EW Weekly, June 15, 2018

June 15, 2018
Volume 24 , Number 21

CMS moves to issue J code for Avedro crosslinking drug formulations

The Centers for Medicare and Medicaid Services (CMS) has said it will establish a Healthcare Common Procedure Coding System J code for the Photrexa riboflavin drug formulations (Avedro, Waltham, Massachusetts) used in the only FDA-approved crosslinking procedure in the U.S. This is considered a preliminary decision with the final decision to be made in November 2018 and new or revised codes being implemented by Jan. 1, 2019. Prior to this decision and until a finalized code is made, Photrexa drug claims are submitted under the miscellaneous J3490 code, which requires manual review, according to Avedro's news release about the preliminary decision. Eric Donnenfeld, MD, said in Avedro's press release that this J code, if finalized, would simplify billing. "A product-specific J code will streamline the claims submission process for physician practices and better serve ectatic patients in need of treatment."

Optovue receives FDA approval for OCT angiography metrics software

Optovue (Fremont, California) announced this week that the FDA approved AngioAnalytics, which the company describes as the "world's first optical coherence tomography angiography (OCTA) blood vessel measurement technology." The software, the press release said, improves OCTA image quality and measurement accuracy by including 3-D projection artifact removal (3D PAR). "AngioAnalytics and 3D PAR are game changers because they 'erase' overlying inner retinal blood vessel artifacts, allowing for better visualization and more accurate measurement of the outer retina and choroidal structures, essential in treating the abnormal blood vessel growth (CNV membrane) that leads to blindness for patients with wet age-related macular degeneration (AMD)," Paul Tornambe, MD, said in the company's press release. "In the past, we've relied on two-dimensional imaging to determine the presence or absence of fluid leaking from these abnormal vessels in the retina, and whether or not additional treatment is necessary with VEGF inhibitor drugs." According to the company, AngioAnalytics, which is incorporated into the AngioVue OCTA system, monitors retinal and vascular changes that could be associated with disease progression or treatment.

Vitamin to combat blue light

With the amount of time adults are exposed to screens, and thus blue light, on a daily basis, Bausch + Lomb (Bridgewater, New Jersey) announced its development of OcuviteBlue Light, a vitamin with lutein and zeaxanthin, which the company's press release explains are carotenoid pigments naturally found in the eye that can help absorb blue light as it reaches the macula.

Register for ASCRS webinar "Mastering Cataract Removal with the Stellaris Elite"

Register now for the upcoming ASCRS webinar "Mastering Cataract Removal with the Stellaris Elite," which will take place on Wednesday, June 20 at 9:00 p.m. EDT. Sponsored by the ASCRS Cataract Clinical Committee, this webinar is the second in a three-part series focused on phacoemulsification systems by Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), and Johnson & Johnson Vision (Santa Ana, California). In this session, attendees will learn from experts how to use dynamic infusion, vacuum, and dual linear control on the Bausch + Lomb Stellaris Elite phacoemulsification system to optimize surgical outcomes in all phases of cataract removal. Join moderator Robert Weinstock, MD, and panelists Michael Patterson, DO, and Zaina Al-Mohtaseb, MD, for an interactive discussion.


  • A retrospective case series published in the Journal of Cataract and Refractive Surgery looked at patient characteristics and outcomes of retained lens fragments after uneventful phacoemulsification cataract surgery. The research by John Norton and Sunali Goyal, MD, identified 19 patients with retained lens fragment in the anterior chamber from 2016 to 2018 at University of Arkansas for Medical Sciences, Jones Eye Institute. Of those, 13 were myopic and 15 had corneal edema and anterior chamber inflammation. Most retained fragments (n=17) were found in the inferior angle, and on average, fragments were removed 34.7 days after cataract surgery. Ultimately, the study authors determined that long eyes, those with steep corneas, and a shallow anterior chamber depth could be at more risk for retained lens fragments.
  • Research published in the journal Eye evaluated changes in retinal nerve fiber layer (RNFL) thickness after trifocal intraocular lens implantation. Javier Garcia-Bella, MD, and coinvestigators performed a prospective, double-masked study in 50 eyes of 50 patients with bilateral cataract. Each patient had a trifocal diffractive IOL implanted in one eye and a monofocal IOL in the other. After IOL implantation, the researchers found a 7.29 ± 10.51 µm increase from baseline in RNFL thickness in the eyes with trifocals compared to a 1.96 ± 2.90 µm increase from baseline in the monofocal eyes. Garcia-Bella et al. wrote, "a higher RNFL thickness measurement found on a patient who had been previously implanted with a trifocal IOL should be interpreted carefully because [it] could be due to the lens optical variations produced on the OCT images."
  • Soon-Phaik Chee, MD, and Nicole Shu-Wen Chan describe a new suture snare technique for scleral fixation of IOLs and capsular tension devices in the British Journal of Ophthalmology. The technique, meant to overcome the challenges of using the current Gore-Tex needle within the eye, "eliminates the inappropriate needle and the need for a large sclerostomy, and is cost-effective and can also be used in combination with the conjunctival-sparing Hoffman corneoscleral pocket," the authors wrote.
  • Researchers describe a new scoring system based on topographic diagnostic signs of spectral domain OCT in glaucoma diagnosis in myopic eyes. Published in the journal Ophthalmology, Sung Uk Baek, MD, and coauthors present a cross-sectional study of 517 eyes that were divided into a training set and test set. Abnormalities in the RNFL and ganglion cell-inner plexiform layer (GCIPL), specifically temporal hemifield asymmetry of the GCIPL thickness map, location of the RNFL defect, and color tone of the GCIPL defect, were identified as posing a higher risk for a diagnosis of myopic glaucoma. The researchers determined, "Our scoring system including OCT topographic parameters demonstrated to be beneficial for clinicians to differentiate real glaucomatous damage from myopic healthy eyes. Our results support the value of using multitopographic OCT parameters for detecting glaucoma in myopic eyes."
  • Three-year incidence of posterior capsule opacification and Nd:YAG capsulotomy of different IOL materials, specifically AcrySof IOLs (Alcon, Fort Worth, Texas), non-AcrySof hydrophobic IOLs, and non-AcrySof hydrophilic IOLs, were evaluated in research published in the journal Eye by Paul Ursell, MD, and coauthors. More than 13,000 eyes were included in the AcrySof cohort, followed by more than 19,000 in the non-AcrySof hydrophobic group and nearly 20,000 in the non-AcrySof hydrophilic group. Incidence of YAG capsulotomy in the AcrySof group (2.4%) was about two times lower and four times lower than in the non-AcrySof hydrophobic (4.4%) and non-AcrySof hydrophilic (10.9%) groups, respectively. PCO was also lower in the AcrySof group as well. "Real-world evidence shows that within 3 years following implantation, AcrySof IOLs are significantly superior in reducing Nd:YAG capsulotomy and PCO incidence compared to other hydrophilic and hydrophobic acrylic IOLs," Ursell et al. wrote.

This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

EyeWorld Weekly Update (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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