Optometric Physician



Vol. 24, #25 •   Monday, June 19, 2023


Off the Cuff: Insurance Coverage Care Conundrum

This week one of our local glaucoma specialists came by to introduce herself to the practice. She’s not new to the area but moved practices last year and was making the rounds to let her referring optometrists know where she was now. I had referred to her in the past but had never met her in person before this week. She was incredibly kind and personable, which is a major plus when I’m thinking of referring one of my patients out for further care. The conversation turned to her preference of microinvasive glaucoma surgeries (MIGS) to add to a cataract surgery. She said she prefers placing one of the various stents available but most insurance plans won’t cover them with the only MIGS they will cover being the non-stent canaloplasty.

How frustrating, but that explains a lot. There have been multiple times I’ve educated glaucoma patients I was referring for cataract surgery about MIGS, particularly the stents, and the amazing potential postoperative outcomes for their vision as well as lifelong benefit for their glaucoma only for them to return with just an IOL placement or having had a canaloplasty with no stents placed. I blamed the surgeons or their offices believing the request for MIGS had been missed or ignored, or worse, that they weren’t keeping up with the latest and greatest. For many of the MIGS stents available, if they’re not done in conjunction with the cataract surgery, that ship has sailed. I should have known it was an insurance thing. All these amazing MIGS options and advancements, and the glaucoma specialists are forced to perform a non-preferred procedure.

I found an article called “Fighting the MIGS Insurance Battle” from November 2019 by Drs. Michael Patterson and Russell Swan. It was largely about their frustrations of paying thousands for stents and getting reimbursed hundreds, or nothing at all, and having to choose what was best for the patient versus the survival of their surgical practices. It got me thinking about upgrade options the patient is offered for cataract surgery. Their plan covers a standard IOL, or they can opt to pay for a toric, multifocal, or light adjustable IOL. Their plan covers a standard manual cataract procedure, or they can opt to pay for laser-assisted cataract surgery. I’m no expert in surgical center billing practices, but is there an option for their plan to cover a standard canaloplasty or can they opt to pay for (insert name of the surgeon's recommended stent here)? This may already exist, but I know it hasn’t been offered to my patients. At least in this way, the patient’s care isn’t dictated solely by their insurance coverage and instead puts care back under the patient’s control and into the hands of the providers.

Shannon L. Steinhäuser, OD, MS, FAAO
Chief Medical Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.



Influencing Factors of Glare in Patients with Myopia After Small Incision Lenticule Extraction

Thirty patients (60 eyes) aged 24.9 ± 4.5 years with spherical equivalent of -6.69 ± 1.10 diopters (D) and astigmatism of -1.25 ± 0.76 D who underwent small incision lenticule extraction (SMILE) were consecutively recruited in this prospective study to investigate influencing factors of glare in patients with myopia after SMILE. Visual acuity, subjective refraction, Pentacam corneal topography (Oculus Optikgeräte), pupillometry, and glare test (Monpack One; Metrovision) were measured preoperatively and postoperatively. All patients were followed up for six months. The generalized estimation equation was used to judge the determinants of glare after SMILE, and a p-value less than .05 was statistically significant.

Under mesopic conditions, the halo radii preoperatively and at one, three and six months after SMILE were 207.72 ± 46.67, 216.17 ± 40.63, 200.67 ± 34.68, and 193.50 ± 40.75 minutes of arc (arcmin), respectively. Under photopic conditions, the glare radii were 79.10 ± 17.78, 87.00 ± 20.44, 78.00 ± 14.59, and 72.00 ± 15.27 arcmin, respectively. Compared with preoperative glare, no significant changes were detected in postoperative glare. However, glare at six months was statistically significantly improved compared to the values at one month. Under mesopic conditions, the main influencing factors of glare were sphere, astigmatism, uncorrected distance visual acuity (UDVA), and postoperative time. Under photopic conditions, the main influencing factors of glare were astigmatism, UDVA, and postoperative time.

Glare improved with time during the early stages after SMILE for myopia. Less glare was found to be associated with better UDVA, and greater residual astigmatism and sphere translated to more obvious glare.

SOURCE: Zhao W, Wang J, Fu D, et al. Influencing factors of glare in patients with myopia after small incision lenticule extraction. J Refract Surg. 2023 Jun;39(6):398-404.



Distinguishing Glaucoma, Cataract, and Glaucoma Suspect Based on Visual Symptoms

Cataract, glaucoma, and glaucoma suspect patients report differing visual symptoms. Asking patients about their visual symptoms may provide useful diagnostic information and inform decision-making in patients with comorbid conditions. Glaucoma, cataract, and glaucoma suspect patients at Wilmer Eye Institute responded to a questionnaire rating the frequency and severity of 28 symptoms. Univariate and multivariable logistic regression determined the symptoms that best differentiate each disease pair.

A total of 257 patients (mean age: 67.4 ± 13.4 y; 57.2% female; 41.2% employed), including 79 glaucoma, 84 cataract, and 94 glaucoma suspect patients, participated. Compared to glaucoma suspects, glaucoma patients were more likely to report poor peripheral vision (OR, 11.29; 95% CI, 3.73-34.16), better vision in one eye (OR, 5.48; 95% CI, 1.33-22.64), and light sensitivity (OR, 4.85; 95% CI, 1.78-13.24), explaining 40% of the variance in diagnosis (i.e., glaucoma vs. glaucoma suspect). Compared to controls, cataract patients were more likely to report light sensitivity (OR, 3.33; 95% CI, 1.56-7.10) and worsening vision (OR, 12.20; 95% CI 5.33-27.89), explaining 26% of the variance in diagnosis (i.e., cataract vs. glaucoma suspect). Compared to cataract patients, glaucoma patients were more likely to report poor peripheral vision (OR, 7.24; 95% CI, 2.53-20.72) and missing patches (OR, 4.91; 95% CI, 1.52-15.84), but less likely to report worsening vision (OR, 0.08; 95% CI, 0.03-0.22), explaining 33% of the variance in diagnosis (i.e., glaucoma vs. cataract).

Visual symptoms distinguish disease state to a moderate degree in glaucoma, cataract, and glaucoma suspect patients. Asking about visual symptoms may serve as a useful diagnostic adjunct and inform decision-making, for example in glaucoma patients considering cataract surgery.

SOURCE: Quintero M, Mihailovic A, Sikder S, et al. Distinguishing glaucoma, cataract, and glaucoma suspect based on visual symptoms. J Glaucoma 2023; May 25. [Epub ahead of print].


Comprehensive Metabolic Profiling of Diabetic Retinopathy

Diabetic retinopathy (DR) is an important complication of diabetes mellitus and a prevalent blind-causing ophthalmic disease. Despite years of efforts, rapid and accurate diagnosis of DR remains a challenging task. Metabolomics has been used as a diagnostic tool for disease progression and therapy monitoring. In this study, retinal tissues were collected from diabetic mice and age-matched non-diabetic mice. An unbiased metabolic profiling was performed to identify altered metabolites and metabolic pathways in DR.

A total of 311 differential metabolites were identified between diabetic retinas and non-diabetic retinas under the criteria of variable importance in projection (VIP)>1 and p<0.05. These differential metabolites were highly enriched in purine metabolism, amino acid metabolism, glycerophospholipid metabolism, and pantaothenate and CoA biosynthesis. Researchers then evaluated the sensitivity and specificity of purine metabolites as the candidate biomarkers for DR through the area under the receiver-operating characteristic curves (AUC-ROCs). Compared with other purine metabolites, adenosine, guanine, and inosine had higher sensitivity, specificity, and accuracy for DR prediction.

Researchers concluded that the study shed new light on the metabolic mechanism of DR, which can facilitate clinical diagnosis, therapy, and prognosis of DR in the future.

SOURCE: Han X, Zhang L, Kong L, et al. Comprehensive metabolic profiling of diabetic retinopathy. Exp Eye Res. 2023; Jun 10. [Epub ahead of print].




Industry News

Bausch + Lomb Launches Biotrue Hydration Boost Contact Lens Rehydrating Drops and PreserVision AREDS 2 Formula Soft Gels Plus CoQ10 in US, Announces New Scientific Data at AOA Optometry's Meetings

Bausch + Lomb announced the U.S. launch of Biotrue Hydration Boost Contact Lens Rehydrating drops, which the company says is the first and only preservative-free rehydrating drop in a multi-dose bottle indicated to lubricate and rewet soft contact lenses, including daily disposables, and rigid gas permeables. Read more.

The company also announced the U.S. launch of PreserVision AREDS 2 Formula soft gels plus coenzyme Q10, combining the exact nutrient formula recommended by the National Eye Institute to help reduce the risk of moderate to advanced age-related macular degeneration progression in AMD patients and CoQ10 to help support heart health. Learn more.

In addition, the company announced that researchers presented the results of 11 scientific poster presentations involving the company’s consumer, vision care and pharmaceutical products during the American Optometric Association Optometry’s Meeting e-posters Virtual Event, June 13-14. The company will host several sponsored education events at the Optometry’s Meeting in Washington, D.C., June 21-24. Poster presentations will include data from Phase III trials GOBI and MOJAVE, and 12-month KALAHARI safety extension study of Miebo (perfluorohexyloctane ophthalmic solution), approved for the treatment of the signs and symptoms of dry eye disease. Learn more.

Prevent Blindness Focuses on Eye Safety for Upcoming Solar Eclipses

Prevent Blindness is getting ready for upcoming US solar eclipses by launching the Prevent Blindness Eclipse + Your Eyes program to raise awareness about the dangers of looking directly at the sun during an eclipse. Read more.












Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO

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