Furthermore, the AAO Preferred Practice Pattern on cataract surgery (2016) stated that Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and reduces the amount of ultrasonic energy required to remove a cataract. 1999;3(5):295-302. Electrophysiologic tests (including electroretinography). They found no RCTs or quasi-RCTs that had compared surgery versus no surgery to remove the lens from eyes of adults in which cataracts had developed following vitrectomy. Cochrane Database Syst Rev. Ophthalmology. Situations that prevent normal examination include lid problems (e.g., severe edema, partial or total tarsorrhaphy), keratoprosthesis, corneal opacities (e.g., scars, severe edema), hyphema, hypopyon, miosis, pupillary membranes, dense cataracts, or vitreous opacities (e.g., hemorrhage, inflammatory debris). An UpToDate review on Laser refractive surgery (Bower, 2016) states that Wavefront Testing -- In a standard eye examination, the refractive surgeon will test for myopia, hyperopia, and astigmatism. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs (RR = 0.89, 95 % CI: 0.71 to 1.12 for spectacle independence; RR = 1.81, 95 % CI: 0.50 to 6.54 for PCO incidence; RR = 0.98, 5 % CI: 0.86 to 1.12) for patient satisfaction. cursor: pointer; Surgical outcomes and safety of femtosecond laser cataract surgery: A prospective study of 1500 consecutive cases. Capsulotomy. Based on the simulated complication rates of PCS and FLACS and assuming resultant VA outcome improvement of 5 % in uncomplicated cases of LCS, the cost-effectiveness (dollars spent per QALY) gained from LCS was not cost-effective at $92,862 Australian Dollars. } Philadelphia, PA: W.B. Guidelines for cataract practice. American Academy of Ophthalmology (AAO)EyeWiki. The member's medical and mental health should permit surgery to be performed safely. 2015;25(2):112-8. Aetna launched a troubling new prior authorization policy on July 1, that applies to all cataracts surgeries even when patients face emergency situations. The short answer: Yes. Cataract removal surgery involving removal of the lens is considered medically necessary without regard to visual disability when any of the following criteria is met: Member has lens-induced disease (e.g., phacomorphic glaucoma, phacolytic glaucoma, phacoanaphylactic endophthalmitis, dislocated or subluxated lens). 2000;26(10):1435-1437. In such cases, diagnostic B-scan ultrasound can accurately image intra-ocular structures and give valuable information on the status of the lens, vitreous, retina, choroid, and sclera. Laser refractive surgery. No study reported any vision-related quality of life data or cost outcome. Slit-lamp examination provides more details about the character, location, and extent of the opacity. Li A, He Q, Wei L, et al. Some IOLs may be a combination of more than one type (eg, light absorbing monofocal) and most IOLs are available in multiple models (eg, TECNIS monofocal, TECNIS multifocal, TECNIS toric monofocal, TECNISSymfony). margin-top: 38px; Next, the temporary suture was released, a capsular hook(s) was placed to support the lens, and the lens was emulsified. in which cataract surgery will not improve the members independence). Obstbaum SA. Cataracts may result in progressive loss of vision. 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. In general, driving an automobile is the limiting life-style activity with visual acuity in the 20/50 to 20/60 range. Ophthalmic Surg Lasers. Patients underwent IRB for IOL power estimation. Martnez Palmer A, Gmez Faia P, Espaa Albelda A, et al. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate. 2001;27(12):1961-1968. In a prospective, interventional case-series study, Roberts and co-workers (2013) reported the surgical outcomes and safety of FLACS with greater surgeon experience, modified techniques, and improved technology. }. American Academy of Ophthalmology (AAO),Cataract/Anterior Segment Panel,. However, there was no statistically significant difference between the 2 groups in the uncorrected distance VA (UDVA) and corrected distance VA (CDVA) (MD = 0.01, 95 %CI: - 0.01 to 0.04 for UDVA; MD = 0.00, 95 % CI: - 0.01 to 0.01 for CDVA). Stodola E. An update on billing policy for femtosecond laser use. People receiving accommodative lenses had more PCO which may be associated with poorer distance vision. Most health insurance plans cover cataract surgery. Main outcome measures included intra-operative complication rates and comparison between groups. These can be either multi-focal lenses, which enable both near and distance vision by virtue of the design of the lens itself, or accommodating lenses, which are intended to move within the eye in a manner similar to a natural human lens. Data were available for all patients at 6 months and 20 patients at 1 year. WebAetna considers Optiwave Refractive Analysis (ORA) not medically necessary for cataract surgery. Data were collected about patient demographics, pre-operative investigations and intra-operative complications. Menapace RM, Dick HB. The Panel found inadequate evidence that potential vision testing can help the ophthalmologist in predicting the outcome of cataract surgery. Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery. They included 4 RCTs, including 229 participants (256 eyes), conducted in Germany, Italy and the UK. Subjects' mean age ranged from 58 to 64 years. Indian J Ophthalmol. Cochrane Database Syst Rev. Cataracts obscure the normal "red reflex" that is elicited by examining the dilated pupil with the ophthalmoscope held about 1 foot away. Early experience with the femtosecond laser for cataract surgery. This condition usually occurs as a part of the aging process, developing on a continuum extending from minimal changes in the crystalline lens to the extreme stage of total opacification. Of the 1CU eyes, 9 patients (30 %) could read J6 or better at a reading speed of 80 words/min or better. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (5 years or more). In this unique scenario, the corneal curvature readings from ORA could be quite different from pre-operative readings or from stabilized post-operative corneal measurements. Linebarger EJ, Hardten DR, Shah GK, Lindstrom RL. Another drawback was only 121 patients out of 289 patients had recorded anterior chamber lengths in chart review. The AAO and ASCRS claim that Aetna's only reason for the new policy was that 4-5% of cataract surgeries were unnecessary. However, there may be some out-of-pocket costs, such as a copayment or coinsurance. Abell and Vote (2014) performed a comparative cost-effectiveness analysis (CEA) of FLACS and conventional phacoemulsification cataract surgery (PCS). This review does not mention the Optiwave refractive analysis system/intra-operative refractive biometry. Retrospective screening of database of 6,000 consecutive cataract surgeries was done; BCVA, complete ocular examination with slit lamp examination (SLEx), IOP, direct ophthalmoscope, fundus examination with +78/+90D were noted. These lenses have biconvex, convexoplano, convexoplano with HofferTM* ridge modification, or meniscus optics with supporting haptics. Cataract surgery. Multifocal versus monofocal intraocular lenses after cataract extraction. After cataract extraction, refractive correction is accomplished by glasses, contact lenses, or implantation of an IOL. Refractive outcomes of intraoperative wavefront aberrometry versus optical biometry alone for intraocular lens power calculation. These investigators included 9 RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months; 7 trials were conducted in Europe, 1 in Canada and South Africa, and 1 in the United States. J Cataract Refract Surg. Additional trials, with longer follow-up, comparing different accommodative IOLs, multi-focal IOLs and mono-focal IOLs, would help map out their relative efficacy, and associated late complications. Mean contrast sensitivity was better for the monofocal IOL group than for the multi-focal IOLs. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count less than 2,000/mm2 were excluded from the study. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm511446.html. Filkorn and associates (2012) compared IOL power calculation and refractive outcome between patients who underwent laser refractive cataract surgery with a femtosecond laser and those with conventional cataract surgery. 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. Data collected included patient demographics, pre-operative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intra-operative complications, and post-operative outcomes. The authors concluded that multi-focal IOLs were effective at improving near vision relative to mono-focal IOLs although there was uncertainty as to the size of the effect. The member is medically unfit (e.g., conditions such as comatose patients, organic brain syndrome, end stage Alzheimer's disease, persons with no light perception, etc. Unfortunately, the answer to this question is not The member has been educated about the risks and benefits of cataract surgery, including alternatives to treatment and the member determines if the expected reduction in the disability outweighs the potential risk, cost and inconvenience of surgery. 2000;238(9):765-773. A beam of light is refracted from the eye and goes through a micro-lens array producing a spot image array of reflected light. Packer M, Fine IH, Hoffman RS. background-color: #cc0066; What Eyecare (Including LASIK) Does Aetna Offer? #closethis { At 1 year, trifocal IOL showed no evidence of effect on uncorrected distance VA (MD 0.00, 95 % CI: -0.04 to 0.04; I2 = 0 %; 2 studies, 107 subjects; low-certainty evidence) and uncorrected near VA (MD 0.01, 95 % CI: -0.04 to 0.06; I2 = 0 %; 2 studies, 107 subjects; low-certainty evidence). Modeling a best-case scenario of FLACS with excellent visual outcomes (100 %), a significant reduction in complications (0 %) and a significantly reduced cost to patient (of $300) resulted in an ICER of $20,000. The Panel stated that cataract removal surgery should be performed on each eye separately and sufficient time be allowed for the first eye to heal before the second cataract removal is performed (an interval of 2 to 6 months is customary). The authors concluded that in the authors' experience, the surgical outcomes and safety of LCS improved significantly with greater surgeon experience, development of modified techniques, and improved technology. 2020;46(8):1075-1085. Scott A. list-style-type: decimal; Compare patient reviews and book online instantly. AcrySof. Cataracts in Adults: Management of functional impairment. The authors concluded that there is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate VA at 1 year; however, there is no evidence of a difference between trifocal and bifocal IOL for uncorrected distance VA, uncorrected near VA, and BCVA at 1 year. Centers for Medicare and Medicaid Services (CMS). In a Cochrane review, these investigators evaluated the visual effects of multi-focal IOLs in comparison with the current standard treatment of mono-focal lens implantation. 2008;19(1):1-4. Routine preoperative medical testing for cataract surgery. They contacted study investigators for additional information. #backTop:hover { The authors concluded that laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, post-operative refraction and surgical satisfaction. The other models are SN6AT6, SN6AT8, and SN6AT9. Ruling No. Presently, objective techniques exist for a comprehensive measurement of the optics of the eye. Cochrane Database Syst Rev. However, in many instances, ultrasound is used for diagnostic purposes even though pathology is clinically visible. ), and this may prove beneficial in the future research by providing additional data to aid in comparison between groups. No statistically significant differences were observed between the 2 groups in visual acuity, contrast sensitivity evaluated under mesopic and photopic conditions, or the number of subjects who passed the Farnsworth D-15 color perception test. 1999;128(1):31-37. More recently, IOLs have been developed that are designed to allow both distance and reading vision without glasses. The surgeons with prior experience with femtosecond lasers had fewer complications in the first 100 cases (p < 0.001). The procedure was completed by phacoemulsification and insertion of an IOL. Patient demographics were similar between groups. In a prospective, comparative, non-randomized study, these investigators examined the effectiveness of IC antibiotic with and without post-operative topical antibiotic in reducing the incidence of acute endophthalmitis following cataract surgery in rural India. Second, several studies in this meta-analysis did not report sufficient data on risk assessment, especially random sequence generation, allocation concealment and setting blinding, which may have led to bias. The authors concluded that the significant reduction of phacoemulsification use after femtosecond laser application might render the use of OVDs obsolete in many cases. Day care versus in-patient surgery for age-related cataract. The relative effect of the lenses on reading speed and spectacle independence was uncertain. There is evidence of short-term efficacy in correcting visual acuity but there is inadequate evidence that the procedure achieves accommodation. IOLs can be classified as standard, premium or refractive and can be further identified according to type - monofocal, multifocal accommodating, and phakic. All eyes undergoing LCS between April 2011 and March 2012 were included in the study. There were no date or language restrictions in the electronic searches for trials. In a Cochrane review, Casparis et al (2012) noted that cataract and age-related macular degeneration (ARMD) are common causes of decreased vision that often occur simultaneously in people over age 50. hr.separator { 2010;36(4):603-608. Murrill CA, Stanfield DL, Brocklin MD. Language services can be provided by calling the number on your member ID card. 2022 Feb 13 [Online ahead of print]. Rathi VM, Sharma S, Das T, Khanna RC. UpToDate [online serial]. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. In addition, the CADTH assessment stated that long-term follow-up is needed to confirm patient outcomes, and ascertain if the benefits justify the additional cost. They searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid Medline, Ovid Medline In-Process and other non-indexed citations, Ovid Medline Daily, Ovid OldMedline (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP). Posterior capsular opacification in 1 eye (2.4 %), anterior capsule phimosis in 1 eye (2.4 %) and cystoid macular edema (CME) in 1 eye (2.4 %) were detected as late complications. 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. How much is cataract surgery with insurance? Technology News. } WebAetna considers the Hydrus Microstent medically necessary for the treatment of adults with mild or moderate open-angle glaucoma and a cataract when the individual is currently In a prospective, consecutive cohort study, Bali and colleagues (2012) described the intra-operative complications and evaluated the learning curve with femtosecond laser-assisted cataract surgery (FLACS). In a prospective, randomized controlled trial, Heatley and colleagues (2005) examined the near visual clinical performance of an accommodative IOL when compared with a standard monofocal IOL in a fellow eye comparison. In general, the surgeon looked for agreement in various formulas when choosing an IOL. The quick answer is 'it depends' regarding cost, but about $3000 per eye is a reasonable ballpark figure for everything including the surgeon fee, facility fee, 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. 2006;17(1):54-61. The authors concluded that this new technique for patients with insufficiently dilated pupils associated with ectopia lentis has the potential to improve surgical results and minimize complications in selected cases. Rockville, MD: AHRQ; 2001. 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). U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. These researchers judged all studies to be at high risk of performance bias. Participants were patients undergoing cataract surgery with a history of LASIK or photorefractive keratectomy. J Cataract Refract Surg. A significant reduction in the cost to patient (via reduced consumable/click cost) would increase the likelihood of FLACS being considered cost-effective. The authors concluded that femtosecond laser pre-treatment results in a significant reduction in EPT, including the possibility of 0 EPT. Kletke SN, Mallipatna A, Mireskandari K, et al. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: A systematic review and meta-analysis. Number of docking attempts per case (1.5 versus 1.05), incidence of post-laser pupillary constriction (9.5 % versus 1.23 %), and anterior capsular tags (10.5 % versus 1.61 %) were significantly lower in group 2 (p < 0.001 for all comparisons). Other factors, such as patient fixation, intra-ocular pressure (IOP), external pressure from the eyelid speculum, and viscoelastic versus balanced saline solution in the anterior chamber may also affect the accuracy of the ORA measurements. J Cataract Refract Surg. 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. Phakic IOLs are used to achieve refractive correction when the native lens is not removed, similar to the effect of LASIK or laser eye surgery. Doctors reported on the mandates detrimental impact on patient care and the administrative burden it placed on their practices. J Fr Ophtalmol. Konno S, Akiba J, Yoshida A. Retinal thickness measurements with optical coherence tomography and the scanning retinal thickness analyzer. Two intra-individual studies also compared HSM PMMA IOLs with unmodified PMMA IOLs at 3 or 6 months of follow-up. Multiple optic (multi-focal) IOLs are available which claim to allow good vision at a range of distances. However, the technology may not yet be cost-effective, and the overall risk profile has not yet been shown to be superior to that of standard phacoemulsification. Saunders Co.; 1995. In the group without historical data (n = 39), 49 % of eyes were within 0.25 D, 69 % to 74 % of eyes were within 0.50 D, 87 % to 97 % of eyes were within 0.75 D, and 92 % to 97 % of eyes were within 1.00 D of targeted refractive IOL power prediction error. Chang DH, Davis EA. border-radius: 4px; Surgical treatment of cataract involves replacing the patient's opacified lens with an artifical lens, which is usually of fixed power (monofocal), requiring the use of reading glasses for near vision. 2002;28(2):230-234. Due to heterogeneity in lens types evaluated and outcomes reported among the trials, these investigators did not combine data in a meta-analysis. This was combined with approximate costs in a cost-utility analysis model to determine the incremental cost-effectiveness ratios (ICERs). San Francisco, CA: American Academy of Ophthalmology (AAO); September 2013. Roberts TV, Lawless M, Bali SJ, et al. width: 100%; They checked the reference lists of the included trials to identify further relevant trials. Overall, there was a 96.2 % reduction in EPT between controls and the optimized femtosecond pre-treatment group. When useful vision is lost, lens extraction is necessary. However, 6 studies reported no significant differences in visual acuity and 2 studies reported no significant differences in visual fields between the 2 intervention groups post-operatively (data not analyzable). WebIs cataract surgery covered by health insurance? These researchers included 215 patients undergoing cataract surgery with a history of myopic LASIK or photorefractive keratectomy. text-decoration: underline; Patients were randomized to receive either the 1CU accommodative IOL in their first eye or the Acrysof MA30 monofocal IOL. U.S. Food and Drug Administration (FDA), Center for Devices and Radiologic Health (CDRH). 2014;121(1):10-16. Horizon Scanning Prioritising Summary - Volume 6. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 (95 % CI: - 0.02 to 0.10). Clinical Practice Guideline no. Better DCNVA was seen in the accommodative lens group at 12 to 18 months in the 3 trials that reported this time-point but considerable heterogeneity of effect was seen, ranging from 1.3 (95 % CI: 0.98 to 1.68; 20 people, 40 eyes) to 6 (95 % CI: 4.15 to 7.85; 51 people, 51 eyes) Jaeger units and 0.12 (95 % CI: 0.05 to 0.19; 40 people, binocular) logMAR improvement (low quality evidence). National Institute for Health and Clinical Excellence (NICE). 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. There were 8 RCTs included in this study. Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
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