This chapter will discuss refractive lens exchange and its applicability to younger patients than those who generally undergo cataract surgery. In addition, there is a clear distinction between refractive lens exchange in myopic eyes and hyperopic eyes, which are not subject to the effects of the retinal stretching that can lead to premature choroidal neovascularization and macular degeneration. The natural history of high myopic eyes will also be discussed, and how it is associated with the prevalence of choroidal neovascularization. It will also be argued that light toxicity is a potential cause of premature macular degeneration and has to be considered in relation to the light-blocking characteristics of replacement lens implants. Clinical signs associated with the premature onset of AMD and family history of AMD are important clinical considerations for patients thinking of undergoing refractive lens exchange.