Ocular Photodynamic Therapy (OPT) is a treatment for age-related macular degeneration (AMD), a common eye disease among the elderly. AMD is the leading cause of blindness in adults over the age of 50. OPT involves the infusion of an intravenous (IV) photosensitizing drug called verteporfin followed by exposure to a laser. The laser activates verteporfin, which selectively targets and treats the pathologic ocular tissue. Verteporfin therapy is neither a cure nor a preventative for AMD; it is meant to slow progression of the disease. Medicare's OPT national coverage determination (NCD) is at 80.3.1 of the NCD manual.
The Centers for Medicare & Medicaid Services (CMS) on May 25, 2012 received a formal written request from the American Academy of Ophthalmology for review and rescission of NCD 80.3.1. The requestors note that the current coverage decision for OPT is from 2004, prior to the emergence of targeted anti-VEGF intravitreal treatments. The requestors say these newer therapies have largely supplanted OPT as initial management of AMD, and that OPT is largely relegated to patients in whom the newer therapies have failed. The requestors believe that the current NCD requirement for followup fluorescein angiography with OPT is not supportable for these "end-stage" patients.
