LCD Reference Article Response To Comments Article

Response to Comments: Cataract Surgery (DL39905)

A59904

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Source Article ID
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Article ID
A59904
Original ICD-9 Article ID
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Article Title
Response to Comments: Cataract Surgery (DL39905)
Article Type
Response to Comments
Original Effective Date
10/13/2024
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This article summarizes the comments WPS received for Draft Local Coverage Determinations (LCD) Cataract Surgery DL39905. Thank you for the comments.

Response To Comments

Number Comment Response
1

Comments were received from the American Academy of Ophthalmology (the Academy) and the American Society of Cataract and Refractive Surgery (ASCRS) with recommendations that they state will bring the proposed LCD in closer alignment with current practice trends in same-day bilateral cataract surgery, also known as immediate sequential bilateral cataract surgery (ISBCS).

They state the proposed LCD generally reflects current clinical guidelines supported by the American
Academy of Ophthalmology’s Preferred Practice Pattern (PPP) on Cataract in the Adult Eye (2021). The authors appreciate the care selection of coverage criteria for same day surgery, which reflects the importance of patient safety and patient choice in the option.

However, they feel language throughout the LCD, particularly in the the opening sentences of the Coverage Limitations- Second Eye Surgery and the Summary of Evidence, over states the risks and ignores the benefits of same-day bilateral surgery. While the Academy’s PPP does state that same-day bilateral surgery is not commonly performed in the US, the PPP goes on to positively clarify the potential patient benefits, emphasizing individual patient preferences and making the decision for same-day bilateral surgery on the best interests for the individual patient’s visual health and refractive status.

They state there have been innovations in cataract surgery that address previous concerns regarding same-day, bilateral cataract surgery. Intracameral antibiotics have dramatically reduced the rate of infections such as endophthalmitis and other complications from cataract surgery. Modern optical biometry and improved algorithms help to ensure that the intraocular lenses will function properly without the need to check the results in one eye before operating on the second eye. Note that the protocol used to prevent infections and complications requires performing the surgeries on each eye sequentially, using separate sets of instruments, medications, and other materials. Therefore, same-day, bilateral cataract surgery can now safely be performed on appropriate patients who understand the risks and benefits.

The authors recommend changing the wording to use similar or the same language as CGS Administrators LCD L33954 regarding immediate sequential bilateral cataract surgery to ensure that appropriate Medicare beneficiaries have access to this sight-restoring surgery.

Thank you for the thoughtful comments. WPS agrees that same-day bilateral surgery has potential patient benefits, based on individual preferences as outlined in the American Academy of Ophthalmology’s Preferred Practice Pattern (PPP) on Cataract in the Adult Eye (2021). As a result, WPS has eliminated the second eye surgery limitation. Instead, we have added for clarification that only one cataract surgery can be performed per eye.

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