Conductive Keratoplasty

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What is Conductive Keratoplasty (CK Eye Surgery)?

Conductive keratoplasty (CK) is an FDA-approved procedure that corrects farsightedness (with or without astigmatism). The non-invasive procedure uses radiofrequency energy to change the curvature of the cornea. This can help correct presbyopia and low hyperopia (farsightedness). Presbyopia is an age-related disease that affects near visual acuity over time. 

Conductive keratoplasty

Other eye surgeries can correct these refractive errors, like LASIK or photorefractive keratectomy (PRK). However, when compared, a CK procedure is noninvasive, doesn't use lasers, is lower in costs, and just as effective.

In some cases, conductive keratoplasty is a preferred or more suitable type of refractive surgery for some individuals due to the following reasons:

  • No use of laser
  • No removal of tissue
  • No cutting of tissue
  • No change to the central cornea

The procedure is trademarked by Refractec Inc. under the name NearVision CK.

How Does Conductive Keratoplasty Work?

The CK procedure only takes a few minutes. An ophthalmologist uses a small tool (keratoplast tip) to send low-level into your cornea. The electrical physics from the radio frequency raises the tissue temperature of the thickest layer of your cornea (peripheral stroma) to 65°C. This shrinks the collagen in your tissue.

The surgeon will do this in a circular pattern around the peripheral of your eye. This shrinkage tightens the middle of your cornea, increasing your corneal curvature. This gives you stronger refractive power and corrects your near vision. Most people notice better near vision immediately after the procedure. However, it usually takes a few weeks for full correction to settle in. Most people do not need reading glasses after this.

Conductive Keratoplasty Procedure Steps

Eye surgeons will use different techniques to perform conductive keratoplasty. Here is one example of a CK procedure that may occur:

  1. First, you'll receive a local anesthetic (eye drops), as well as antibiotics.
  2. The eye surgeon places a speculum to prevent the eye from blinking and marks the visual axis with an inked tool called the Sinsky hook. 
  3. The surgeon then centers the inked CK marker over the visual axis and applies it to the cornea. 
  4. The surgeon will use a sponge to dry the cornea and prevent any complications that could arise through the spread of energy by a wet surface. 
  5. The surgeon sets the CK console's power and duration and places a sterile keratoplast tip on a sterile handpiece. 
  6. A tool called the nomogram will help guide the surgeon as the keratoplast tip is inserted into the cornea in the marked areas.
  7. The degree of vision correction at a given spot will depend on how much pressure the surgeon places using the tip. 
  8. Once the surgeon has created the right number of spots in the peripheral cornea, the patient receives antibiotic drops in the eye and a soft contact lens over the cornea.

It is important to remember that individuals should stop wearing soft contact lenses at least 2 weeks before the examination. In the case of rigid gas permeable (RGP) contact lenses, individuals should discontinue use at least 4 weeks before the examination plus 1 additional week for every 10 years.

Benefits of Conductive Keratoplasty

Conductive keratoplasty offers many benefits. Here is a list of advantages of this type of surgery:

  • Equal or better results than other types of refractive surgery. Many studies have demonstrated that conductive keratoplasty is as effective, if not more, as other vision correction procedures for hyperopia (farsightedness) or hyperopic astigmatism (farsightedness plus irregularly shaped cornea or lens). 
  • Few complications and side effects. Many individuals who underwent this type of procedure reported a foreign-body sensation and light sensitivity for the first few days after surgery. 
  • Reduce the need for reading eyeglasses. Conductive keratoplasty can help delay presbyopia progression, and with that, the dependence on reading eyewear. 
  • Low risk of re-treatments. Individuals who opt for this procedure do not usually need to undergo further follow-up treatments due to complications or poor outcomes. 

Overall uncorrected visual acuity (UCVA) of 20/40 or better has been reported in 89% of patients with hyperopia or astigmatism who received CK. 

Monovision CK

Monovision is a type of vision correction where one eye is corrected for near vision while the other is stronger for distance vision. If you have presbyopia but good distance vision, your surgeon may recommend CK on one eye.

Before surgery, your doctor may advise you to try monovision correction with contact lenses. This will help you determine whether you can adapt to monovision. If this is successful, you may be a good candidate for monovision CK.

Conductive Keratoplasty Side Effects

The majority of CK side-effects are temporary, and include:

  • Light sensitivity
  • Fluctuating vision
  • Slight nearsightedness
  • Visual regression resulting in the need for additional treatments or alternative vision correction

Who is a Candidate for Conductive Keratoplasty?

Individuals who are not good candidates for laser procedures like LASIK may find conductive keratoplasty more suitable for their needs. These individuals may have problems with the eye’s anatomical structure (small corneal diameter, too steep or flat cornea, deep orbit, etc.) or psychological concerns (fear of laser use or removal of corneal tissue, etc.).

The ideal candidate for conductive keratoplasty have the following characteristics:

  • Are 40 years or older 
  • Between +0.75 and +2.50 diopters of correction 
  • Lower than .75 diopters of astigmatism 
  • Have presbyopia 

Individuals who should not undergo this type of refractive procedure include:

  • Females who are pregnant or breastfeeding
  • Corneal dystrophies or corneal scarring within the central 6-7 mm optical zone 
  • A history of herpetic keratitis
  • Autoimmune or collagen vascular disease
  • Immunocompromised 
  • Advanced atopic disease
  • Diabetes (insulin-dependent)
  • People with dry eye or other eye diseases

Individuals who have a pacemaker should not undergo this procedure, as radio waves emitted during the surgery may affect the heart device’s performance. 

How Much Does CK Eye Surgery Cost?

Insurance companies do not provide coverage for conductive keratoplasty. This means that it is an elective procedure, and prices will differ depending on various factors. Some of these factors include a surgeon’s experience, the location of the ophthalmology clinic, and more. 

The price range for this type of surgery runs between $1,000 and $2,000 per eye. However, the price can be higher. 

It is best to speak with the ophthalmology clinic to consider all financing options, including monthly payments or an interest-fixed loan.

Resources
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“Conductive Keratoplasty.” University of Utah Health, www.healthcare.utah.edu/moran/lasik/conductive-keratoplasty.php

Du, Ted T; Fan, Vincent C; Asbell, Penny A Conductive keratoplasty, Current Opinion in Ophthalmology: July 2007 - Volume 18 - Issue 4 - p 334-337 https://journals.lww.com/co-ophthalmology/Abstract/2007/07000/Conductive_keratoplasty.11.asp.

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