ASCRS News
September 2023
by Sumit “Sam” Garg, MD
Chief Medical Editor
Any surgeon that states that they have never had a complication either: 1) does not operate, or 2) is not telling the truth. Ophthalmic surgery can be humbling. From time to time all surgeons experience challenges in surgery that can sometimes result in suboptimal outcomes or morbidity to our patients. All too often, we as ophthalmic surgeons undervalue the time and intensity of the surgeries we perform. Granted, cataract surgery can be done in 20 minutes or less, but in some cases, it takes longer, and the time spent is some of the most concentrated we have. When discussing cataract surgery with our patients, it is not uncommon for surgeons to try and allay fears of surgery and reassure patients that they will be fine afterward. Part and parcel with this are glossing over the various options of IOLs available to them, the pros and cons of each choice, and the surgical complications. This, in my opinion, undervalues the complexity and intensity of what we do and importantly does not properly meet the requirements of informed consent. Ophthalmic surgery has risks, and it takes us a lifetime of learning to perform and refine these surgeries for our patients.
Over the past few years, some of our reimbursement cuts to cataract surgery (and other ophthalmic surgery, e.g., MIGS) may be a result of others touting “fast and easy” surgery, which is reflected in the RUC analysis that Medicare uses to set reimbursement rates. Currently, we are at risk of having other MIGS coverage be in jeopardy. In June 2023, five of the seven Medicare Administrative Contractors (MACs) responsible for processing Medicare Part A and Part B medical claims in assigned jurisdictions across the U.S. published a series of “Proposed Local Coverage Determinations (LCDs)” on MIGS in what appears to be a well-coordinated effort between the MACs. In these proposed LCDs, the MACs are suggesting that a number of commonly performed procedures including canaloplasty, goniotomy, and cyclophotocoagulation are experimental and investigational in patients over age 18, and they are therefore proposing to cease coverage. It is first important to understand that these are “proposals,” and until final rulings are issued, we can continue to perform the procedures. Secondly, it is also important to remember that often these proposals are retired before ever taking effect. ASCRS, AAO, and AGS have voiced strong opposition to these proposals and have collaborated in response to the MACs, sending letters of opposition and actively presenting at the open meetings. We have also seen an outpouring of support from our members who have written numerous letters opposing the LCDs. It is important that our members continue to be active by being informed, educated, and involved. ASCRS sends our membership Washington Watch Weekly, which is a great source to stay up to date on these very pertinent issues to all our practices.
The last issue of EyeWorld focused on best practices. This issue explores challenging cases, warning signs, complications (and avoidance of), and management. Some of the topics we delve into include management of posterior capsular tears, zonular weakness and dehiscence, Yamane secondary IOL fixation, malignant glaucoma, neovascular glaucoma, lamellar corneal graft infections, and post-LASIK ectasia. One particularly interesting article is on the use of topical losartan to aid in the treatment of corneal scars. The topics covered highlight the complexity of evaluation, decision making, and surgical skills that are necessary for us to provide optimal outcomes. What we do is not easy, and we need to be united in protecting adequate coverage for the care we offer our patients.
Lastly, it’s hard to believe I’ve already been Chief Medical Editor of EyeWorld for 1 year. I would like to take the opportunity to thank our editorial staff, section editors, Editorial Board, and contributors, all who dedicate their time and effort to better inform and educate our membership. I would also like to thank the ASCRS leadership and membership for continuing to support ASCRS and its various initiatives. ASCRS is strong, and its strength comes from all of us, so please continue to stay involved. As always, if you have any suggestions for topics, improvements, etc., please feel free to reach out to me at gargs@uci.edu.
