Learning Center
Surgeries We
Don’t Perform
It is the primary responsibility of every physician to provide the most effective diagnosis and treatment to each of their patients. It is the equal responsibility not to subject their patients to unproven, experimental, or ineffective treatments. While opinions may change with time, it is necessary to make initial judgments on new procedures and decide the relative value or risk of each.
Laser ThermoKeratoplasty (LTK)
This procedure was approved by the FDA in June 2000, with one of highest safety profiles ever seen. It was designed to reduce hyperopia (farsightedness) which was, at the time, one of the more difficult and unpredictable procedures being attempted by the well-established excimer laser systems. Many surgeons were excited to have a reportedly safe alternative treatment and slowly introduced it into their practices. LTK employed thermal lasers that could project spots of energy onto the cornea, which would in turn cause shrinking and re-shaping of the cornea. This re-shaping is designed to cause steepening of the central cornea, thus reducing hyperopia. The FDA knew this effect was not permanent, but felt that the several years of improvement that it could provide was worthwhile in this difficult area of hyperopic correction.
We quickly noticed that there tended to be astigmatism induced during the LTK treatments for hyperopia. Sometimes this was a small and insignificant amount, but for some patients it was significant enough to cause blurring and would neutralize the overall effect of the procedure. Unfortunately, the LTK procedure had no mechanism for correcting this astigmatism and we were forced to wait many months for healing to occur and, if the astigmatism was still a problem, employ our more traditional methods for correction of the astigmatism. While this problem was not significant in the majority of our patients, it did occur frequently enough to make us uncomfortable with the further use of this technology, especially after our main excimer laser technology underwent several upgrades that made us feel that LASIK had, once again, become the best choice available.
Bottom Line: At Hale Vision Laser & Implant Center we are not offering LTK as an alternate in the arena of hyperopic or presbyopic treatments. The original company filed for bankruptcy and a new company has been formed and is attempting to perfect and re-introduce this technology to the marketplace in the future. We see little hope for this technology at any time in the near future without the ability to create a more permanent change in the corneal shape and to deal with astigmatism.
Note: As of December 2004, Visx laser systems received the first industry approval from the FDA to treat hyperopia and astigmatism with the new CustomVue wavefront-guided treatments. These treatments, since introduced for the treatment of nearsightedness and astigmatism in June 2004, have become the mainstay of our LASIK procedures and when combined with the Intralase flap-making technology, have produced the best visual results we have ever seen. We hope the same will hold true for the treatment of hyperopia and astigmatism.
Conductive Keratoplasty (CK)
This technology is based upon the same concept of corneal steepening used in LTK (see above). Instead of using laser-generated heat beams, the CK unit utilizes radio frequency waves to induce a heating effect. This effect is delivered by inserting a metal probe into the cornea at multiple locations and activating the unit. This procedure has also been shown to induce astigmatism in some patients.
While CK may have some advantages over LTK, primarily the ability to deal with induced astigmatism somewhat better than LTK, it is still creates a temporary reduction in hyperopia and depends on the
monovision effect to help patients over forty regain some ability to read.
At Hale Vision Laser & Implant Center, we will continue to monitor the long-term success of the CK procedure beyond the publicity interest it has received. At this time we are reserving final judgment on this CK but are not making it available to our patients at this time.
INTACS
The Intacs procedure was designed for the correction of mild myopia without astigmatism and involved the insertion of acrylic arc-shaped implants into the cornea. This procedure never achieved popularity and the original company filed bankruptcy in March 2001. The technology was purchased by another group and has become a niche product with some application in the area of keratoconus treatment.
At Hale Vision Laser & Implant Center we will not be using the Intac procedure, as it has a very limited range of correction and cannot address wavefront issues, however we may recommend it for those patients with keratoconus that can no longer be treated with contact lenses or glasses.
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