BlueCross BlueShield of Tennessee Medical Policy Manual

Transpupillary Thermotherapy (TTT)


Transpupillary thermotherapy (TTT) is a technique in which low-level heat is delivered through the pupil to the choroid and retinal pigment epithelium using a modified diode laser. TTT is being evaluated as a treatment for several ophthalmologic conditions. Some of these conditions include retinoblastoma, choroidal melanoma, classic and occult choroidal neovascularization, which is a common cause of adult onset blindness or age-related macular degeneration.

This laser technique contrasts with the laser used in standard photocoagulation therapy, in that TTT uses a lower power laser for more prolonged periods of time and is designed to gently heat the choroidal lesion, thus limiting damage to the overlying retinal pigment epithelium.




Evidence remains insufficient to determine whether transpupillary thermotherapy is as beneficial as the established alternatives. Well-designed studies are needed to validate safety and efficacy.


American Academy of Ophthalmology. (2015). Preferred practice pattern: age-related macular degeneration. Retrieved October 5, 2017 from

Giudice, G., de Belvis, V., Tavolato, M., Galan, A. (2011). Large-spot subthreshold transpupillary thermotherapy for chronic serous macular detachment. Clinical Ophthalmology, (5), 355-360. (Level 3 evidence)

Hasanreisoglu, M., Saktanasate, J., Schwendeman, R., Shields, J. A., & Shields, C. L. (2015). Indocyanine green-enhanced transpupillary thermotherapy for retinoblastoma: analysis of 42 tumors. Journal of Pediatric Ophthalmology and Strabismus, 52 (6), 348-354. Abstract retrieved November 23, 2016 from PubMed database.

Manayath, G.J., Karandikar, S.S., Narendran, S, Kumarswamy, K.A., Saravanan, V.R., Morris, R.J., & Venkatapathy, N. (2017). Low fluence photodynamic therapy versus graded subthreshold transpupillary thermotherapy for chronic central serous chorioretinopathy: results from a prospective study. Ophthalmic Surgery, Lasers and Imaging Retina, 48 (4), 334-338. Abstract retrieved August 24, 2018 from PubMed database.

Mashayekhi, A., Shields, C. L., Rishi, P., Atalay, H. T., Pellegrini, M., McLaughlin, J. P., et al. (2015). Primary transpupillary thermotherapy for choroidal melanoma in 391 cases: importance of risk factors in tumor control. Ophthalmology, 122 (3), 600-609. Abstract retrieved November 23, 2016 from PubMed database.

National Institute for Health and Care Excellence. (2004). Transpupillary thermotherapy for age-related macular degeneration. Retrieved August 24, 2018 from

Nowak, M., Jurowski, P., Grzybowski, A., Goś, R., Pastuszka, M., Kapica, A., et al. (2012). A prospective study on different methods for the treatment of choroidal neovascularization. The efficacy of verteporfin photodynamic therapy, intravitreal bevacizumab and transpupillary thermotherapy in patients with neovascular age-related macular degeneration. Medical Science Monitor, 18 (6), CR374-380. (Level 2 evidence)

Shah, P., Narendran, V., & Kalpana, N. (2011). Large spot transpupillary thermotherapy: A quicker laser for treatment of high risk prethreshold retinopathy of prematurity - a randomized study. Indian Journal of Ophthalmology, 59 (2), 155-158. (Level 2 evidence)

Turcotte, S., Bergeron, D., Rousseau, A., & Mouriaux, F. (2014). Primary transpupillary thermotherapy for choroidal indeterminate melanocytic lesions. Canadian Journal of Ophthalmology, 49 (5), 464-467. Abstract retrieved October 5, 2017 from PubMed database.




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