Refractive Lens Exchange (RLE) is an elective procedure involving the replacement of the clear crystalline lens with an intraocular lens (IOL). It has gained popularity for correcting high myopia, hyperopia, astigmatism, and presbyopia. While RLE eliminates the need for future cataract surgery, it can lead to diplopia, particularly in patients with diffractive posterior chamber IOLs in one eye and a monofocal IOL or natural lens in the other. Diplopia may also arise from factors such as ocular surface disorders, monovision, IOL decentration, aniseikonia, or pre-existing strabismus. In some cases, RLE itself can resolve diplopia that is refractory to other treatment modalities, as seen in patients with spasms of the near reflex or paralytic strabismus. Successful outcomes depend on careful patient selection, thorough preoperative evaluation, and precise refractive planning. RLE remains a valuable treatment modality when performed in suitable candidates, offering both refractive correction and prevention of future cataract surgery.