All RCTs comparing a multi-focal IOL of any type with a mono-focal IOL as control were included. Cataract Surgery Comprehensive Ophthalmology Lenses Lifestyle Lenses Implantable Collamer Lens (ICL) Vivity Extended Vision IOL Keratoconus Treatments Cross-Linking INTACS Corneal Implants Oculoplastic Cosmetic Treatments Cosmetic Treatments Blepharoplasty Dry Eye Treatments Dry Eye Treatments TearCare Glaucoma Surgery Outpatient Ophthalmic Surgery Society, Society for Excellence in Eye Care, Society for Geriatric Ophthalmology, and the Ophthalmic Anesthesia Society. J Refract Surg. J Cataract Refract Surg. margin-top: 38px; They last searched the electronic databases on October 10, 2013. American Association for Pediatric Ophthalmology and Strabismus. Furthermore, an UpToDate review on Cataract in children (McCreery, 2019) states that A complete eye examination by the ophthalmologist may require the use of sedation or general anesthesia and is often performed at the time of surgical intervention. Doane JF. background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; In general, driving an automobile is the limiting life-style activity with visual acuity in the 20/50 to 20/60 range. The IOL becomes a permanent part of the eye, not requiring any care and cannot be seen or felt. Am J Ophthalmol. What Eyecare (Including LASIK) Does Aetna Offer? San Francisco, CA: American Academy of Ophthalmology (AAO); September 2013. Frequent changes in eyeglass prescription help maintain vision during cataract development. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. More recently, IOLs have been developed that are designed to allow both distance and reading vision without glasses. In addition, in this study, several different types of IOLs were used although the majority consisted of ZCB00 or ZA9003 (Abbott Medical Optics, Santa Ana, CA), or SN60WF (Alcon, Fort Worth, TX). 2014;111(7):624-637. Cataracts in Adults: Management of functional impairment. Patients underwent IRB for IOL power estimation. 1999;44(2):123-147. Physical disability prevents satisfactory immediate post-operative care. Ophthalmology. An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07 %) of the 4,970 eyes. Clinical acute endophthalmitis occurred in 15 eyes. 2013;120(5):942-948. Indian J Ophthalmol. Mamalis N, Crandall AS, Linebarger E, et al. Guidance on multi-focal IOLs from the National Institute for Health and Clinical Excellence (NICE, 2008) concluded: "The evidence on the implantation of multifocal (non-accommodative) intraocular lenses (IOLs) during cataract surgery raises no major safety concerns. This was combined with approximate costs in a cost-utility analysis model to determine the incremental cost-effectiveness ratios (ICERs). The Alcon AcrySof Natural UV and blue light filtering acrylic foldable multi-piece posterior chamber lenses are optical implants for the replacement of the human crystalline lens in the visual correction of aphakia in adult patients following cataract surgery. 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. Glasses or visual aids provide satisfactory functional vision; The members lifestyle is not compromised; or. 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. According to Medicare.gov, cataract surgery is considered medically necessary. They checked the reference lists of the included trials to identify further relevant trials. Most cases relied on the Holladay 1 formula, with some preference to SRK/T for eyes with longer axial length, and Hoffer Q for eyes with shorter axial length. Last Review12/05/2022. London, UK: NICE; June2008. color: #FFF; 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. The authors concluded that in this case-series study, there was a clear learning curve associated with the use of FLACS. All subjects had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Saiki M, Negishi K, Dogru M, et al. They planned to include RCTs and quasi-RCTs that had compared surgery versus no surgery to remove the lens from eyes of adults in which cataracts had developed following vitrectomy. Next, the temporary suture was released, a capsular hook(s) was placed to support the lens, and the lens was emulsified. 2022 Feb 13 [Online ahead of print]. The groups were called for follow-up on day 1, 1 week, 1 month, and 3 months, post-operatively. These pre-operative tests include contrast sensitivity testing, glare testing, potential vision testing, and specular photographic microscopy (endothelial cell photography). Improvements in BCVA obtained from the literature were used to calculate the increase in quality-adjusted life-years (QALYs) in a hypothetical cohort between 6 months and 1 year after cataract surgery. Nd:YAG laser capsulotomy in any of the following situations because of insufficient evidence in the peer-reviewed literature: If performed concurrently with cataract surgery; If scheduled routinely after cataract surgery without regard to whether there is clinically significant opacification of the posterior capsule. Ophthalmologe. 1995;21(1):99-102. 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. About 4 million people in the United States have This test reveals and quantifies decreased perception of low-contrast objects. The length of follow-up among the studies ranged from 1 to 24 months after cataract surgery. WebOf the $2,627 total, Medicare pays $2,101 and the patient coinsurance is $524. London, UK: NICE; 2007. The American Society of Cataract and Refractive Surgery (ASCRS) and American Society of Ophthalmic Administrators (ASOA) (Stodola, 2013) stated that According to the ASCRS/ASOA policy, the allowable Medicare reimbursement for cataract surgery does not change according to the surgical methods used. This was compared with the earlier rate of endophthalmitis in the same locations. 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). Complications were reported at 12 months (2 studies), 12 to 18 months (1 study), and 2 years (4 studies) after surgery. Therefore, the procedure should not be used without special arrangements for consent and for audit or research." Cost savings were evaluated in 1 study that estimated the costs to be 2.55 times higher in those with pre-operative medical testing compared to those without pre-operative medical testing. Transient IOP increased in 5 eyes (12 %) and corneal edema in 14 eyes were noted. Besides precision and predictability, the low rate of complications impresses surgeons working with the technology, particularly those employing a laser with a fluid-filled interface which appeared to prevent major complications including increases in IOP. Malyugin et al (2018) described a new approach for cataract surgery in ectopia lentis associated with an inadequately dilated pupil. background-color: #cc0066; Participants were hypothetical cohort of patients undergoing cataract surgery in the better eye based on a review of the current literature and the authors direct experience using FLACS. There was no difference in cancellation of surgery between those with pre-operative medical testing and those with no or limited pre-operative testing, reported by 2 studies. 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. These investigators performed a separate analysis comparing 1CU and AT-45 IOL. None of the included studies reported quality of life outcomes. Accessed April 3, 2019. Does Aetna Medicare Cover Glasses After Cataract Surgery? Mean contrast sensitivity was better for the monofocal IOL group than for the multi-focal IOLs. 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. 4, Cataract in Adults: Management of Functional Impairment of the Cataract Management Guideline Panel of the Agency for Health Care Policy and Research (AHCPR, 1993). No significant differences were found between age, axial length, keratometry, and pre-operative corrected VA in the laser and conventional groups (p > 0.05; Mann-Whitney U test). /*margin-bottom: 43px;*/ There was substantial heterogeneity with respect to the ages of participants and etiologies of uveitis within and across studies. Rockville, MD: AHRQ; 2001. A prospective, 6-month, multicenter, bilateral, randomized, evaluator- and subject-masked trial compared 148 cataract patients implanted with the Tecnis Symfony IOL to 151 cataract patients implanted with a monofocal IOL. Treating providers are solely responsible for medical advice and treatment of members. Indian J Ophthalmol. October 9, 1995: 20-21. The other models are SN6AT6, SN6AT8, and SN6AT9. ORA depends on several variables (e.g., IOP, hydration, and external pressure), and these data were not recorded in this retrospective study. .strikeThrough { Two review authors screened the search results and for included studies, assessed the risk of bias and extracted data independently. People receiving accommodative lenses had more PCO which may be associated with poorer distance vision. 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. Standardized surgery included a 4.0to5.0 mm capsulorhexis and phacoemulsification. For near distances, patients with the Tecnis Symfony IOL were able to read two additional, progressively smaller lines on a standard eye chart than those with the monofocal IOL. There was no statistically significant difference among the methods. Celik et al (2015) reviewed the indications, clinical outcomes and complications of CTR implantation in a series of consecutive phacoemulsification surgeries during a 3-year period. 1998;29(3):185-189. However, cataract surgery may independently lower intra-ocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. None of the studies reported the mean change in visual acuity or visual fields. Friday, October 6, 1995;60(194):52396-52403. 2019;19(1):78. 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. You can receive basic lens replacement, paid in If you are considering having cataract surgery, you may wonder if you have insurance to cover the procedure. This system captures wavefront images of the patients eye during surgery. Aetna considers the following Experimental and Investigational (not an all inclusive list): The following specialized ophthalmologic services for the pre-operative work-up for cataract surgery, unless there is another indication in addition to cataracts, because they are of no proven value in routine pre-operative evaluation of cataracts: The pre-operative tests listed above are considered experimental and investigational in most cases before cataract surgery. In a Cochrane review, these investigators evaluated the safety and effectiveness of surgery versus no surgery for post-vitrectomy cataract with respect to VA, quality of life (QOL), and other outcomes. border-radius: 4px; To evaluate for heterogeneity, these researchers carried out meta-regression on co-variates including PCR incidence, use of topical antibiotics and study design. The degree of loss depends on the location of the cataract, its size, and its density. Does Aetna Cover Laser Cataract Surgery You would need to check with your Aetna plan directly to confirm whether coverage of cataract surgery extends to These investigators searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). Controls underwent phacoemulsification cataract extraction plus insertion of an IOL. Aetna launched a troubling new prior authorization policy on July 1, that applies to all cataracts surgeries even when patients face emergency situations. 2011;152(3):345-357. Multifocal versus monofocal intraocular lenses after cataract extraction. border: none; OL OL OL LI { 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. This test is used to measure and record the evaluation of corneal endothelial cells. --> The Panel stated that, for patients with a dense or cataract mature that interferes with ophthalmoscopic examination, a diagnostic B-mode ultrasonography (B-scan) may be appropriate to rule out retinal detachments or vitreous hemorrhages, ocular pathology which may influence the decision to perform cataract surgery. Sheard R. Optimising biometry for best outcomes in cataract surgery. Patients implanted with the Tecnis diffractive ZM900 were those reporting more photic phenomena. Any additional provider or physician services required to insert or monitor a patient receiving a presbyopia-correcting IOL are also not covered. CPB 0130 - Computerized Corneal Topography. The refractive surgery patient may benefit from the correction of higher order aberrations by improving best spectacle corrected visual acuity (BSCVA), night vision, contrast sensitivity, and reducing glare and halos. These images are used to calculate the patients total refractive error, from all aberrations due to the eyes optical imperfections, at any point during the surgical procedure: phakic, aphakic or pseudophakic. They also contacted investigators and experts in the field to identify additional trials. Accessed May 31, 2012. color: white; Kiss B, Findl O, Menapace R, et al. Heatley CJ, Spalton DJ, Hancox J, et al. First Coast Service Options, Inc.Local Coverage Determination (LCD): Cataract Extraction (L33808). A cost-effectiveness decision tree model was constructed to analyze the cost-effectiveness of FLACS compared with PCS. 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. Cataract removal surgery is considered medically necessary according to the members level of visual impairment as follows: For members with visual disability with a Snellen Acuity of 20/50 or worse, cataract surgery is considered medically necessary when all of the following subjective, objective, and educational criteria are met: The member perceives that his or her ability to carry out needed or desired activities is impaired. These data were incorporated with time trade-off utility values converted from visual acuity outcomes. Surgery for postvitrectomy cataract. CMS Rulings. 2020a;68(5):819-824. Potential vision testing is designed to determine whether patients with obviously impaired vision have the potential to see well following cataract surgery. Main outcome measures were median absolute error of prediction and percentage of eyes within 0.50 diopters (D) and 1.00 D of refractive prediction error. Keay L, Lindsley K, Tielsch J, et al. Haigis W, Lege B, Miller N, et al. Agency for Healthcare Research and Quality (AHRQ). 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. At all follow-up visits, a full assessment was made of distance, near and reading visual performance, and accommodative amplitude. A B-scan is used in place of the A-scan when the patient has a dense cataract. The mean diameter of the manual and the femtosecond laser capsule disk group were not statistically significantly different (manual 4.91 0.34; femtosecond: 4.93 0.03; p = 0.58). Comparative evaluation of rotational stability and visual outcome of toric intraocular lenses with and without a capsular tension ring. Mean binocular distance best spectacle-corrected visual acuity (BSCVA) (logMAR) was 0.05 for controls, 0.08 for ZM900, 0.07 for ReZoom, and 0.11 for TwinSet, with mean binocular distance BSCVA at near of 0.49, 0.06, 0.22, and 0.11, respectively. Anterior capsule tears occurred in 4 % and 0.31 % of eyes, posterior capsule tears in 3.5 % and 0.31 % of eyes, and posterior lens dislocation in 2 % and 0 % of eyes in groups 1 group 2, respectively (p < 0.001 for all comparisons). 2004;15(1):16-21. 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). And yes, most health insurance plans cover cataract surgery when your doctor considers it to be medically necessary. They did not use any date or language restrictions in the electronic searches for trials. 2014;111(7):614-623. Centers Near You Enter A New Address Procedures Custom LASIK Cataract Surgery Other Procedures Aetna considers the following procedures medically necessary as a diagnostic test prior to cataract surgery: In addition to a comprehensive or brief/intermediate eye examination, A-mode ultrasound (A-scan) may be considered medically necessary prior to cataract surgery to determine the appropriate pseudophakic power of the IOL.Footnote1*. 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. 05-01. In this study, Healon was used in the anterior chamber for all ORA measurements, which very well may impact the predictions by ORA. A cataract is a hardening and opacification (or clouding) of the normally transparent crystalline lens within the eye behind the pupil. 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. 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The reference lists of the included trials to identify additional trials, Tielsch J, et al arrangements consent. Doctor considers it to be medically necessary, IOLs have been developed that are designed to determine incremental.