Refractive lens exchange is becoming a more popular method of refractive surgery in the presbyopic patient. The limitations of keratorefractive surgery have led to a resurgence of lens exchange surgery for patients with prescriptions outside the limits of corneal refractive procedures, in addition to patients with routine refractive errors requesting a surgical procedure to achieve emmetropia and also address presbyopia. A review of the recent literature was performed to determine recent advances in this surgical procedure.New multifocal and accommodative lens technology should enhance patient satisfaction. In addition, newer lens extraction techniques using microincisions and new phacoemulsification technology will enhance the safety of this procedure, ultimately allowing refractive lens exchanges to be performed through two microincisions as future lens technologies become available.Attention to detail in regard to proper patient selection, preoperative measurements, intraoperative technique, and postoperative management has resulted in excellent outcomes and improved patient acceptance of this effective technique.