The Business of Contact Lenses - Scorecard - MDSpire
Advertisement
The Business of Contact Lenses
Discover the key requirements for referring patients for corneal cross-linking with riboflavin (CXL) and the challenges related to insurance coverage in specialty contact lens prescribing.
Clinical Scorecard: Corneal Cross-Linking (CXL) in Specialty Contact Lens Practice
At a Glance
Category
Detail
Condition
Keratoconus and corneal ectasia post-refractive surgery
Key Mechanisms
Corneal cross-linking with riboflavin to prevent progressive corneal distortion
Target Population
Patients aged 14 years or older with documented progression of keratoconus or ectasia
Care Setting
Ophthalmology and specialty contact lens practice with referral to CXL-capable surgeons
Key Highlights
CXL is FDA-approved and considered standard of care since 2015 for keratoconus and ectatic diseases.
Medical necessity criteria include documented progression via keratometry or refraction changes within 24 months.
Contraindications include corneal scarring, severe ocular surface disease, prior herpetic infection, and insufficient corneal thickness.
Guideline-Based Recommendations
Diagnosis
Confirm keratoconus diagnosis based on keratometry and corneal topography.
Document progression defined as ≥1 D increase in steepest keratometry or manifest cylinder, or ≥0.50 D increase in spherical equivalent within 24 months.
Ensure corrected distance visual acuity worse than 20/20 with proper correction.
Management
Refer patients meeting criteria for CXL to qualified surgeons or perform CXL if trained.
Verify corneal thickness is ≥300 microns (some guidelines recommend ≥400 microns) before procedure.
Rule out contraindications such as corneal scarring, severe ocular surface disease, prior or current herpetic infection.
Monitoring & Follow-up
Monitor keratometry and refraction changes over time to assess progression.
Maintain documentation to support medical necessity for insurance coverage.
Risks
Potential for delayed epithelial healing especially in patients with prior chemical injury or systemic disease.
Contraindications include corneal scarring and active ocular infections.
Patient & Prescribing Data
Patients with progressive keratoconus or ectasia aged 14 years and older
Insurance coverage may vary; patients should verify benefits due to possible coverage gaps despite medical necessity.
Clinical Best Practices
Establish firm diagnosis with topography before referral.
Provide detailed progression documentation to surgeons to support insurance approval.
Educate patients about potential insurance coverage limitations and encourage verification with their payors.
In this year’s keynote speech, Craig Norman and Patrick Caroline took a walk down memory lane to examine the last 2 and a half decades of both the Global Specialty Lens Symposium and specialty contact lenses.
