+1  A: 

GIST for your X,Y much the same as PostGIS does. As a matter of fact you could even use the PostGIS extension for Postgresql and get quite a bit of bang for your buck

TheSteve0
+1  A: 

cluster the table on "ywot_tile_world_id_key", the primary key seems like it is simply an artificial id. If you have more unique vertical values, than horizontal you might want to reverse the order (world-id, y, x). Also remove the lone index on world-id, it is duplicated by the compound index.

Justin
AFAICT, clustering would bring my site down, and would have to be repeated on a regular basis, so this is not an ideal solution.
Andrew B.
I think that all high change tables need to get re-org done periodically. If you know your growth rate, you can leave a percent-free in the data pages, to allow for changes (or delay the time between re-orgs).
Justin
A: 
Andrew B.
That's actually pretty good.
Justin