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The Complete Patient Guide to Custom Lens Replacement (CLeaR)

Custom Lens Replacement (CLeaR) is a life-changing procedure that offers a safe and effective vision correction for individuals seeking freedom from glasses and contact lenses.

Custom Lens Replacement is an alternative to LASIK, PRK, and EVO ICL that is often the best option for patients over the age of 45.

Let’s explore everything you to know about Custom Lens Replacement, helping you make an informed decision about the right procedure for your eyes & lifestyle.

What is Custom Lens Replacement (CLeaR)?

Custom Lens Replacement, also known as refractive lens exchange, is a vision correction procedure that can increase your freedom from glasses & contact lenses.

The procedure involves replacing the eye’s natural lens with an advanced intraocular lens (IOL) implant, customized to meet your specific vision needs.

The procedure is similar to modern cataract surgery; however, it is designed for patients who do not yet have cataracts, and would like to be free from glasses & contacts. Custom Lens Replacement is able to correct nearsightedness, farsightedness, and astigmatism.

Who is a Good Candidate for Custom Lens Replacement?

There are many different vision correction procedures, including procedures like LASIK, PRK, SMILE, and EVO ICL. There is no one-size-fits-all best procedure. For many patients, especially those over the age of 45, Custom Lens Replacement may be the best option.

Let’s discuss some of the factors that might make patients a good candidate for Custom Lens Replacement.

Custom Lens Replacement 1


As we age, the natural lens of our eyes undergoes changes. Initially, it loses its flexibility, which gradually limits our range of vision, making it harder to focus on nearby objects, a condition known as presbyopia.

Over time, the lens may become cloudy and develop a cataract, causing blurry vision, reduced contrast sensitivity, and difficulty with daily activities.

Laser vision correction procedures and EVO ICL cannot restore the youthful flexibility or clarity of the natural lens.

Custom Lens Replacement, or refractive lens exchange, offers a solution by replacing the aging lens with an advanced intraocular lens, restoring clear vision and addressing both presbyopia and cataracts.

After the age of 45, Custom Lens Replacement becomes an increasingly better option for most patients. Because the new lens implant is permanent CLeaR can be a longer lasting solution compared to laser vision procedures or EVO ICL.


Prescription is very important when considering a vision correction procedure. In addition to age, farsighted patients are particularly good candidates for Custom Lens Replacement.

Laser procedures, like LASIK, can be performed on patients at any age. However, there are limitations to LASIK in farsighted patients. LASIK eye surgery tends to not be as accurate or long-lasting in farsighted patients compared to nearsighted patients. This is particularly true for farsighted patients with higher prescriptions, such as greater than +3.0 D.

For nearsighted patients over the age of 45, there are a variety of options. Patients may be good candidates for laser vision procedures or CLeaR. For patients on the younger side, the argument is stronger for laser. As patients become older, the case becomes stronger for CLeaR.

For example, consider a 52-year-old patient with a prescription of -4.50 in both eyes. This patient may be able to have LASIK, and have great vision the very next day… But how long will it last? As the patient’s natural lens continues on it’s path towards cataract, the prescription will drift. The patient may expect to get 5 years out of LASIK, whereas with Custom Lens Replacement, they may achieve freedom from glasses for the rest of their life.

Which Lens Implant Should I Choose?

There are a variety of lens implant options that patients having Custom Lens Replacement can select from. In our opinion, it’s best for patients to think about how their vision will look after surgery, rather than specific brands or models of lens implants.

There is no one-size-fits-all option that’s the best for every patient. The procedure is customized to your eyes, lifestyle, and vision goals. Everyone is different, and it’s reasonable for different patients to prefer different options.

Let’s discuss the 3 options for how you can select for your vision to look after surgery:

1. Best Distance Vision

Distance vision activities include things like reading street signs, watching television, and outdoors activities.

If you choose to have the “Best Distance Vision”, then you should expect to be free from glasses & contact for these distance vision activities. This means that you will need to wear reading glasses for up close.

Many patients prioritize these distance vision activities and depth perception, and don’t mind wearing reading glasses. This is the best option for them.

2. Blended Vision or Monovision

Blended vision or monovision is for patients who would like to gain some additional freedom from reading glasses.

In this option, one eye is set for distance vision, and the other is set for near vision. Even though there is a difference between the two eyes, when both eyes are open, they blend together & work together.

Many patients become used to this wearing contact lenses or after a history of LASIK in the past. For these patients it makes sense to keep this type of vision.

Even for patients who have not experienced this before, it is a common selection for their vision correction procedure. Only a very small percentage of patients dislike blended vision. This percentage may very from surgeon to surgeon.

3. Multifocal or Extended Depth of Focus (EDOF)

Multifocal and Extended Depth of Focus (EDOF) lens implants give patients more freedom from both distance glasses and reading glasses.

You can think of Multifocal implants as bifocals or trifocals inside your eye. The goal is that both eyes can see clearly without glasses both far away & up close. There are many different models of multifocal implants with different variations.

Two of the most popular Multifocal Lens Implants:

Multifocal implants work by splitting up the light that enters the eye into distance and near focal points. When this light is split, some of it is scattered, which can result in unwanted glare, halos or starbursts. For most patients, these symptoms are a minor nuisance, and they are overall thrilled with their vision at all ranges, and freedom from glasses. However, a small percentage of patients may not be happy with this trade-off.

Extended Depth of Focus (EDOF) lens implants were designed to give a more continuous range of vision from distance to near. In addition to the more continuous range, some of these lenses were designed optics aimed at reducing the glare and halo symptoms of multifocals. The Vivity lens implant is an example of one of the most popular EDOF implants.

4. Bonus option… Mix-and-match

Lens implants are combined in a variety of ways. Some patients choose to have distance vision in one eye, and a multifocal in another. Others may choose two different models of multifocals or EDOF lenses.

Additionally, the Light Adjustable Lens is an implant that can have its prescription adjusted after it’s inside your eye. The options for how your vision will look remain essentially the same. However, the advantage of being able to adjust the prescription can allow surgeons to be more accurate in hitting your desired target.

The most important thing… far more important than choosing a brand of lens… if to discuss your activities, lifestyle, and personal goals for your vision with an experienced surgeon. The goal of Custom Lens Replacement is truly to customize your vision to your lifestyle.

The CLeaR Procedure: What to Expect

Let’s review everything that you should expect from your pre-operative evaluation, through your procedure day, and recovery.

Pre-Operative Evaluation

Before undergoing Custom Lens Replacement, you will have a comprehensive pre-operative evaluation. This evaluation will include a thorough examination of your eyes to determine your candidacy for the procedure, as well as considering other procedures such as LASIK or Evo ICL that may be options.

You should discuss your lifestyle, activities, and vision goals with your doctor as part of a conversation about which lens implants to select.

Measurements help your surgeon choose the correct prescription of your lens implants. These measurements look at the length of your eyes and shape of your cornea.
Your doctor will discuss the available intraocular lens options and help you select the most suitable lens for your visual needs and lifestyle.

Procedure Day

On the day of your Custom Lens Replacement procedure, you check-in at the front desk and head to the pre-op area. You should expect to have a driver to and from the center.

The surgery center staff will check vital signs and administer dilating eye drops. Expect to be in the pre-operative area for approximately 1 hour. Once your eyes are nicely dilated, you’ll head to the procedure room. Nearly all patients are administered sedation to help relax during the procedure.

Similar to laser cataract surgery, a laser may be used to perform some of the delicate steps of the procedure.

During the procedure most patients are relaxed, sedated, and simply observe a light show. You will be in “twilight sedation”, which means that you may still have some awareness of what’s going on, but will be calm & comfortable.

After removing your natural lens, your implant will be inserted. The entire procedure typically takes 10-15 minutes.

Recovery & Post-Operative Care

Following Custom Lens Replacement, you will receive specific post-operative instructions to promote healing and optimize your visual outcomes. These will include eyedrop instructions and activity restrictions.

Most surgeons prescribe anti-inflammatory & antibiotic eyedrops. The surgeon or staff will review these instructions with you.

Your surgeon may discuss activity restrictions such as strenuous activities, swimming, and watersports. Your doctor will let you know when you are legal to drive. Many patients are legal to drive the very next day. However, you are not allowed to drive on the day of your procedure.

You may experience mild irritation, sensitivity to light, and temporary blurriness immediately after the surgery, but these effects typically subside within a few days.

It is important to attend follow-up appointments with your eye care professional to monitor your progress and ensure proper healing.

Benefits of Custom Lens Replacement (CLeaR)

Many patients who have Custom Lens Replacement start their journey being interested in LASIK or other laser vision procedures. Let’s discuss some of the key features of CLeaR that may make it a better option for you.

Replaces the Dysfunctional Natural Lens

After the age of 45, the natural lens becomes dysfunctional. It stiffens, loses its range of vision, and changes shape resulting in a gradual change in your prescription.

If you have LASIK or another laser vision procedure, these changes to your natural lens will still occur, limiting the longevity of your procedure.

In CLeaR, your natural dysfunctional lens is replaced by a clear lens implant, that will never change shape, last the rest of your life, and set your vision to match your vision goals.

Never Need Cataract Surgery

The natural lens eventually turns into a cataract in everyone if you grow old enough. Once it is replaced with a lens implant, you’ll never need to worry about cataracts deteriorating your vision.

Range of Vision

Modern lens implants can provide patients a youthful range of vision that laser vision procedure can’t. For patients over the age of 45, achieving freedom from both distance glasses and reading glasses is a common outcome with Custom Lens Replacement.

Long Lasting

Once your natural lens is removed, it will never grow back. Your new lens implant should remain with your for the rest of your life.

The main reason your prescription changes after the age of 45 is due to growth of the natural lens. Once it’s replaced, your prescription should be relatively stable for the rest of your life.

Risks of Custom Lens Replacement (CLeaR)

Custom Lens Replacement, like any surgical procedure, carries potential risks. The most serious complication is infection. Reports show that infections occur less than 0.1% of the time with modern intraocular antibiotics.

Minor Irritation

More commonly, minor irritation and blurry vision is typical for a few days after the procedure.

Hitting the Bullseye

You and your surgeon both want to hit the target perfectly for your new lens implant. In some patients the measurements for your lens implant are not as accurate. These may include patients with extreme presriptions, irregular corneal shapes, corneal scars, and history of eye surgery.

If your lens implant is off the target, there are ways to do a “touch-up” for most patients. These methods include LASIK, PRK, piggyback lens implants, and lens implant exchange.

Temporary Glare and Halos

Almost all patients experience glare, halos, or starbursts during the early recovery period. With some implants these symptoms may last longer. These symptoms are most common with diffractive multifocal implants. Discuss the risks of these with your doctor before surgery based on different lens implants.

Complications related to being unable to remove the natural lens, or properly position your new lens implant are rare. They are often straight-forward to fix, but may require an additional surgery.

How to Choose a Surgeon for Custom Lens Replacement (CLeaR)?

Selecting a qualified and experienced surgeon is important for a successful outcome. We recommend finding a surgeon who is an expert in refractive surgery. That means they should be in a practice that offers all types of refractive surgery, specifcally:
an expert Consider the following tips when choosing a surgeon:

1.) Laser Vision Correction (e.g. LASIK, PRK, and/or SMILE)
2.) Evo ICL
3.) Custom Lens Replacement

You want the best procedure for your eyes and your lifestyle. For the best chance of make sure this happens, go to a surgeon skilled in all aspects of refractive surgery.

Custom Lens Replacement

While many patients are great CLeaR candidates, you don’t want to miss out on LASIK or Evo ICL if they are the best procedure for you.

Browse Our Database

Our database includes surgeons across the country whose practices perform all 3 areas of refractive surgery – Laser vision correction, Evo ICL, and Custom Lens Replacement.

After browsing our Directory, if you find a surgeon near you, you can contact them through their Profile.

If you don’t find a surgeon in your area, contact us, and we’ll help you find one.

Financial Considerations

Medical insurance typically does not cover LASIK or any other vision correction procedure. Discuss the cost of LASIK with the surgeon and their staff.

Inquire about payment options, Health Savings Accounts (HSA’s), and any potential financing plans available.


Custom Lens Replacement, also known as refractive lens exchange, is a life-changing procedure that offers a safe and effective solution for achieving clear vision and reducing dependence on glasses or contact lenses.

By replacing the eye’s natural lens with an advanced intraocular lens (IOL), Custom Lens Replacement can correct refractive errors and address age-related vision changes like presbyopia.

With personalized IOL options, this procedure is customized to your unique visual needs and lifestyle. Consult with your eye care professional to explore this option for vision correction.

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