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. .arrowPurpleSmall, a:hover.arrowPurpleSmall { 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. While they are a top choice, they are a bit more expensive than some of the insurers on our list. Guidelines for cataract practice. Waldron RG. Vision Insurance is generally for routine eye exams, glasses, and contact lenses. 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. Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. hr.separator { Use of Nd:YAG laser capsulotomy. Mamalis N, Crandall AS, Linebarger E, et al. .fixedHeaderWrap { Duman et al (2015) evaluated the impact of 4 different IOLs on PCO by comparing the Nd:YAG laser capsulotomy rates. 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). They stated that further research is needed to improve the understanding of how accommodative IOLs may affect near visual function, and whether they provide any durable gains. This study examined the accuracy of ORA in standard mono-focal non-toric IOLs only. Glare testing measures the effect of simulated glare on vision function. Dislocation of PCIOL was not observed in any case. Unfortunately, in developing country settings, medical history questionnaires would be useless to screen for risk since few people have ever been to a physician, let alone been diagnosed with any chronic disease. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 (95 % CI: - 0.02 to 0.10). 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. In comparison to a highly experienced cataract surgeon, the achieved results in size were similar. Is Cataract Surgery Covered by Insurance? Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery. The time for surgery and the amount of fluid that went into the eye were similar to those of a standard procedure. Compare patient reviews and book online instantly. Cochrane Database Syst Rev. 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 ORA depends on several variables (e.g., IOP, hydration, and external pressure), and these data were not recorded in this retrospective study. the extent to which accommodative IOLs improve unaided near visual function, in comparison with mono-focal IOLs; the extent of compromise to unaided distance visual acuity; and. Main outcome measures included median absolute error (MedAE), mean absolute error (MAE), and percentage of eyes within 0.25, 0.50, 0.75, and 1.00 diopters (D) of refractive prediction error. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/MSICS), and received IC antibiotic (cefuroxime/moxifloxacin). background: url('https://www.aetna.com/cpb/medical/data/assets/images/purplearrow.jpg') no-repeat; WebCataract Surgery and Medicare Coverage Uncovered The short answer: Yes. 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. This may influence the data by introducing confounding and bias. The following are considered medically Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: A meta-analysis. list-style-type: decimal; These researchers concluded that no measurable variable distinguished eyes that developed functional reading vision from those that did not. } Cochrane Database Syst Rev. Eyeonics, Inc. American Academy of Ophthalmology (AAO)EyeWiki. li.bullet { Specular photographic microscopy may be done before an intra-ocular operation because the corneal endothelium is particularly sensitive to the trauma of the surgery. Landmarks in the evolution of cataract surgery. When useful vision is lost, lens extraction is necessary. Post-operatively, contrast sensitivity and color perception were measured up to 180 days and up to 1 year (for visual acuity) after implantation. Cochrane Database Syst Rev. This study did not compare the predictive errors of each individual prediction formula (i.e., Haigis versus Holladay 1 versus Hoffer Q, etc. Powell SK, Olson RJ. These cataracts tend to cause glare in bright light. In 23 eyes undergoing surgery without the use of OVDs, no complications were observed within a 1-month follow-up period. They last searched the electronic databases on October 10, 2013. height:2px; 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. They did not use any date or language restrictions in the electronic searches for trials. In cases of more profound zonulopathy, other options include capsular retractors, a modified capsular tension ring, or a capsular tension segment for scleral suture fixation. Monet's cataract surgery. Schultz and co-workers (2015) compared histologically the size and appearance of capsule disks after FLACS and conventional cataract surgery. Participants were patients undergoing cataract surgery with a history of LASIK or photorefractive keratectomy. Comparison of visual acuity between phacoemulsification and extracapsular cataract extraction: A systematic review and meta-analysis. 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. Cochrane Database Syst Rev. 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. 15,00035,000, and are given in sublimity. 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. Posterior chamber IOL (PCIOL) was implanted into the capsular bag in all eyes. Links to various non-Aetna sites are provided for your convenience only. In a prospective, non-randomized, study, these researchers compared the effectiveness of IC cefuroxime and moxifloxacin prophylaxis in reducing the incidence of acute endophthalmitis following cataract surgery in rural India. London, UK: NICE; June2008. Verhulst E, Vrijghem JC. Do and colleagues (2018) stated that cataract formation or acceleration can occur after intra-ocular surgery, especially following vitrectomy, a surgical technique for removing the vitreous that is used in the treatment of many disorders that affect the posterior segment of the eye. 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. 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. Pre-operative data were obtained with the IOLMaster. However, there may be some out-of-pocket costs associated with the procedure, such as the deductible, What Eyecare (Including LASIK) Does Aetna Offer? At all follow-up visits, a full assessment was made of distance, near and reading visual performance, and accommodative amplitude. 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. Fogla R, Rao SK. color: blue display: block; Treating providers are solely responsible for medical advice and treatment of members. 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. background-color:#eee; The device is not intended for use on patients who have had previous trauma to their eye. The authors concluded that supplementing IC antibiotic with topical antibiotic post-operatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India. Records were analyzed for indication of CTR implant and clinical outcome on day 1, 1-month and 6-month follow-up. In 100 eyes of 100 patients with visually significant cataracts, a femtosecond laser capsulotomy or a capsulorhexis with an aimed diameter of 5.0 mm was performed by 1 experienced surgeon. Ophthalmologe. N Engl J Med. They searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015. They did not use any date or language restrictions in the electronic searches for trials. Glare was reported less frequently with accommodative lenses but the relative effect of the lenses on glare was uncertain (RR any glare 0.78; 95 % CI: 0.32 to 1.90, 1 study, 40 people, and RR moderate/severe glare 0.45; 95 % CI: 0.04 to 4.60, low quality evidence). They last searched the electronic databases on August 14, 2013. The authors concluded that based on the trials identified in this review, there is uncertainty as to which type of IOL provides the best visual and clinical outcomes in people with uveitis undergoing cataract surgery. 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). Multifocal versus monofocal intraocular lenses after cataract extraction. list-style-type: decimal; CrystaLens, U.S. Food and Drug Administration (FDA), Center for Devices and Radiologic Health (CDRH). Ancillary testing such as ocular ultrasound may be necessary in total cataracts where the posterior segment of the eye cannot be visualized. Nielsen NE, Naeser K. Epidemiology of retinal detachment following extracapsular cataract extraction: A follow-up study with an analysis of risk factors. Graefes Arch Clin Exp Ophthalmol. The authors stated that further randomized controlled studies with standardized methods evaluating adverse effects (e.g., posterior capsular opacification) are needed to clarify the trade-offs. 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. The SN6AT7 appears to be a type of AcrySof IQ toric posterior chamber IOL. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count less than 2,000/mm2 were excluded from the study. ul.ur li{ Bellevue, WA: McIntyre Eye Clinic and Surgical Center; February 1993. The IOL becomes a permanent part of the eye, not requiring any care and cannot be seen or felt. 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). Comparative evaluation of rotational stability and visual outcome of toric intraocular lenses with and without a capsular tension ring. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health (CADTH); August 2006. Complications were reported at 12 months (2 studies), 12 to 18 months (1 study), and 2 years (4 studies) after surgery. 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. A total of 201 eyes underwent cataract surgery between April 2012 and July 2012. Heterogeneity was assessed using the I2 test. Available at: http://www.crystalens.com/. The immediate surgery group showed mean improvement in best-corrected visual acuity (BCVA) compared with the delayed surgery group at 6 months (mean difference (MD) 0.15 LogMAR, 95 % CI: 0.28 to 0.02). 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. Subjects received monofocal Tecnis Z9000 (AMO) (n = 24, 48 eyes); symmetric diffractive multi-focal Tecnis ZM900 (AMO) (n = 26, 52 eyes); zonal refractive multi-focal ReZoom (AMO) (n = 32, 64 eyes); or asymmetric diffractive multi-focal TwinSet (Acri.Tec) (n = 32, 64 eyes) IOLs. An unexpected loss of zonules during surgery may also support the medical necessity of a CTR. In a retrospective consecutive case-series study, Fram and colleagues (2015) compared the accuracy of intra-operative aberrometry technology and the Fourier-domain optical coherence tomography (OCT)-based intra-ocular lens (IOL) formula for IOL power calculation in eyes undergoing cataract surgery after previous laser vision correction (LVC) compared with established methods. Premium IOLs are intended to also correct astigmatism, preclude the need for reading glasses, preclude the need for contact lenses after surgery, or a combination of these. 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 J Clin Diagn Res. There was no difference between baseline cataract grades (2.59 0.71 versus 2.52 0.72, not significant); 100 % of cases pre-treated with the femtosecond laser had complete capsulotomy. Issues in Emerging Health Technologies Issue 85. National Institute for Health and Clinical Excellence (NICE). } These researchers graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies. --> The indications were hyper-mature senile cataract in 9 cases, hyper-mature senile cataract with lens induced glaucoma in 9 cases, pseudo-exfoliation syndrome in 9 cases, post-blunt injury traumatic cataract in 6 cases, iridochoroidal coloboma in 6 cases, hyper-mature cataract with pseudo-exfoliation and Marfan syndrome in 3 cases, respectively. 2014;121(1):56-60. These investigators included RCTs that compared trifocal and bifocal IOLs among subjects 30 years or older with presbyopia undergoing cataract surgery. Yes, cataract surgery is covered by health insurance. Imagine Crystalens [website]. Interventional Procedure Guidance 264. Note: A drop in visual acuity in bright light is the quantitative element that allows one to correlate the "loss of vision" with the "member's complaints". Patient demographics were similar between groups. The main outcome measure was the occurrence of acute clinical endophthalmitis within 6 weeks of the surgery. 2014;121(1):10-16. 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. 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. The studies summarized in this review should assist recommendations for the standard of care of cataract surgery, at least in developed settings. These researchers did not use any date or language restrictions in the electronic searches for trials. Such trials should stratify participants by their age, the retinal disorder leading to vitrectomy, and the status of the underlying disease process in the contralateral eye. Such instances include differentiating iris or ciliary body lesions; ruling out ciliary body detachments; and differentiating intra-ocular tumors, serous versus hemorrhagic choroidal detachments, rhegmatogenous versus exudative retinal detachments, and disc drusen versus papilledema. However, due to small sample sizes and heterogeneity in outcome reporting, the authors found insufficient information to assess these and other types of IOL materials for cataract surgery for eyes with uveitis. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) (MD = 0.18, 95 % CI: 0.12 to 0.24 for UIVA and MD = 0.19, 95 %CI: 0.13 to 0.25 for DCIVA). Heatley CJ, Spalton DJ, Hancox J, et al. Zhang Z, Thomas LW, Leu SY, et al. 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. The authors stated that a drawback of the study was that there was no standardized pre-operative IOL calculation method, instead relying on surgeon's best choice. The member's decision is based on: Note: Functional impairment due to cataracts refers to lost or diminished ability to perform everyday activities, participate in hobbies or other leisure-time activities, or to work in ones occupation. In this prospective study, 77 eyes from 77 patients underwent laser refractive cataract surgery (laser group; Alcon LenSx femtosecond laser), and conventional cataract surgery with phacoemulsification was performed in 57 eyes from 57 patients (conventional group). 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. The Panel also concluded that neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy should not be performed prophylactically or scheduled routinely at particular times after cataract surgery. The authors concluded that additional studies are needed to assess the visual outcomes of the Crystalens in a larger number of patients. The difference was statistically significant (p = 0.003). Controls underwent phacoemulsification cataract extraction plus insertion of an IOL. CMS Rulings. These researchers used the Science Citation Index to search for references to publications that cited the studies included in the review. In the 4rth study (60 participants), the study eye of each participant was randomized to receive a hydrophobic or hydrophilic acrylic IOL. The mean area of the capsule disks was 18.85 2.69 mm2 in the manual and 19.03 0.26 mm2 in the femtosecond group (p = 0.64). The authors concluded that there was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. 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 study evaluated visual acuity at near, intermediate and far ranges; contrast sensitivity (the ability to distinguish small differences between light and dark); and adverse events for six months after implantation. The Panel found inadequate evidence that potential vision testing can help the ophthalmologist in predicting the outcome of cataract surgery. #backTop:hover { border-radius: 4px; The short answer is "Yes." 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. ReZoom provided better distance BSCVA than the TwinSet diffractive model. Celik E, Koklu B, Dogan E, et al. This system captures wavefront images of the patients eye during surgery. The investigators conducted a meta-analysis to compare accommodating IOLs and monofocal IOLs in restoring accommodation in cataract surgery. Ruling No. Model eye for Nd:YAG laser capsulotomy. 2010;248(1):133-140. Available at: https://www.eyeworld.org/article-an-update-on-billin. Effective phacoemulsification time was reduced 28.6 % within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8 % reduction was achieved with a 20-gauge phacoemulsification tip. Two review authors independently screened the search results according to the standard methodological procedures expected by Cochrane. In 2020, the average cost for 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. 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. Typically, insurance will cover the majority of the costs associated with cataract surgery. To be covered under insurance, the cataract will generally need to be advanced enough to be impairing your vision to a specific degree outlined by the policy or carrier. 2008;24(3):257-264. They identified 5 studies conducted in Europe with a total of 175 subjects. Pediatric cataract surgery. Cataracts may result in progressive loss of vision. 2012;119;891-899. Participants who received the accommodative IOLs achieved better distance-corrected near visual acuity (DCNVA) at 6 months (mean difference (MD) -3.10 Jaeger units; 95 % CI: -3.36 to -2.83, 2 studies, 106 people, 136 eyes, moderate quality evidence). Cataracts may be diagnosed with procedures included in the comprehensive ophthalmologic examination. Posterior subcapsular and nuclear cataract after vitrectomy. This was compared with the earlier rate of endophthalmitis in the same locations. 2002;28(2):239-242. A modified CTR was then inserted and sutured to the ciliary sulcus to center the capsular bag and the IOL was implanted. Abell and Vote (2014) performed a comparative cost-effectiveness analysis (CEA) of FLACS and conventional phacoemulsification cataract surgery (PCS). Various drugs are available for IC use. 2018;66(3):411-415. All 5 studies examined uncorrected distance VA (primary outcome of the review), while some also examined secondary outcomes including uncorrected near, intermediate, and best-corrected distance VA, as well as CS. 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, Rockville, MD: Agency for Health Care Policy and Research (AHCPR); February 1993. 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. However, patients may have irregular astigmatism defined as higher order aberrations (e.g., coma or spherical aberrations). Regarding insurance coverage, the brief answer is that yes, cataract surgery is covered by Medicare and commercial insurance. } San Francisco, CA: American Academy of Ophthalmology (AAO); September 2013. Dick HB, Schultz T. Femtosecond laser-assisted cataract surgery. Two authors independently evaluated the search results against the inclusion and exclusion criteria. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, post-operative refraction and surgical satisfaction. Both sets of patients had comparable results for good distance vision. Ruling No: 05-01, May 3, 2005. Analysis was performed to determine the accuracy of mono-focal IOL power prediction and post-operative manifest refraction at 1 month of the ORA versus IOLMaster. } These researchers did not use any date or language restrictions in the electronic search for trials. Aliso Viejo, CA; Eyeonics; 2003. They also contacted investigators and experts in the field to identify additional trials. The member's decision is based on: The loss of vision mimicking the member's complaints should be verified before the member is considered a candidate for cataract surgery. Kolb CM, Shajari M, Mathys L, et al. Curr Opin Ophthalmol. 2020;46(8):1075-1085. 2016;12:CD003169. 2020;6(6):CD012648. The RR of developing endophthalmitis was 2.94 (95 % CI: 1.07 to 8.12; p = 0.037) in eyes that did not receive IC antibiotics. Health Care Financing Administration. They contacted study investigators for additional information. Clinical acute endophthalmitis occurred in 15 eyes. 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. list-style-type: upper-roman; A beam of light is refracted from the eye and goes through a micro-lens array producing a spot image array of reflected light. background: #5e9732; Alcon UV-absorbing single-piece PMMA, Monoflex PMMA posterior chamber lenses, and single-piece PMMA anterior chamber lenses are optical implants for the replacement of the human crystalline lens in the visual correction of aphakia in adult patients following cataract removal. An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07 %) of the 4,970 eyes. These investigators evaluated the safety and effectiveness of cataract surgery in eyes with ARMD. 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); the member's perception of the impact of the disability on lifestyle (e.g., loss of independence, loss of income); the member's complaints of glare disabling eyesight in daylight conditions is inconsistent with the visual acuity measured in a darkened room; however, it must be confirmed by the documented assessment of visual functions under conditions of bright ambient light. OL OL OL OL LI { Physical disability prevents satisfactory immediate post-operative care. Spectacles only correct lower order aberrations such as sphere and cylinder. 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