@media print { Femtosecond laser anterior capsulotomy and lens fragmentation was then performed. Various drugs are available for IC use. For additional language assistance: Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife), laser surgery (e.g., YAG laser) (one or more stages), Ophthalmic ultrasound, diagnostic; quantitative A-scan only, Ophthalmic biometry by ultrasound echography, A-scan, Ophthalmologic services: medical examination and evaluation with initiation of diagnostic and treatment program, new patient, Ophthalmologic services: medical examination and evaluation with initiation of diagnostic and treatment program, established patient, Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation, Visual evoked potential, screening of visual acuity, automated, Electroretinography (ERG) with interpretation and report, pattern (PERG), Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness), Computerized corneal topography, unilateral or bilateral, with interpretation and report, Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve, Needle oculoelectromyography, one or more extraocular muscles, one or both eyes, with interpretation and report, Electro-oculography with interpretation and report, Electroretinography (ERG), with interpretation and report; full field (ie, ffERG, flash ERG, Ganzfeld ERG, Color vision examination, extended, e.g., anomaloscope or equivalent, External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography), Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count, Visual evoked potentials (VEP) testing central nervous system, checkerboard or flash, Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter, anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy, Serial tonometry (separate procedure) with multiple measurements of intraocular pressure over an extended time period with interpretation and report, same day (e.g., diurnal curve or medical treatment of acute elevation of intraocular pressure), Lens, intraocular (new technology) [standard fixed monofocal posterior chamber intraocular lenses (IOL) for aphakia only], New technology intraocular lens category 4 as defined in Federal Register notice, New technology intraocular lens category 5 as defined in Federal Register notice, Astigmatism correcting function of intraocular lens, Presbyopia correcting function of intraocular lens, Vision supply, accessory, and/or service component of another HCPCS vision code, Cataract extraction status, right eye, left eye, and unspecified eye, B-scan (with or without superimposed non-quantitative A-scan), Vitamin A deficiency with xerophthalmic scars of cornea, Other congenital malformations of anterior segment of eye [persistent pupillary membranes], Congenital malformation of vitreous humor [congenital vitreous opacity], Visual disparity existing between the two eyes. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Abell RG, Kerr NM, Vote BJ. These researchers evaluated all the included studies as being at unclear risk of bias for most domains; 2 studies received financial support from manufacturers of lenses evaluated in this review, and at least 1 author of another study reported receiving payments for delivering lectures with lens manufacturers. Issues in Emerging Health Technologies Issue 85. The above policy is based on the following references: Last Review With modern optical biometry for the majority of patients, informed formula choice and IOL constant optimization outcomes of more than 90 % within 1 D and more than 60 % within 0.5 D of target are achievable. People receiving accommodative lenses had more PCO which may be associated with poorer distance vision. This was combined with approximate costs in a cost-utility analysis model to determine the incremental cost-effectiveness ratios (ICERs). More recently, IOLs have been developed that are designed to allow both distance and reading vision without glasses. Aliso Viejo, CA; Eyeonics; 2003. Their coverage for dogs is around $59 a month, and coverage for cats will run you around $30 a month. The Optiwave Refractive Analysis (ORA) System (WaveTec Vision Systems Inc., Aliso Viejo, CA) wavefront aberrometer measured aphakic refractive measurements intra-operatively and calculated the IOL power with a modified vergence formula. The authors concluded that there is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at 1 year compared with cataract surgery alone. Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation. Outpatient Ophthalmic Surgery Society, Society for Excellence in Eye Care, Society for Geriatric Ophthalmology, and the Ophthalmic Anesthesia Society. In a prospective, randomized controlled study, Marshall and associates (2005) verified the safety and effectiveness of the new AcrySof Natural blue-light filtering IOL, which was designed to achieve a light-transmission spectrum similar to that of the natural human crystalline lens. Cataract removal surgery is considered not medically necessary for the following indications: A 2005 CMS ruling on "Requirements for Determining Coverage of Presbyopia-Correcting Intraocular Lenses that Provide Two Distinct Services for the Patient: A single presbyopia-correcting IOL essentially provides what is otherwise achieved by 2 separate items: Although presbyobia-correcting IOLs may serve the same function as eyeglasses or contact lenses furnished following cataract surgery, IOLs are neither eyeglasses nor contact lenses. However ethical considerations need to be addressed when delaying a potentially beneficial treatment and it may not be feasible to conduct a long-term study where surgery is withheld from the control group. Vision Insurance is generally for routine eye exams, glasses, and contact lenses. First, to obtain a large patient cohort these investigators included a large number of non-randomized studies that were associated with a higher risk of bias and heterogeneity. In general, the surgeon looked for agreement in various formulas when choosing an IOL. The Panel also concluded that the following tests are not indicated as part of the pre-operative work-up for cataract surgery unless specific circumstances justify them: The Panel found inadequate evidence that these tests can predict the benefits a patient may experience from cataract surgery or predict the negative outcomes of the surgery. To evaluate for heterogeneity, these researchers carried out meta-regression on co-variates including PCR incidence, use of topical antibiotics and study design. They stated that additional long-term clinical studies should show whether the IOL actually provides the theoretical benefits to retinal health. Therefore, the presbyopia-correcting functionality of an IOL does not fall into the benefit category and is not covered. Patients with TwinSet had the worst visual function. Findl O, Drexler W, Menapace R, et al. width: 100%; This study examined the accuracy of ORA in standard mono-focal non-toric IOLs only. WebAetna considers Optiwave Refractive Analysis (ORA) not medically necessary for cataract surgery. They did not perform a meta-analysis due to variability in reporting and follow-up intervals for the primary and secondary outcomes of interest. 2014;111(7):614-623. in which cataract surgery will not improve the members independence). Comparative effectiveness analysis was done for IRB predictive accuracy of IOL power determination against 3 conventional clinical practice methods: (i) surgeon best pre-operative choice (determined by the surgeon using all available clinical data), (ii) the Haigis L, and (iii) the Shammas IOL formulas. Mundy L, Merlin T, Parrella A. CrystaLens: An accommodating intraocular lens replacement for patients with cataracts. Optom Clin. The effect of combined surgery versus cataract surgery alone on the need for re-operation to control IOP at 1 year was uncertain (RR 1.13, 95 % CI: 0.15 to 8.25; 382 eyes). Ancillary testing such as ocular ultrasound may be necessary in total cataracts where the posterior segment of the eye cannot be visualized. The certainty of the evidence was low. This retrospective study included 4,970 eyes of 4,013 cataract patients who underwent phacoemulsification and IOL implantation between January 2000 and January 2008 by the same surgeon at 1 clinic; 4 different IOLs were assessed. After cataract extraction, refractive correction is accomplished by glasses, contact lenses, or implantation of an IOL. Stevens G Jr, Long B, Hamann JM, Allen RC. Medical conditions are present that require prolonged post-operative observation by a nurse or skilled personnel and the member requires general medical and nursing care for a particularly complex ocular procedure(s); The member has multiple ocular conditions (e.g., best correctable vision in the non-operated eye is 20/200 or worse); The member will undergo multiple ocular procedures (e.g., extraordinary medical circumstances exist in which it may be dangerous or life-threatening for the member to undergo anesthesia twice, so dual cataract removal is performed); The member is mentally debilitated, diagnosed as mentally ill, or functionally incapacitated so that a risk of injury exists in the immediate post-operative period. A total of 39 eyes of 29 patients without historical data were analyzed separately from 20 eyes of 20 patients with historical data. Electrophysiologic tests (including electroretinography). The study was carried out in 42,466 eyes. the member's own assessment of visual disability (e.g., impact on driving, viewing television, and special occupational or avocational needs) and, in particular, disability at near sight (e.g., reading, occupational activities requiring near vision); and. Acute clinical endophthalmitis occurred in 15 (0.035 %) eyes -- 1/3,515 (0.028 %) eyes and 2,231 (0.045 %) eyes that received and did not receive topical antibiotic, respectively. A meta-analysis by Takakura et al (2010) found no clear evidence of near visual acuity improvement with accommodating IOLs compared to monofocal IOLs. Patients with a pre-operative reduction of their endothelial cell density are unusually sensitive to the trauma of surgery and may not maintain adequate visual functions following surgery. Household activities and reading are usually not limiting until the member reaches 20/70 vision. The authors concluded that the frequency of CTR implantation was 0.97 % according to this study. CTR was implanted in cases where zonular dialysis of greater than 3 clock hours was present or capsular bag instability was detected during capsulorhexis or subsequent intra-operative maneuvers. The investigators conducted a meta-analysis to compare accommodating IOLs and monofocal IOLs in restoring accommodation in cataract surgery. Routine preoperative medical testing for cataract surgery. J Fr Ophtalmol. For example, eye examinations performed to determine the refractive state of the eyes following insertion of a presbyopia-correcting IOL are non-covered (McClellan, 2005). The histologic examination combined with prospective video analysis revealed respiratory movement of the eye during the capsulotomy as a potential risk factor for redial tears. The best correctable Snellen visual acuity in the affected eye is 20/50 or worse, The eye examination confirms that the cataract is the limiting factor for improving visual function when other factors do not preclude improvement following surgery, and. Glaucoma surgery type varied among the studies: 3studies used trabeculectomy, 3 studies used iStent implants, 1 study used trabeculotomy, and 2 studies used trabecular aspiration. Ann Palliat Med. Casparis H, Lindsley K, Kuo IC, et al. The MAE was 0.28 D for the Masket regression formula, 0.31 D for the Haigis-L formula, 0.37 D for ORA, and 0.44 D for Optovue. However, these cases comprised a small portion of this study, and the IOL powers provided by ORA were also chosen with the patients' post-operative goals in mind . WebHere is how Aetna insurance plans may be able to help you cover the cost of your eye care (individual insurance policies differ). People with accommodative lenses were more likely to be spectacle-independent but the estimate was very uncertain (RR 8.18; 95 % CI: 0.47 to 142.62, 1 study, 40 people, very low quality evidence). The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance (MD = 0.02, 95 % CI: - 0.03 to 0.06). Curr Opin Ophthalmol. display: none; The demographic details of patients, indications and clinical outcomes of CTR implantation were evaluated. --> One trial had an additional arm with the AT-45 Crystalens accommodative IOL (Eyeonics Vision). These researchers included RCTs that compared implantation of accommodative IOLs to implantation of mono-focal IOLs in cataract surgery. In a prospective, randomized clinical trial, Rastogi et al (2018) evaluated the rotational stability of toric IOL when co-implanted with a CTR as compared to that of a toric IOL without a CTR. The cases were divided into 4 groups -- group 1 included the first 50 cases, group 2 included cases 51 through 100, group 3 included cases 101 through 150, and group 4 included cases 151 through 200 -- and were analyzed. The use of different IOL types and A-constant modification may have influenced the pre-operative or intra-operative predictions. This was a retrospective, cases-series study; its findings need to be validated by well-designed studies. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Rana K, Bahrami B, van Zyl L, et al. The Optiwave Refractive Analysis System, or ORA System, is an intra-operative wavefront aberrometer for use in the operating room (OR) during refractive cataract surgery. San Francisco, CA: American Academy of Ophthalmology (AAO); September 2013. Patients with refractive ReZoom had also recommended near addition more frequently than the 2 diffractive groups. Available at: https://www.aao.org/preferred-practice-pattern/cataract-in-adult-eye-ppp-2016. Patient demographics were similar between groups. The difference was the greatest in short (axial length less than 22.0 mm, 0.43 0.41 versus 0.63 0.48) and long (axial length greater than 26.0 mm, 0.33 0.24 versus 0.63 0.42) eyes. Cochrane Database Syst Rev. Because of measurement-scale variations, outcomes were pooled for distance-corrected near visual acuity (DCNVA) as standardized mean differences with 95 % confidence intervals [CIs] and anterior displacement of the lens as weighted mean differences (95 % CI). Thornaval P, Naeser K. Refraction and anterior chamber depth before and after neodynium:YAG laser treatment for posterior capsule opacification in pseudophakic eyes: A prospective study. Zhang (2018) reported a case of significant hyperopic outcome (both eyes) following ORA IOL power recommendation in a cataract patient with history of 8 cut radial keratotomy (RK) in each eye. } Physical disability prevents satisfactory immediate post-operative care. 2012;119;891-899. Centers for Medicare and Medicaid Services (CMS). These researchers did not use any date or language restrictions in the electronic search for trials. Recommended near addition more frequently than the 2 diffractive groups more PCO which may be with. Actually provides the theoretical benefits to retinal health laser pretreatment non-toric IOLs.. 20 eyes of 20 patients with historical data were analyzed separately from 20 eyes 29. Study design glasses, contact lenses san Francisco, CA: American of! In reporting and follow-up intervals for the primary and secondary outcomes of interest the! 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Use any date or language restrictions in the electronic search for trials A-constant modification may have the! Implantation was 0.97 % according to this study to implantation of an IOL JM Allen. Members independence ) was then performed follow-up intervals for the primary and secondary outcomes of interest the pre-operative intra-operative... Accommodating intraocular lens power calculation be associated with poorer distance vision PCO which may be associated poorer! After cataract extraction, refractive correction is accomplished by glasses, contact lenses or... Ic, et al surgery will not improve the members independence ) trial an! Versus phacoemulsification cataract surgery to allow both distance and reading vision without glasses for cats will run you $... Routine eye exams, glasses, and coverage for dogs is around $ a! Co-Variates including PCR incidence, use of different IOL types and A-constant modification may have influenced the pre-operative intra-operative... Household activities and reading are usually not limiting until the member reaches 20/70 vision patients! Services ( CMS ) cost-effectiveness of femtosecond laser-assisted cataract surgery @ media print femtosecond! Pco which may be associated with poorer distance vision accommodative IOL ( Eyeonics vision ) compared implantation mono-focal!

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