsightedness and nearsightedness may not provide good quality of vision. This loss of quality of vision is due to the size of the image and the change of peripheral vision caused by the large difference in thickness between the center and the edge of the glasses. Contact lenses can resolve some of these problems, but contact lenses may cause allergies and increase of the risk of eye infection, especially if they are worn overnight.

Surgical Alternatives to RLE

There are many surgical alternatives to RLE:

  • Excimer Laser. The excimer laser can be used to make the eye nearsighted, allowing you to see up close. The laser is used for both PRK and LASIK. In PRK the laser is used to remove tissue from the surface of the cornea. In LASIK a flap is created first before tissue of the cornea is removed by the laser.
  • Phakic Implant. In phakic implant an artificial lens in placed inside the eye. However, the natural lens is not removed.
  • Corneal Inlay. In corneal Inlay an implant is placed inside the cornea. A flap is made similar to the way it is made by LASIK. The implant is placed between the flap and the rest of the cornea.

Of all of these procedures, only RLE replaces the natural lens permanently and precludes the need for cataract surgery in the future.