Is Glaucoma Policy Short-Sighted?

Redefining innovation to keep an eye on patient access.

Sara Riaz, MSc; Blake Oberfeld, MD; Hani El Helwe, MD; Henisk Falah, BS; and David Solá-Del Valle, MD

Glaucoma Today

Glaucoma is an incurable disease and a leading cause of blindness that is expected to affect up to 120 million people by 2040.1 In the United States, glaucoma specialists complete at least 13 years of rigorous training to manage this prevalent disease, yet reimbursement for glaucoma care is largely dictated by US health insurance payers. Last year, multiple Medicare Administrative Contractors (MACs) announced that they would no longer cover several MIGS procedures. Ultimately, lobbying by patient advocacy groups, glaucoma specialists, and ophthalmology societies, among others, led to the reversal of this controversial coverage policy.2 Nevertheless, other modern and effective glaucoma treatments such as certain standalone and combined MIGS procedures, drug delivery systems, new antiglaucoma medications, and preservative-free antiglaucoma drugs remain at risk of coverage restrictions. When insurers do not cover costs, patients must either pay out of pocket or lose access, potentially worsening inequities in eye care.3 Health care policy plays a crucial role in controlling the costs of care at a population level. However, policies guiding glaucoma care should also account for the lack of curative therapies, the limitations of feasible research, patient-specific factors directing treatment, and the burden of patient nonadherence. In this sense, we would argue that, for glaucoma policy, reimbursement rules should not be designed to discourage research and innovation and that, for ophthalmologists, innovation should not stop at the development of new drugs and devices. To balance care and costs, innovation should continue through the long-term study of cost-effectiveness and quality-of-life improvements that existing glaucoma drugs and devices can offer. With the help of industry and government, ophthalmologists should be ready to lead data-driven policy reform, ensuring that patients can access the care they need and deserve. AT A GLANCE Glaucoma policy determinations may be failing to meet the goals of patients and practitioners as well as the overall policy goal of controlling costs. The ophthalmology community and policymakers must take innovation a step further by studying the long-term cost-effectiveness of existing treatments and the impact that restrictive coverage policies can have on patient quality of life.

Are Your Patients Solar Eclipse-Savvy?

It’s likely they need to be educated about safe viewing options.

Modern Optometry

HOT TOPIC Researchers Create Contact Lens That Garners Energy From Light and Tears Researchers from the University of Utah have developed an all-in-one hybrid energy-generation contact lens. In a paper published in the journal Small, they describe how their breakthrough design combines a flexible silicon solar cell with a device that can convert tears into energy. They claim that the system can reliably supply enough power to operate intelligent contact lenses and other ocular devices. Using photovoltaic cells to capture both artificial and natural light sources it is exposed to while using a blink-activated battery, this smart lens can harness the wearer’s natural tears as a biofuel. Interestingly, the electrolytes within the tears serve as the biofuel to generate the power. Erfan Pourshaban Power harvesting does not occur when the eye is open; however, once the eye blinks, the electrolytes within the tear contact the magnesium anode, triggering an oxidation reaction and the creation of electrons. These same electrolytes contact both an anode and the platinum cathode, fostering the creation of even more energy and further oxidation on the surface of the anode and oxygen reduction on the surface of the cathode. (Read more here.) My Two Cents Biosensor experts call this system “an exciting development in the realm of smart contact lenses,” and I agree! They say the development of smart contact lenses has been held back because “the key hurdle for these devices is their need for a sustainable power source.” What an ingenious concept—using tears, electrolytes, light sources, and the mechanical action of the blink itself to power the lens. This is further proof that this is such an exciting time for contact lenses!

Determining When to Use Modifiers -58 and -78

Both are used in association with the original surgery, but ultimately serve different purposes.

Joy Woodke, COE, OCS, OCSR

Retina Today

When retina procedures are performed during the global period of a surgery, an appropriate modifier must be appended to the CPT code for reimbursement. When an unrelated procedure is performed postoperatively in the fellow eye, for example, modifier -79 is used. However, when the surgery is related to the original procedure, either modifier -58 or -78 should be considered. DEFINITIONS When considering which modifier is appropriate for a related procedure, clinicians should carefully review the definitions of modifiers -58 and -78. Modifier -58 is defined as a staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period and has three definitions for use: 1. Planned or anticipated (staged) 2. More extensive than the original procedure 3. Therapy following a surgical procedure Modifier -78 is used for a related but unanticipated return to the OR or office procedure room by the same physician or other qualified health care professional during the postoperative period of the initial procedure. Reporting modifier -58 will initiate a new global period for the CPT code reported. Modifier -78, on the other hand, does not prompt a new postoperative period, and the original global period remains.