.arrowPurpleSmall, a:hover.arrowPurpleSmall { 2006;17(1):99-104. 2012;28(8):540-544. London, UK: NICE; 2007. 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. list-style-image: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') !important; #backTop { Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. This may influence the data by introducing confounding and bias. An A-scan ultrasound is not necessary unless an IOL is to be inserted. A total of 30 patients (60 eyes) with bilateral cataracts but otherwise normal eyes were recruited from a single university hospital cataract waiting list. San Francisco, CA: American Academy of Ophthalmology; 1991. Phakic intraocular lenses. Comparison of visual acuity between phacoemulsification and extracapsular cataract extraction: A systematic review and meta-analysis. Moreover, these researchers stated that future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate VA to examine important outcomes such as CS and QOL. This was combined with approximate costs in a cost-utility analysis model to determine the incremental cost-effectiveness ratios (ICERs). 2017;65(9):813-817. WebAetna considers Optiwave Refractive Analysis (ORA) not medically necessary for cataract surgery. Accessed May 31, 2012. Am J Ophthalmol. The cases were divided into 2 groups: Group 1, initial experience consisting of the first 200 cases; and group 2, the subsequent 1,300 cases performed by the same surgeons. The authors concluded that this review has shown that routine pre-operative testing does not increase the safety of cataract surgery. 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. An inpatient setting for cataract removal surgery generally is not considered medically necessary. The indications of CTR implantation were zonular dehiscence or weakness associated with mature cataract (29.2 %), trauma (24.3 %), pseudo-exfoliation syndrome (19.5 %), retinitis pigmentosa (14.6 %), degenerative myopia (9.7 %), and lens coloboma (2.4 %). They searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 5), Medline Ovid (1946 to May 17, 2017), Embase.com (1947 to May 17, 2017), PubMed (1946 to May 17, 2017), Latin American and Caribbean Health Sciences Literature database (LILACS) (January 1982 to May 17, 2017), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com); last searched May 2013, ClinicalTrials.gov (www.clinicaltrials.gov); searched May 17, 2017, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched May 17, 2017. The secondary objectives included cost-analyses for different surgical techniques for co-existing cataract and glaucoma. 1999;128(1):31-37. Ophthalmologists, as well as the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, are up in arms, saying that this new policy is disruptive and burdensome and will result in delays in care for 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. CPB 0130 - Computerized Corneal Topography. In a Cochrane review, these investigators examined the safety and effectiveness of implantation with trifocal versus bifocal IOLs during cataract surgery among subjects with presbyopia. In a prospective, consecutive, single-surgeon, case-control study, Abell and colleagues (2013) compared effective phacoemulsification time after femtosecond laser pre-treatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss. Preoperative evaluation for elective cataract surgery - systematic review. Available at: https://www.eyeworld.org/article-an-update-on-billin. The SN6AT7 appears to be a type of AcrySof IQ toric posterior chamber IOL. Rathi VM, Sharma S, Das T, Khanna RC. 2014;121(1):10-16. 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). The science of wavefront aberrometry is based upon the shape of the wavefront of light reflected from the eye. 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 Packer M, Fine IH, Hoffman RS, et al. ol.numberedList LI { In the largest study (140 participants), the study eye of each participant was randomized to receive 1 of 4 types of IOLs: Proportions of participants with 1 or more Snellen lines of visual improvement were similar among the 4 treatment groups at 1 year' follow-up: 45 of 48 (94 %) in the hydrophobic acrylic IOL group, 39 of 44 (89 %) in the silicone IOL group, 18 of 22 (82 %) in the HSM PMMA IOL group, and 22 of 26 (85 %) in the unmodified PMMA IOL group. An unexpected loss of zonules during surgery may also support the medical necessity of a CTR. Sheard (2014) stated that biometry has become one of the most important steps in modern cataract surgery and, according to the Royal College of Ophthalmologists Cataract Surgery Guidelines, what matters most is achieving excellent results. J Cataract Refract Surg. Patients without historical data (n = 39) were compared using 3 methods (Haigis-L, ORA, and Optovue), and patients with historical data (n = 20) were compared using all methods (Masket regression formula, Haigis-L, ORA, and Optovue). Various drugs are available for IC use. 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. hr.separator { OL OL OL LI { Ophthalmology. They searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2013), EMBASE (January 1980 to August 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2013), the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). Routine pre-operative medical testing did not reduce the risk of intra-operative (OR 1.02, 95 % CI: 0.85 to 1.22) or post-operative medical adverse events (OR 0.96, 95 % CI: 0.74 to 1.24) when compared to selective-testing or no-testing. Abstracts of Clinical Care Guidelines. It was hypothesized that increased IOP from phacoemulsification could make the RK cuts swell, and change cornea shape intra-operatively. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 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. At 6 months, 4 participants were lost to follow-up; 2 participants from each group. J AAPOS. Clin Exp Ophthalmol. CrystaLens, U.S. Food and Drug Administration (FDA), Center for Devices and Radiologic Health (CDRH). Aetna is the third-largest insurer in the nation and the only one to require prior authorization for cataract surgery. Decision of CTR implant was intra-operative in 42 patients. Ophthalmology. Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. Rana and colleagues (2021) stated that MSICS is a widely used technique for cataract surgery in the developing world. Pediatric cataract surgery following treatment for retinoblastoma: A case series and systematic review. In the 4rth study (60 participants), the study eye of each participant was randomized to receive a hydrophobic or hydrophilic acrylic IOL. Vogel A, Dick HB, Krummenauer F. Reproducibility of optical biometry using partial coherence interferometry: Intraobserver and interobserver reliability. Of these 234 eyes, 6 were excluded, 107 had the same recommended IOL power by ORA and IOLMaster; 64 %of these eyes were within 0.5D; 95 eyes had IOL power implantation based on ORA instead of IOLMaster; 70 % of these eyes were within 0.5D of target refraction; 26 eyes had IOL power chosen based on IOLMaster predictions instead of ORA; 65 % were within 0.5D. } Trifocal IOL implantation may improve uncorrected intermediate VA at 1 year (MD -0.16, 95 % CI: -0.22 to -0.10; I2= 0 %; 2 studies, 107 subjects; low-certainty evidence), but showed no evidence of effect on best-corrected distance VA at 1 year (MD 0.00, 95 % CI: -0.03 to 0.04; I2= 0 %; 2 studies, 107 subjects; low-certainty evidence). Posterior subcapsular and nuclear cataract after vitrectomy. Policy statement on cataract surgery in the otherwise healthy adult second eye. Do DV, Gichuhi S, Vedula SS, Hawkins BS. American Association for Pediatric Ophthalmology and Strabismus. 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. The authors concluded that intra-operative wavefront aberrometry with the ORA system provided post-operative refractive results comparable to conventional biometry with the IOLMaster for mono-focal IOL selection. 2016;12:CD003169. They also noted that whether that improvement outweighed the adverse effects of multi-focal IOLs, such as glare and haloes, would vary between people; and motivation to achieve spectacle independence was likely to be the deciding factor. 2005;140(2):207-213. J Clin Epidemiol. J Cataract Refract Surg. } https://www.nvisioncenters.com/cataracts/insurance-coverage Ophthalmology. Aliso Viejo, CA; Eyeonics; 2003. Cochrane Database Syst Rev. Risks of bias, heterogeneity of outcome measures and study designs used, and the dominance of one design of accommodative lens in existing trials (the HumanOptics 1CU) mean that these results should be interpreted with caution. 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). The Panel concluded that posterior capsulotomy should never be scheduled at the time cataract surgery is performed because one can not predict whether a cataract surgery patient will develop posterior capsular opacification or predict the time at which opacification will occur. In the long run FLACS might replace phacoemulsification which has been the standard in cataract surgery over the last 20 years. 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). The following specialized ophthalmologic services are considered medically necessary for the routine pre-operative work-up for cataract surgery: Note: Contrast sensitivity testing, glare testing (BAT), and potential vision testing (PAM) are considered integral to the ophthalmologic examination and are not separately reimbursed. There were no lens-related adverse events in either group. #closethis { 2001;27(3):437-444. list-style-type: decimal; 2020a;68(5):819-824. Multifocal versus monofocal intraocular lenses after cataract extraction. Main outcome measures included EPT, intra-operative complications, corneal endothelial cell loss, as well as post-operative BCVA, IOP, and refractive outcomes. The main outcome measure was the occurrence of acute clinical endophthalmitis within 6 weeks of the surgery. Patients implanted with the Tecnis Symfony IOL may experience worsening of or blurred vision, bleeding or infection. Cases underwent pre-treatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion. Standardized surgery included a 4.0to5.0 mm capsulorhexis and phacoemulsification. Such avenues may lead to cost-effective means of identifying those at increased risk of medical adverse events due to cataract surgery. Electrophysiologic testing in the form of visual evoked potential (VEP) is helpful in total cataracts to assess the function of the visual pathway. They graded 2 studies with high risk of detection bias and 1 study with high risk of selection bias. Some patients may experience visual halos, glare or starbursts. } Gierek-Ciaciura S, Cwalina L, Bednarski L, Mrukwa-Kominek E. A comparative clinical study of the visual results between three types of multifocal lenses. At 6 months, no difference was found in distance-corrected visual acuity between the2 IOLs. 1993;5(3):1-5. Roach L. Intraoperative wavefront aberrometry: Wave of the future? Both IC cefuroxime and moxifloxacin proved effective. Following monofocal lens placement, glasses may be required to assist with near or distance vision. The member's best correctable Snellen visual acuity is 20/40 Snellen or better in the affected eye, There is a significant loss of visual acuity in bright ambient light thatisconfirmed bythe use of (but not limited to) procedures such as glare testing, brightness acuity testing (BAT), or contrast sensitivity testing, or, Complaints of monocular diplopia or polyopia, or, Visual disparity existing between the two eyes (anisometropia),and. American Society of Cataract and Refractive Surgery (ASCRS) and American Society of Ophthalmic Administrators (ASOA). 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. 1999;44(2):123-147. An IOL is used to improve vision after the native lens is removed by helping to focus light directly onto the retina. Refractive eye surgeries (eg, LASIK, laser eye surgery, etc.) The Panel found inadequate evidence that contrast sensitivity testing provides information, beyond that obtained through a patient's history and eye examination that is useful for determining whether a patient would benefit from cataract surgery. Cataract in the adult eye PPP 2016. One specialized ophthalmologic service is frequently needed prior to cataract surgery in routine cases. Since the intent of the multifocal and accommodating IOLs, is to preclude the need for reading glasses or contact lenses post- surgery, those types of IOLs are considered not medically necessary. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm511446.html. The Alcon CZ70BD is a single-piece polycast polymethylmethacrylate (PMMA) intra-ocular lens (IOL; posterior chamber). They carried out a literature search in PubMed and Embase databases to identify studies published from October 1992 to April 2020 evaluating MSICS with a minimum of 500 eyes reported. Am J Ophthalmol. The MedAE was 0.21 D for the Masket regression formula, 0.22 D for the Haigis-L formula, 0.25 D for ORA, and 0.39 for Optovue. Rana K, Bahrami B, van Zyl L, et al. 2014;121(1):56-60. 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. Dick (2005) stated that the potential clinical benefits of accommodative IOL technology for both cataract patients and refractive patients may place accommodative IOLs in a competitive position with multi-focal IOL technology. The authors concluded that femtosecond laser pre-treatment results in a significant reduction in EPT, including the possibility of 0 EPT. Saiki M, Negishi K, Dogru M, et al. Surgeons should be cautious when using ORA on RK patients, especially for those patients who have more than 6 cuts. 2022;11(2):551-559. Federal Register. 2010;36(3):380-388. Nuclear cataracts are located in the central substance of the lens. .newText { 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. 2002;28(2):230-234. Spectacles only correct lower order aberrations such as sphere and cylinder. Several instruments such as the VF-14, the activities of daily vision scale and the visual activities questionnaire are available for assessing functional impairment related to cataract. padding-bottom: 4px; The 3 RCTs included in this review reported results for 21,531 total cataract surgeries with 707 total surgery-associated medical adverse events, including 61 hospitalizations and 3 deaths. Steele M, O'Leary JP. 2015;8:CD006291. 1995;21(2):132-135. 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). 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