Laser Thermokeratoplasty - Laser Eye Surgery Guide

Laser Thermokeratoplasty, or LTK, is a version of laser eye surgery that is employed to correct long-sightedness (or hyperopia) as well as astigmatism. The procedure is quick and involves a laser shrinking the cornea and reshaping it: it is this shrinking step that defines LTK from LASIK, PRK and other laser vision surgeries. The latter reshaping stage is performed to correct any refractive errors to improve the focussing power of the eye.

The LTK procedure is also different from others as it is temporary and further surgery may be required, especially once reaching middle age. The surgery also does not incorporate any incisions into the corneal tissue; therefore it is less invasive than certain other procedures, such as LASEK.

How exactly does LTK differ from the other laser eye surgical procedures?

It has been noted that the key differences between LTK and other laser eye procedures lie in the actual technique and outcomes.

In terms of technique, in LTK a laser is employed to create a circle of heat spots on your cornea to force it to contract. This contraction means that the cornea has shrunk and changed shape, which subsequently improves your vision and the ability of your eye to focus light. Throughout this procedure there is no cutting of the corneal epithelium as in LASIK, LASEK and PRK.

The second difference noted is the results. For LTK, the benefits are only short term and so future surgeries will be needed to maintain the results. To try and compensate for the natural regression of one's eyesight, the cornea is sometimes overcorrected. Evidence has shown that in the first three months after your LTK procedure, a significant amount of the corrective contraction will be lost. This is a great contrast with the permanent results achieved from the PRK, LASIK and LASEK procedures.

Who is a suitable candidate for LTK?

There are a number of factors that often make an individual more suited to undergoing the LTK procedure. To start, the surgery is often performed on those who are over 40 years old to account for the temporary results and minimise the number of repeat procedures requires.

Another aspect that is taken into account when assessing your suitability is the stability of your prescription. If your hyperopia prescription has barely changed, if at all, over the past two years then you will considered more suitable for LTK.

More general points looked at when determining if you are suitable or not include general health and medical history, lifestyle, expectations of the result and your justification for undergoing surgery.

Alternatives to LTK

If you are not considered a suitable candidate for LTK then there are other options. Alternatives that you may consider include:

Intra-ocular lenses (IOL)
Implantable contact lenses (ICL)
Conductive keratoplasty (CK)

For the most part, CK has actually replaced LTK so it may be worth looking in detail at the two procedures to determine if you feel more in favour of one in particular.

If your surgeon assesses you and decides that LTK is not the best laser eye surgery for you then he or she will discuss these alternatives with you in detail. You can then make an informed decision as to which surgery is best for you.

Potential risks of LTK

Laser eye surgery as a whole is an extremely safe procedure, however, as with many other forms of surgery, there are some risks that you should consider. The key risks and complications that are associated with LTK include:

The feeling of having something in your eye after the surgery. This may be irritating and uncomfortable but can be eased using certain eye drops.
As the procedure sometimes involves the overcorrection of your cornea, you may experience temporary short-sightedness (or myopia). This may result in you requiring contact lenses or glasses to aid your vision for a number of weeks after your LTK procedure.
For a couple of days after your surgery, you may experience some sensitivity to light but this should ease off quickly.
There is potential of you developing astigmatism.
The procedure is only temporary and so you will experience some regression. This is often noticed around 3 months after you have undergone the procedure and many individuals notice that their eyes go back to their pre-operative state within 3 years.

The benefits of LTK

To decide if a surgical procedure is right for you, it is important to not only consider the risks but also analyse the benefits. For LTK, the key benefits are:

The surgical procedure is quick and performed on an outpatient basis
The risk of developing an infection is considered low
It is very unlikely that you will experience a loss of vision
The procedure and recovery period involve minimal pain and/or discomfort
You should be able to go back to your everyday routine within the next day or two of your surgery

Your LTK consultation

You will be required to attend a consultation prior to undergoing your LTK procedure. Your surgeon will carry out this consultation. They will assess areas such as your health, lifestyle and well being to ensure that LTK is the correct procedure for you.

During the consultation, you will have the time to ask any questions you need. If you would like some ideas as to the sorts of questions that may benefit you then please visit our section, 'Laser Eye Surgery: General FAQs'. These questions are aimed at covering all areas of laser eye surgery and so you may wish to adapt some of the questions to suit you and LTK in particular.

At the end of your consultation, the surgeon should be able to supply you with a quote as to how much your LTK surgery will cost. This price will vary from clinic to clinic depending on location, technology and the surgeon's experience and skill. However, you can expect to pay a minimum of £1,000 per eye, although note that this is only a rough estimate.

The actual LTK procedure: what happens?

Prior to the surgery, your surgeon will use a special clip to hold open your eye and prevent you from blinking throughout the procedure. When this has been correctly positioned, eye drops will be applied to numb the eyes and minimise any potential pain and discomfort.

Once numbed, the surgeon will use a specialised laser that emits a ring of heat onto the eye. This causes the cornea to contract and therefore shrink to enhance it's focussing ability.

The overall result of this contraction is that the cornea will have a steeper curvature. This will allow light to pass through the eye efficiently subsequently leading to clearer vision.

How long can I expect the results of LTK to last?

Unlike laser eye surgeries such as LASIK and PRK, the results of LTK are not permanent, which is often considered as a significant disadvantage. In an attempt to make the effects last as long as possible, some surgeons tend to overcorrect the corneas to delay complete regression.

The result of the overcorrection is often that you experience a level of short-sightedness, which may mean you will require vision aids such as glasses or contact lenses for a few weeks.

You should expect to notice your eyesight getting slightly worse within the 3 months after your LTK procedure. This regression will continue, but at a slower rate, for a couple of years after the surgery until your vision is back to its pre-LTK state.

This is not the same pattern for everyone, however. A number of studies have proven that the effects have the potential to last significantly longer. For a few patients, the outcome can last for between 5 and 10 years. But either way, the LTK procedure is temporary and you should expect to need future surgery to maintain the effects.

Recovery from the LTK procedure

The LTK procedure does not involve your cornea being cut or burnt, which consequently results in a speedy recovery time, often deemed as a significant advantage.

To aid the recovery of your eye(s), you will be administered some specialised antibiotic and anti-inflammatory eye drops to try and stop your eyes falling vulnerable to infections.

You may experience some pain and/or discomfort, however this can be eased using over-the-counter painkillers such as aspirin, ibuprofen or paracetamol. However, this pain and discomfort is rare.

There will also be an aftercare programme following your LTK procedure. This will begin the very next day with a check up at the clinic. This is important to attend as it allows your surgeon to monitor you eye's progress and ensure that there have been no complications. After this initial meeting, you may be required to attend a number of further appointments in the coming months for further monitoring.