Eyeworld

Name of Ad Page number 6 be sent relevant clinical stud- ies and other documents establishing cross-linking as the standard of care for pro- gressive KC 6,10,11 and a peer-to- peer call should be request- ed. Regarding patient age, it is important to know that the safety and efficacy of iLink was established in clin- ical studies in patients aged 14-65. ■ A cover sheet with check- boxes for progression crite- ria can also be an efficient way to do this. If a claim or pre-authoriza- tion is rejected for any reason, including age, corneal thick- ness, or supposed lack of pro- gression, the insurer should 6 Worsening tomographical signs of ectasia including steepening of Kmax ≥1.00 D Clinical signs of visual decline, including ≥1.00 D increase in manifest cylinder and/or ≥0.50 D increase in manifest myopia Decrease of ≥ 0.10 mm change in the back optical zone radius of corneal rigid gas permeable lenses Increasing contact lens base curve consistent with corneal steepening State that progression has been documented based on the following (Delete any that are not relevant to the case; add to your template any clarifications or evidence that payors in your market have requested in the past): Exam Note Pearls When I am confident the patient has progressive keratoconus, I avoid delays prompted by insurer requests for additional information by ensuring that relevant key phrases are included in the exam notes: State right up front that the patient has keratoconus with progression. Differentiate between vision and disease treatment plans: For best visual function, will continue to recommend contact lenses (including RGP, hybrid, or scleral CLs). For disease treatment, will now recommend corneal collagen cross-linking. + + ▶ ▶ ▶ ▶ ▶ • • + New inability to fit with a specialty contact lens based on worsening corneal shape consistent with ectasia Progressive thinning on pachymetry readings Increased mean simulated keratometry in central 3.0-mm zone Worsening posterior float steepening ▶ ▶ ▶ ▶ ▶ Circle back to confirm that progression has been documented clinically and through corneal imaging (if that is the case). ▶ + Derek W. DelMonte, MD

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