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Lens-based vision correction

Refractive procedures: CLE or IPCL?

We offer two lens-based procedures for refractive errors. The choice depends on more than dioptres: age, natural lens, eye anatomy and visual needs all matter.

Two procedures – carefully chosen

Understanding the options helps you decide.

With Clear Lens Extraction (CLE) the natural lens, which is still clear or only slightly cloudy, is removed and replaced with an individually calculated artificial lens. This procedure is also known as Refractive lens exchange.

With a Phakic posterior chamber lens, such as IPCL, your natural lens stays in place and a specially calculated artificial lens is implanted alongside it. The refractive errors it can correct depend on the lens model and its approved indications. Special models are also available for presbyopia, although there is less long-term clinical evidence for these.

Both procedures correct refractive errors by placing a lens inside the eye. Unlike LASIK and other laser vision correction procedures, they do not reshape the cornea by removing tissue. The aim is to greatly reduce your reliance on glasses or contact lenses. Whether you can stop wearing glasses altogether depends on your eyes and the type of lens chosen.

Compare CLE and IPCL Request a consultation
The procedures in detail

What happens during the operation?

Both procedures are planned individually and performed on an outpatient basis. These descriptions explain the basic approach; the details vary with your eye and the lens chosen.

The natural lens is preserved

Phakic posterior chamber lens: an additional lens inside the eye

The foldable lens is inserted through a small opening at the edge of the cornea and positioned behind the iris, in front of the natural lens. It adds to the eye’s focusing power without removing corneal tissue or the natural lens. IPCL is the name of a particular product family.

Key benefits

  • Preserving the natural lens and its remaining focusing ability
  • May be useful for higher prescriptions or when corneal laser treatment is unsuitable
  • No laser-related changes in corneal shape
  • Correction of astigmatism possible depending on the findings and model
  • Presbyopia-correcting lenses may extend the range of vision; long-term evidence and achievable distances vary by model
  • The lens can be removed or replaced surgically if medically necessary

Important: ‘Removable’ does not mean risk-free or fully reversible. The natural lens may become cloudy later, and regular long-term checks remain necessary.

The natural lens is replaced

CLE: refractive lens exchange

Clear lens exchange uses the same surgical technique as modern cataract surgery to remove the natural lens. A precisely calculated artificial lens is then placed inside the remaining lens capsule. Its optical properties are chosen to suit your examination results and the distances at which you want to see clearly.

Key benefits

  • Can correct high short-sightedness, long-sightedness and regular astigmatism
  • Lens options for distance, intermediate and, in suitable eyes, near vision
  • The removed natural lens cannot develop a cataract later
  • May be particularly useful when presbyopia or early lens changes are already affecting vision
  • No laser-related changes in corneal shape

Important: The natural lens is permanently removed, along with its remaining ability to change focus. Even modern artificial lenses cannot fully reproduce natural vision.

Direct comparison

CLE and IPCL at a glance.

This table shows typical differences. It does not replace an individual assessment of suitability.

CriterionIPCLCLE
Basic principleAn additional lens is placed behind the iris, in front of the natural lens.The natural lens is removed and replaced with an artificial lens.
Natural lensIs retained, preserving the remaining focusing ability in younger eyes.Permanently replaced. Natural focusing ability is lost.
Typical life phaseOften adults with a clear natural lens and a stable prescription. Special models for presbyopia have less long-term evidence.Often people with presbyopia, higher long-sightedness or early lens changes.
Refractive errorMay be particularly useful for higher myopia and astigmatism; other corrections depend on the lens model.Can correct short-sightedness, long-sightedness and astigmatism; the target distance depends on the artificial lens chosen.
PresbyopiaSpecial lens models designed for presbyopia aim to extend clear vision at near and far distances. Long-term scientific evidence is more limited. The range of vision, contrast and side effects depend on the particular lens and the individual eye.Can use monofocal, toric, EDOF or multifocal lenses, each with its own optical benefits and drawbacks.
CorneaNo corneal tissue is removed for correction.No corneal tissue is removed for correction.
ReversibilityThe lens can generally be removed or replaced surgically, but a complete return to the original state cannot be guaranteed.Replacing the natural lens is irreversible.
Subsequent developmentBecause the natural lens remains in place, a cataract may still develop later.The removed lens cannot develop a cataract again, although treatable clouding of the remaining capsule is possible.
Which option suits whom?

Age alone is not the deciding factor

Age and refractive error help guide the options. The full anatomy, eye health and realistic expectations remain decisive.

IPCL is often more suitable if ...
  • you are an adult and your glasses prescription has been stable for some time.
  • your natural lens is clear and its focusing ability should be preserved where possible.
  • you have moderate to high myopia or correctable astigmatism.
  • you have presbyopia and a particularly careful assessment shows that an approved presbyopia-correcting lens suits your eye’s anatomy and optical needs.
  • laser treatment is not the preferred option because of the prescription, corneal thickness or shape, or dry eyes.
  • the chamber depth, drainage angle, pupil and endothelial cell count provide a sufficient safety margin.
  • the retina, optic nerve and eye pressure show no significant reason against treatment.

Why? In younger eyes, the natural lens is usually still clear and able to change focus. Keeping it preserves the eye’s remaining ability to focus at close range. For people with presbyopia, a special lens model may extend the range of clear vision. Results vary, however: freedom from glasses cannot be guaranteed, and long-term experience with these models is more limited.

CLE is often more suitable if ...
  • presbyopia is well advanced and the natural lens’s remaining focusing ability offers little benefit.
  • you have higher long-sightedness or want a lens-based plan for several viewing distances.
  • the natural lens shows early changes or a future cataract is foreseeable.
  • an IPCL is unsuitable because of age, anatomy, insufficient anterior chamber depth or other measurements.
  • you accept permanent removal of your natural lens and the chosen artificial lens’s optical properties after a detailed consultation.

Why? If your natural lens is already losing flexibility or becoming slightly cloudy, replacing it may address both your refractive error and presbyopia. A cataract cannot subsequently develop in the natural lens once it has been removed.

Particular caution is needed

If you have high myopia, lens replacement can further affect your already increased risk of retinal detachment. Diseases of the cornea, retina, macula or optic nerve, glaucoma, inflammation, an unstable glasses prescription, pregnancy, breastfeeding or unrealistic expectations may also rule out surgery or mean it needs to be postponed.

Safety before speed

What we examine before recommending treatment.

All the measurements together allow a responsible decision and precise lens calculation.

Refraction and stability

We check your glasses prescription, best-corrected visual acuity and changes in your refractive error. You may need to stop wearing contact lenses before the measurements.

Cornea and the front of the eye

Topography, keratometry, thickness, chamber depth, drainage angle, pupil size and endothelial cell count show whether there is enough space and a sufficient safety margin.

Lens, retina and optic nerve

We check the natural lens for clouding and examine the macula and retina after dilating the pupils. Eye pressure and the optic nerve are also assessed.

Visual objectives and everyday life

We consider your work, screen use, reading, night driving, sport and tolerance of halos or a continued need for glasses.

Choosing a lens for CLE

Planning your range of vision means balancing priorities.

Lens choice is about more than dioptres. Optical quality, astigmatism, pupil, cornea, macula, optic nerve and your everyday priorities all matter.

Monofocal

Usually prioritises one distance, often far vision, with very clear image quality. Glasses are usually needed for near or intermediate tasks.

Toric lens

Also corrects regular astigmatism. Toric optics can be combined with different lens designs and must be aligned precisely.

EDOF

Often extends vision from distance into the intermediate range. Reading glasses may still be needed for small print; halos and contrast changes are possible.

Multifocal

Divides light between several viewing distances and may reduce reliance on glasses more substantially. Halos, glare and reduced contrast may be more noticeable.

Benefits and limits

What to know before you decide.

Refractive surgery is optional surgery on an eye that can often see well with glasses or contact lenses. Benefits and risks therefore need particularly careful consideration.

Possible common side effects

  • Residual refractive error and a continued need for glasses
  • Glare, halos or reduced contrast, especially at night
  • temporary inflammation, pressure fluctuations or delayed healing
  • rare but serious risks such as infection, bleeding, retinal problems or permanent vision loss
  • further procedures to correct vision, reposition the lens or treat complications

Additional considerations for IPCL

  • Unsuitable distance from the natural lens or iris (‘vault’)
  • Raised eye pressure or changes to the drainage angle
  • Loss of corneal endothelial cells
  • Development of lens opacity or a cataract
  • Regular long-term checks are necessary

Additional considerations for CLE

  • Permanent loss of natural focusing ability
  • Posterior capsule opacification, which may later require laser treatment
  • A difference from the intended prescription
  • Macular oedema or other known risks from cataract surgery
  • Careful assessment of retinal risk in high myopia
Surgery and follow-up care

Precise planning. Close follow-up.

Surgery is usually performed under local anaesthetic through a small opening in the eye. Afterwards, you will use the prescribed eye drops and attend scheduled follow-up appointments. You will need to avoid rubbing your eye, swimming, eye make-up, strenuous physical activity and sport for a time. We will tell you how long each restriction applies in your case.

Contact us immediately after surgery, if you develop pain, increasing redness, a marked loss of vision, flashes of light, many new black spots or a shadow in your visual field.

Frequently asked questions

Making an informed decision.

These answers provide general guidance. We can recommend treatment for you only after a full examination and a discussion of your options.

Will CLE or IPCL guarantee I no longer need glasses?

No. Both procedures can greatly reduce your reliance on glasses or contact lenses, but neither guarantees complete freedom from glasses. You may still need them because of a remaining refractive error, changes during healing or particular visual tasks.

Is the IPCL really reversible?

An IPCL can generally be removed or replaced in a further operation, which is an important difference from clear lens exchange. Even so, the procedure cannot be reversed without consequences, and we cannot promise that the eye will return to exactly its original state.

Can a phakic posterior chamber lens also correct presbyopia?

Special lenses designed to correct presbyopia aim to extend clear vision at both near and far distances. Early clinical results are promising, but there is less long-term evidence than for established monofocal procedures. Whether an approved model is suitable for you depends on factors including your eye’s anatomy, pupil, retina, visual goals and tolerance of possible halos or changes in contrast.

Can a cataract develop after IPCL?

Yes. The natural lens remains and may become cloudy later. Cataract surgery may then be needed, removing the IPCL and replacing the natural lens with an artificial one.

Can a cataract develop after CLE?

No, the natural lens has already been removed. Its capsule behind the artificial lens may become cloudy, but this can usually be treated with a brief laser procedure.

Which CLE lens is the best?

No single lens is best for everyone. Monofocal lenses usually prioritise one distance and often provide very clear vision. Toric lenses correct regular astigmatism. EDOF and multifocal designs may extend the range of clear vision, but can also cause halos, glare or reduced contrast. Your examination results and visual goals guide the choice.

Why is my glasses prescription not enough to decide whether treatment is suitable?

Your prescription is only one factor in the decision. The depth of the anterior chamber, endothelial cell count, pupil, corneal shape, eye length, natural lens, retina, optic nerve and your expectations can all affect the recommendation or rule out a procedure.

Medical basics

Further clinical information.

This page draws on patient information and specialist reviews from recognised medical institutions. Product approvals and suitable correction ranges vary by lens model and country.

Medical note

This page does not replace an examination, individual risk discussion or medical advice. Whether CLE or IPCL is medically appropriate requires full assessment of both eyes.

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