Purpose of review: To review the evidential basis of current practice in refractive lens exchange (RLE) vs. phakic intraocular lens (pIOL).

Recent findings: Visual outcomes after pIOLs are better than RLE. With RLE, there still remain risks of retinal detachment, cystoid macular oedema, glare, halos and posterior capsule opacification. With pIOLs, risks include pigment dispersion, cataract formation, glaucoma and inflammation. The decision to choose between either is broadly based on age and type of refractive error, and the choice follows thorough evaluation and counselling taking into consideration patient's needs and expectations.

Summary: With advancing technology, newer IOL models for RLE and phakic correction are becoming available. pIOLs provide better visual outcomes for distance correction and currently do not provide near-vision correction possible with RLE.