Laser Thermal Keratoplasty
Laser Thermal Keratoplasty (LTK) is a method of treating farsightness that uses a beam of holmium- YAG laser energy to reshape the cornea. LTK is a non-contact laser procedure, as there is no cutting of the cornea, and nothing touches the eye before, during, or after the procedure except for the laser beam itself and an instrument to hold the eye open. The laser energy is applied in a predetermined pattern to shrink the collagen fibers in a way that steepens the cornea, changing the eye's focal point. No eye tissue is removed in the procedure.
LTK was approved by the FDA for treatment of the temporary reduction of mild hyperopia (between +0.75 diopters to +2.5 diopters) in patients with less than +0.75 diopter astigmatism and who are 40 years of age or older. Over time, the resulting vision correction regresses or drifts with some patients, necessitating the approval for a "temporary" reduction of the refractive error.
* The Laser Thermal Keratoplasty procedure cost depends on the clinic, the type of the laser used and the aftercare.
Unlike procedures such as LASIK and LASEK, Laser Thermal Keratoplasty or LTK as it is abbreviated, involves no tissue removal from the eye.
LTK is a non-contact laser procedure that can reduce or eliminate farsightedness.
- What are the most common benefits of this surgery?
- What will happen at the initial consultation?
- How is the procedure performed?
- How long does the surgery take?
- Where will the procedure be performed?
- How much pain is there?
- What can I expect after the procedure?
- What is the recovery period like?
- What is the long-term outcome like for most people?
- Ideal Candidate:
- Other important information
- Risks and Limitations:
What are the most common benefits of Laser Thermal Keratoplasty?
LTK treats mild farsightness and also provides a means of treating presbyopia (age-induced farsightedness). The procedure aims to allow patients to see near objects without glasses. For the FDA trial that led to approval of the procedure, at 12 months, 85 percent of the eyes were corrected to 20/40 or better and 37.4 percent were corrected to 20/20 or better visual acuity without spectacles or contact lenses. Due to the noninvasive and quick nature of the surgery, there was a lower incidence of complications for LTK than with LASIK, with less than one percent adverse events.
Other benefits unique to LTK include extremely fast procedure time (approximately three seconds of laser per eye), having the procedure done in the physiciaan's office, the ability to have both eyes done at once, and immediate positive results.
What will happen at the initial consultation?
The eye care physician will perform a full eye examination to determine the cause of your vision problems. Before the exam, stay out of your soft contacts lenses for two weeks and out of rigid contact lenses for three to four weeks. This is very important, as the exact nature of the cornea shape problems will determine the exact placement of laser energy to the eye during the procedure. The doctor will also perform a complete history and eye exam to determine if you have pre-existing medical conditions that will make the surgery more difficult.
How is the LTK procedure performed?
The first step in the LTK procedure is the application of a series of anesthetic eye drops. Then, the patient's chin is placed on a padded chin-rest that keeps the head from moving and that allows the doctor to precisely aim the laser. The patient holds still and focuses on a flashing yellow light. Then, the laser energy is applied for about three seconds in a pattern of points around the circumference of an imaginary circle that is outside the line of sight of the eye. The exact number of laser applied "dots" is dependent on the vision correction needed. The same procedure will be followed for the second eye. Most people go home within 30 minutes of the LTK Procedure. Patients are given eye drops to use in the short-term and the surgeon will discuss any other medicines you may need. Often a bandage contact is placed on the eye until the following day.
How long does the surgery take?
The actual application of the laser to the eye takes three seconds. But including the application of anesthesia and a necessary three minutes for the eye's tear film to dry, the procedure runs about 10 or 15 minutes per eye.
Where will the procedure be performed?
The procedure is performed in an ophthalmologist's office or an out-patient surgical center.
How much pain is there?
Local anesthesia, in the form of numbing eye drops, are administered at the beginning of the procedure so there is no pain during the surgery. There is usually no pain afterwards as well, other than the possibility of some mild irritation immediately after the surgery. This irritation is so minor that no treatment is usually necessary, although over-the-counter medicine such as acetaminophen or aspirin can be used if desired.
What can I expect after the procedure?
For many patients, there is a noticeable, immediate improvement in the eye's ability to focus on nearby objects. In some patients, particularly younger patients where more energy is used to alter the corneal tissue, there is an initial myopic "over-correction." This means that the corneal tissue is too curved and results in a temporary inability to focus on far objects. This can be treated with lenses. Once the tissue settles into a more stable state, after the first few weeks post-surgery, the need for these lenses usually disappears.
What is the recovery period like?
Recovery is complete in 24 to 72 hours and is characterized by mild irritation of the eye or no symptoms.
What is the long-term outcome like for most people?
In the FDA clinical trials, for some patients about half of the affect of the procedure on near vision is lost by two years, although all patients maintained at least some benefit. These results have led to an estimation of three to five years for the duration of the effects of the procedure. However, the effects could last significantly longer in some patients. Retreatment at the time of loss of the curvature of the cornea is an option, but the safety of this has not yet been determined.
The ideal candidate for this procedure would be someone over 40 who is having trouble focusing on near objects, but whose hyperopia or presbyopia can be characterized as mild. This generally means refractive correction between 0.75 and 2.50 diopters. The vision problem can be one that recently developed or has been present for a while, but it should be stable for at least the past six months before the surgery takes place.
Other important information
The company that developed the LTK procedure and makes the laser used is called Sunrise Technologies.
Risks and Limitations:
LTK is characterized by a very low incidence of side effects. Mild irritation, in the form of a foreign body sensation, was seen in under two percent of the cases and its incidence diminished over time. The greatest limitation of this procedure appears to be the possibility of reversion, or loss, of the vision correction over time. In general, about half of the corrective effect had been lost two years post-surgery.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.
*Disclaimer: Costs source: According to the American Society for Aesthetic Plastic Surgeons (ASAPS), nationally in 2010. Most surgeons offer convenient payments plans for this procedure. Cost does not include anesthesia, operating room facility, hospital stay, and other related expenses. Costs may vary depending the extensiveness of the procedure, location, and other factors. Costs are provided solely for research purposes. We are not a plastic surgery company and do not represent any plastic surgeons. For specific estimates, please contact a qualified plastic surgeon.