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What Is Conductive Keratoplasty (CK)?

Conductive Keratoplasty (CK) is a non-laser, in-office surgical procedure developed for the correction of low to moderate hyperopia (farsightedness) and for the management of presbyopia (age-related near vision loss). Unlike traditional refractive procedures that use excimer lasers to ablate corneal tissue, CK utilizes controlled radiofrequency (RF) energy, typically 350 kHz, delivered through a specialized tip into the peripheral corneal stroma. This application of thermal energy causes the collagen fibers in the treated area to shrink, creating a cinching effect that steepens the curvature of the central cornea, increasing its refractive power and correcting the underlying farsighted error.

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What Is Conductive Keratoplasty (CK)?

Conductive Keratoplasty (CK) is a non-laser, in-office surgical procedure developed for the correction of low to moderate hyperopia (farsightedness) and for the management of presbyopia (age-related near vision loss). Unlike traditional refractive procedures that use excimer lasers to ablate corneal tissue, CK utilizes controlled radiofrequency (RF) energy, typically 350 kHz, delivered through a specialized tip into the peripheral corneal stroma. This application of thermal energy causes the collagen fibers in the treated area to shrink, creating a cinching effect that steepens the curvature of the central cornea, increasing its refractive power and correcting the underlying farsighted error.

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Who Is A Candidate For Conductive Keratoplasty?

CK is generally indicated for patients with low to moderate hyperopia, including those with hyperopic astigmatism. Clinical trials supporting the procedure enrolled patients with hyperopia between +0.75 D and +3.00 D, and a low level of astigmatism, specifically =0.75 D. The procedure has FDA approval for treating these refractive errors.

When utilized for presbyopia, the treatment is typically applied to the non-dominant eye to intentionally induce a mild degree of nearsightedness. This strategy creates monovision, allowing the patient to maintain improved near vision while utilizing the dominant eye for distance viewing. The FDA approved the VIEWPOINT CK SYSTEM in 2004 specifically for the temporary induction of myopia in the range of -1.00 D to -2.00 D to improve near vision in presbyopic patients.

How Is Conductive Keratoplasty Performed?

The procedure is performed quickly in an outpatient setting using only topical anesthesia. The surgeon uses a tiny tip to deliver the RF energy into the peripheral corneal stroma at predetermined spots, usually ranging from 8 to 32 points arranged in a circular pattern. This precise application keeps the center of the visual axis untouched by the thermal energy, concentrating the refractive change in the corneal periphery to achieve the desired central steepening.

Most patients can return to non-strenuous daily activities or work within a few days. However, the period required for complete refractive change stabilization, where the final visual outcome is attained, typically occurs around six months post-procedure. Continuous monitoring is necessary to track the stability of the correction over the longer term.

How Effective Is Conductive Keratoplasty?

Clinical trials have demonstrated high predictability and effectiveness for the correction of hyperopia. One-year data indicated that 91 percent of treated eyes achieved an uncorrected distance visual acuity (UCVA) of 20/40 or better, with 51 percent achieving 20/20 or better. Regarding accuracy, 91 percent of eyes were successfully corrected to be within ?1.00 D of the attempted manifest refractive spherical equivalent correction at the 12-month measurement point.

While the refractive effect typically stabilizes around six months post-procedure, some regression is an expected characteristic of CK. Because the mechanism relies on modifying the biomechanical elasticity of the corneal collagen, the effect naturally diminishes over time as the tissue undergoes biological remodeling. Eyes previously treated with refractive procedures like LASIK or PRK exhibit greater initial refractive fluctuation, showing a statistically significant myopic shift in the first six months compared to eyes without prior surgery, though long-term stability may equalize.

When Should You Consider Conductive Keratoplasty?

Consider CK if you have low to moderate farsightedness between +0.75 D and +3.00 D with minimal astigmatism (=0.75 D), or if you're experiencing presbyopia and want to reduce dependence on reading glasses. The procedure is particularly suitable for patients seeking a non-laser alternative to traditional refractive surgery. Monovision CK can be an option if you're willing to have one eye corrected for near vision while the other maintains distance vision.

Following the procedure, patients commonly report temporary light sensitivity, blurry vision, and eye discomfort. Post-operative instructions usually include strictly following the prescribed regimen of eye drops and protecting the eyes from dust and bright light by consistently wearing sunglasses. A follow-up check is generally scheduled one day after the procedure to monitor the initial healing response. Be aware that the correction is temporary and may require retreatment or a return to corrective lenses over time.

Frequently Asked Questions

What Are The Risks Of Conductive Keratoplasty?

Like other refractive surgeries, CK carries risks that include reduced contrast sensitivity, glare, halo effects, and the potential for induced astigmatism. During the immediate recovery period, common transient side effects include blurry vision, a gritty sensation, sensitivity to light, and general soreness.

The primary long-term concern associated with CK is the biological regression of the achieved correction. Due to this temporary effect, patients may eventually require retreatment or need to return to using glasses or contact lenses, especially for reading tasks. Although rare, corneal scarring, which may appear as a white or milky dot on the cornea, can occur, potentially causing symptoms like light sensitivity or foreign body sensation.

Is The Correction Achieved By Conductive Keratoplasty Permanent?

According to FDA regulatory guidance, while uncorrected vision improves, the amount of correction achieved by CK for farsightedness is temporary for most individuals and will gradually lessen. Due to this biological tissue regression, patients may eventually require reading glasses or follow-up procedures to sustain the desired near vision benefit.

How Does Ck Compare To Other Presbyopia Treatments?

CK presents an established regulatory and safety profile compared to certain newer presbyopia solutions. For instance, the Raindrop Near Vision Inlay was subject to an FDA Class 1 recall after post-approval studies showed an increased risk of significant corneal haze, which affected 75 percent of patients and necessitated device removal in 23.3 percent of cases. CK avoids complications related to implanted devices entirely.

Can Ck Be Used To Treat Astigmatism?

Yes, CK is indicated for addressing hyperopic astigmatism. Clinical trials included patients with astigmatism up to 0.75 D. The procedure's circumferential tightening mechanism helps symmetrically refine the corneal shape to address lower levels of co-existing refractive irregularities.

References

PubMed. Conductive keratoplasty is effective, predictable, and safe to correct low to moderate hyperopia, astigmatism, and manage presbyopia. https://pubmed.ncbi.nlm.nih.gov/17568211/

PubMed. Long-term safety, efficacy, and stability of conductive keratoplasty (CK) in the treatment of presbyopia. https://pubmed.ncbi.nlm.nih.gov/18041244/

PubMed. One-year data show safety and efficacy of CK in the treatment of hyperopia. https://pubmed.ncbi.nlm.nih.gov/11797323/

PMC. Regression of conductive keratoplasty. https://pmc.ncbi.nlm.nih.gov/articles/PMC3519124/

PMC. Comparing the Rate of Regression after Conductive Keratoplasty with or without Prior LASIK or PRK. https://pmc.ncbi.nlm.nih.gov/articles/PMC3046993/

Ophthalmology Times. FDA panel recommends approval of CK system for presbyopia. https://www.ophthalmologytimes.com/view/fda-panel-recommends-approval-ck-system-for-presbyopia

U.S. Food and Drug Administration. VIEWPOINT CK SYSTEM. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?ID=P010018S005

Aetna. Corneal Remodeling Medical Clinical Policy Bulletins. https://es.aetna.com/cpb/medical/data/1_99/0023.html

Healthline. Conductive Keratoplasty Scarring: Causes, Side Effects, and Recovery. https://www.healthline.com/health/conductive-keratoplasty-scars

American Academy of Ophthalmology. FDA Class 1 Device Recall: Raindrop Near Vision Inlay. https://www.aao.org/headline/fda-alert-raindrop-near-vision-inlay-may-raise-ris

NVISION Centers. Everything You Need to Know About Raindrop Eye Surgery. https://www.nvisioncenters.com/eye-surgery/raindrop/

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References