Refractive lens exchange and LASIK both reduce dependence on glasses, but they correct different prescriptions in different parts of the eye. This guide explains how each procedure handles nearsightedness, farsightedness, astigmatism, and the need for reading glasses.
How Does Refractive Lens Exchange Compare to LASIK for My Prescription?
Refractive lens exchange, also called Custom Lens Replacement (CLR), and LASIK suit different prescriptions because they correct vision in different parts of the eye. LASIK reshapes the cornea and fits low to moderate prescriptions in adults whose natural lens still focuses well. Refractive lens exchange replaces the natural lens with a lens implant, can correct prescriptions beyond the LASIK range, and is typically considered for adults 45 and older.
Brusco Vision offers six vision correction procedures, including SBK LASIK and Custom Lens Replacement, and does not accept money from manufacturers or laser companies. Michael Brusco, MD, FACS, recommends a procedure after measuring each patient’s prescription, corneas, and natural lens rather than fitting every patient to one technology.
How Much Prescription Can LASIK and Refractive Lens Exchange Each Correct?
LASIK corrects low to moderate prescriptions, while refractive lens exchange can correct a wider range, because the lens implant’s power is matched to the eye instead of being shaped into the cornea. As of 2026, nearsightedness beyond about −8.00 diopters, farsightedness beyond about +5.00, or astigmatism beyond about 6.00 is often considered too high for LASIK, depending on corneal thickness. Refractive lens exchange limits are set by eye health and available implant powers.
Michael Brusco, MD, FACS, has performed more than 45,000 corneal-based procedures, such as SBK LASIK, and more than 6,000 lens-based procedures, including Custom Lens Replacement. At one point, Dr. Brusco was performing close to 1% of all LASIK procedures in the United States annually.
Detailed LASIK limits are covered in the guide to getting LASIK with a high prescription.
Can Refractive Lens Exchange or LASIK Reduce the Need for Reading Glasses After 40?
Refractive lens exchange can reduce the need for reading glasses, while standard LASIK corrects distance vision but does not stop age-related loss of near focus. Most people start needing reading glasses in their 40s because the eye’s natural lens stiffens, a condition called presbyopia. Refractive lens exchange removes that lens. The replacement can be a lens implant designed to provide near, intermediate, and distance vision.
Michael Brusco, MD, FACS, reviews the lens implant options for Custom Lens Replacement with each patient, including multifocal designs. Dr. Brusco matches the implant to how each patient reads, works, and drives, and personally performs every procedure at Brusco Vision.
Which Corrects High Farsightedness: Refractive Lens Exchange or LASIK?
Refractive lens exchange is commonly used for high farsightedness, especially after 40, while LASIK is typically used for lower farsightedness in younger adults. Farsightedness beyond about +5.00 diopters is often considered too high for LASIK, and farsighted LASIK corrections tend to regress more than nearsighted ones. Farsighted eyes often lose near focus earlier. A lens implant can address distance and near vision together.
Michael Brusco, MD, FACS, graduated from Harvard College and Northwestern University’s medical school and completed his ophthalmology residency at the University of Kansas. During residency, Dr. Brusco performed more eye surgeries than 97% of his colleagues nationally.
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Is Refractive Lens Exchange or LASIK Used to Correct Nearsightedness?
LASIK is the more common nearsightedness correction for adults younger than about 45, while refractive lens exchange is usually reserved for nearsighted adults who need reading glasses or show early lens changes. When nearsightedness exceeds the LASIK range in younger adults, an implantable lens such as EVO ICL is often used. EVO ICL keeps the natural lens in place. Highly nearsighted eyes are checked for retinal health before any lens surgery.
Michael Brusco, MD, FACS, has received the STAAR Top 100 International Surgeon honor in multiple years. STAAR Surgical manufactures the EVO ICL. Dr. Brusco is also a founding member of the World College of Refractive Surgery & Visual Sciences.
How Do Refractive Lens Exchange and LASIK Each Correct Astigmatism?
LASIK corrects astigmatism by reshaping the cornea, while refractive lens exchange corrects it with a toric lens implant positioned to offset the cornea’s uneven curve. LASIK treats astigmatism up to about 6.00 diopters, depending on corneal thickness, together with nearsightedness or farsightedness. A toric implant corrects astigmatism at the same time as the rest of the prescription. Neither procedure needs a separate astigmatism surgery.
Michael Brusco, MD, FACS, is a board-certified ophthalmologist and an Assistant Professor in the George Washington University Department of Ophthalmology. Dr. Brusco scored higher than 96% of all ocular surgeons on the national board certification exam.
If My Cornea Is Too Thin for LASIK, Is Refractive Lens Exchange an Option?
Refractive lens exchange can be an option when the cornea is too thin for LASIK, because it corrects vision with a lens implant and removes no corneal tissue. LASIK requires enough corneal thickness left after treatment to keep the cornea stable. Corneal thickness is measured before surgery. Refractive lens exchange is typically considered for thin-cornea patients 45 and older, while younger patients are often evaluated for PRK or EVO ICL.
Brusco Vision offers second opinions for patients who have been told they are not LASIK candidates. Michael Brusco, MD, FACS, reviews each patient’s corneal measurements against all six vision correction procedures the practice offers before recommending one.
Other options for patients who are not LASIK candidates are covered in the guide to LASIK alternatives.
Key Takeaways: Refractive Lens Exchange vs. LASIK
- Refractive lens exchange, also called Custom Lens Replacement, replaces the natural lens with an implant, while LASIK reshapes the cornea, so each suits different prescriptions.
- Nearsightedness beyond about −8.00 diopters, farsightedness beyond about +5.00, or astigmatism beyond about 6.00 is often considered too high for LASIK, depending on corneal thickness.
- Refractive lens exchange can reduce the need for reading glasses; standard LASIK corrects distance vision but does not stop presbyopia.
- Refractive lens exchange is typically considered for adults 45 and older, especially those with high farsightedness or early lens changes.
- Michael Brusco, MD, FACS, of Brusco Vision has performed more than 45,000 corneal-based and more than 6,000 lens-based vision correction procedures.
Communities Served
Brusco Vision is located at 3120 Fairview Park Dr Ste 100, Falls Church, VA 22042. Patients come for Custom Lens Replacement and SBK LASIK from Northern Virginia, Washington, D.C., Arlington, Alexandria, Fairfax, and across the DMV.
Every consultation at Brusco Vision includes measurements of the cornea and natural lens. Schedule a no-pressure consultation with Dr. Brusco to learn whether refractive lens exchange or LASIK fits your prescription.
Related Resources
Medically Reviewed By:
Michael Brusco, MD
Board-Certified Ophthalmologist
Fellowship Trained Refractive Surgeon, WCRS
Last reviewed on November 10, 2026
