A critical appraisal. Due to heterogeneity in lens types evaluated and outcomes reported among the trials, these investigators did not combine data in a meta-analysis. However, in the event that your procedure is not fully covered, or if you elect to choose Disabling glare is often an indication that a cataract has developed. Abstracts of Clinical Care Guidelines. 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. 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. Effect of intraocular lens size on posterior capsule opacification after phaecoemulsification. Landmarks in the evolution of cataract surgery. 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). Biometry was done with optical low coherence reflectometry (Lenstar LS900, Haag-Streit AG), and IOL calculation was performed with 3rd-generation IOL formulas (SRK/T, Hoffer Q, and Holladay). Nuclear cataracts are located in the central substance of the lens. CrystaLens, U.S. Food and Drug Administration (FDA), Center for Devices and Radiologic Health (CDRH). For most cases involving a simple cataract, a diagnostic ultrasound A-scan is used. Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. ReZoom provided better distance BSCVA than the TwinSet diffractive model. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. 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. Vision Insurance is generally for routine eye exams, glasses, and contact lenses. In the long run FLACS might replace phacoemulsification which has been the standard in cataract surgery over the last 20 years. 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 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. Requirements for determining coverage of presbyopia-correcting intraocular lenses that provide two distinct services for the patient: (1) Restoration of distance vision following cataract surgery, and (2) Refractive correction of near and intermediate vision with less dependency on eyeglasses or contact lenses. Participants were randomized to immediate cataract surgery (within 2 weeks of enrollment) (n = 29) or delayed cataract surgery (6 months after enrollment) (n = 31). In the group with historical data (n = 20), 35 % to 70 % of eyes were within 0.25 D, 60 % to 85 % of eyes were within 0.50 D, 80 % to 95 % of eyes were within 0.75 D, and 90 % to 95 % of eyes were within 1.00 D of targeted refractive IOL power prediction error. Therefore, the presbyopia-correcting functionality of an IOL does not fall into the benefit category and is not covered. OL LI { --> Comparison of femtosecond laser-assisted cataract surgery and conventional cataract surgery: A meta-analysis and systematic review. Two authors independently evaluated the search results against the inclusion and exclusion criteria. This coverage requirement is in line with federal law that mandates Medicare Advantage plans meet the benefit minimums set forth by Original Medicare. Chang DH, Davis EA. They stated that additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are needed to provide evidence to support treatment recommendations. Available at: http://www.crystalens.com/. The above policy is based on the following references: Last Review Macsai MS, Padnick-Silver L, Fontes BM. The investigators conducted a meta-analysis to compare accommodating IOLs and monofocal IOLs in restoring accommodation in cataract surgery. Curr Opin Ophthalmol. All of these studies found a statistically significant greater decrease in mean IOP post-operatively in the combined surgery group compared with cataract surgery alone; the MD was -1.62 mmHg (95 % CI: -2.61 to -0.64; 489 eyes) among 6 studies with data at 1 year follow-up. CMS Rulings. The authors concluded that ORA has been widely used among cataract surgeons on patients with history of RK, but its validation, unlike for laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), has yet to be established by peer reviewed studies. 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*. Post-operatively, contrast sensitivity and color perception were measured up to 180 days and up to 1 year (for visual acuity) after implantation. WebCertain Aetna Medicare Advantage plans may offer coverage for routine vision care. All studies compared trifocal versus bifocal IOL implantation on VA outcomes measured on a LogMAR scale. Roach L. Intraoperative wavefront aberrometry: Wave of the future? Monet's cataract surgery. The femtosecond laser capsule disks displayed a more saw blade-like structure created through the single laser spots. Agency for Healthcare Research and Quality (AHRQ). Note:Aetna considers the following IOLs non-covered deluxe items: Accommodating posterior chamber IOLs (e.g., Crystalens (Eyeonics Inc., Aliso Viejo, CA); multi-focal posterior chamber IOLs (e.g., Array Model SA40 (Abbott Medical Optics, Santa Ana, CA), ReZoom (Abbott Medical Optics, Santa Ana, CA), Tecnis ZM900, Tecnis posterior chamber IOLs (Model ZKB00), and ZMAOO (Abbott Medical Optics, Santa Ana, CA), AcrySof IQ Vivity Extended Vision Intraocular Lens (Model DFT015), AcrySof ReSTOR, (Alcon Surgical, Fort Worth, TX), Acrysof ReSTOR SA60D3 multifocal, Acrysof Natural ReSTOR SN60D3, AcrySof ReSTOR Aspheric IOL model SN6AD1, AcrySof ReSTOR Aspheric IOL model SN6AD3); astigmatism-correcting (toric) posterior chamber IOLs (e.g., Staar Toric IOL (Star Surgical, Monrovia, CA), Staar Elastic Toric Lens Model AA4203TL, Abbott Medical Optics Tecnis Toric model ZCT150, AcrySof IQ Vivity Toric Extended Vision IOLs (DFT315, DFT 415, DFT515), AcrySof Toric IOL (Alcon Surgical, Fort Worth, TX)) AcrySof Aspheric Toric IOL SN6AT3, SN6AT4 and SN6AT5, AcrySof Toric Models SA60T3, SA60T4 and SA60T5, AcrySof Toric Model SA60T, and Acrysof IQ Toric Model SN6ATT, SA6AT3, SN6AT6, SN6AT7 SN6AT8, and SN6AT9); multifocal astigmatism-correcting (toric) IOLs (ReSTOR Multifocal Toric IOL); accommodating toric IOLs (Trulign Toric IOL (Bausch & Lomb, Inc., Rochester, NY); extended depth of focus multifocal lens (Tecnis Symfony ZXR00), and trifocal IOLs (e.g., ALCON PanOptix). 1995;21(2):132-135. Indian J Ophthalmol. The initial 200 eyes undergoing cataract surgery between April 2011 and June 2011 by 6 surgeons were included in the study. Monofocal IOLs have a fixed focal length and provide clear vision at a single, distance (near, intermediate or far) only. Many people are unsure whether eye surgery is supposed to be a Vision Insurance or Health (called Major Medical) Insurance benefit. Footnote2*B-scan ultrasound is considered medically necessary in place of A-scan ultrasound where direct visualization of the retina is difficult or impossible including lid problems (e.g., severe edema, partial or total tarsorrhaphy), keratoprosthesis, corneal opacities (e.g., scars, severe edema), hyphema, hypopyon, miosis, dense cataract, pupillary membranes, or vitreous opacities (e.g., hemorrhage, inflammatory debris). 2021;49(1):25-37. The mean follow-up time was 84 months for all of the IOL groups. Copyright Aetna Inc. All rights reserved. These researchers did not use any date or language restrictions in the electronic searches for trials. 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. Histologic evaluation of in vivo femtosecond laser-generated capsulotomies reveals a potential cause for radial capsular tears. The authors concluded that at this time, it is not possible to draw reliable conclusions from the available data to determine whether cataract surgery is beneficial or harmful in people with ARMD. Steele M, O'Leary JP. This was a retrospective, cases-series study; its findings need to be validated by well-designed studies. They found that many patients of low endothelial cell density can be identified through the patient's medical history and clinical examination. Li A, He Q, Wei L, et al. Am J Ophthalmol. Am J Ophthalmol. American Academy of Ophthalmologys EyeWiki (Patel and Sahu, 2019) lists B-scan ultrasound study for posterior segment evaluation to rule out complicated co-existing intra-ocular diseases for pre-operative work-up of patients with Morgagnian cataract. 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. 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. These researchers used the Science Citation Index to search for references to publications that cited the studies included in the review. Am J Ophthalmol. #closethis { There was no statistically significant difference among the methods. Cases underwent pre-treatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion. To be sure your plan covers cataract surgery, check with your insurance company or read your policy documents. Yes, cataract surgery is covered by health insurance. Ophthalmology. 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. 1993;19(6):673. Links to various non-Aetna sites are provided for your convenience only. The Panel found inadequate evidence that potential vision testing can help the ophthalmologist in predicting the outcome of cataract surgery. While some surgeons already use this technology for LRIs, further studies to elucidate the value of intra-operative aberrometry specifically for toric IOL implantation, rotation, and residual post-operative cylinder would be useful. J Cataract Refract Surg. Regarding the few instances where ORA gave several different IOL powers during aphakic measurements, the IOL was selected to closely match that of the initial prediction by the IOL master. 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