Eyeworld

WINTER 2026 | EYEWORLD | 81 G Reference 1. Teymoorian S, Samuelson TW. New restriction on glaucoma care deserves closer look. Ocular Surgery News. June 24, 2026. www.healio.com/news/ ophthalmology/20260624/new- restriction-on-glaucoma-care- deserves-closer-look. Accessed September 11, 2026 Relevant disclosures Radcliffe: Glaukos, Iantrek, Ocular Therapeutix Samuelson: Glaukos Shah: None Contact Radcliffe: drradcliffe@gmail.com Samuelson: twsamuelson@mneye.com Shah: manjool@gmail.com unwilling or unable to proceed with these cases. An unlisted code may exist as a theoretical alternative, but anyone who works in an ASC understands the practical difficulty of asking a facility to perform a procedure when reimburse- ment is uncertain. The result is that a procedure can effectively disappear from the surgeon's armamentarium even though nothing about the patient, the procedure, or the surgeon's clinical judgment has changed." Dr. Radcliffe experienced this firsthand. "I had patients who I had already evaluated, counseled, and consented for cyclodialysis with scleral reinforcement," he said. But because of a change in the coding environment, he was being asked to choose a different operation. "Think about that conversation from the patient's perspective: 'Yesterday, I thought this was the most appropriate procedure for your eye. Today, I still think it is the most appropriate procedure for your eye. The procedure has not changed. The evidence has not changed. But I may no longer be able to perform it because the reimbursement pathway has changed,'" he said. While in some eyes there was a reasonable alternative, in others, there simply was not an alternative that he thought offered the same combination of mechanism, efficacy, and risk. "Glaucoma surgeons spend their careers trying to individualize treatment precisely because these procedures are not interchangeable. A coding decision should not inadvertently force us to pretend that they are," Dr. Radcliffe said. "This is why I think the ASCRS Glaucoma Clinical Committee's response was so important. The issue was bigger than whether two existing CPT codes perfectly described a new operation. ASCRS recognized that decisions made with- in the reimbursement infrastructure can have immediate consequences in the operating room. What may appear to be a semantic distinction in a coding manual can determine whether a patient receives a treatment at all," he said. Manjool Shah, MD, said the main issue is how administrative and coding delays directly impact physicians' ability to deliver optimal, in- dividualized patient care. "As our toolkit contin- ues to grow and evolve to serve patients where they are, our Society has to be the force that advocates for patients and surgeons in the face of other important systems that may be slower to adapt and thus obstruct progress," he said. Dr. Radcliffe stressed the importance of being clear about the appropriate relationship between these systems and medicine. He noted that CPT codes are necessary, as is accurate cod- ing and responsible stewardship of healthcare resources. But the purpose of this infrastructure is to enable physicians to deliver appropriate care and to appropriately compensate the peo- ple and facilities providing it. He also cautioned that cyclodialysis is a useful warning about what lies ahead because glaucoma innovation is moving faster than the reimbursement structures surrounding it. "We are increasingly treating glaucoma earlier, re- ducing dependence on chronic medications, and selecting interventions based on the individual patient," Dr. Radcliffe said. "Inevitably, new procedures will emerge that do not fit neatly into CPT language written years or decades earlier. If the default response to that mismatch is to make the procedure practically unavail- able while the bureaucracy catches up, we will repeatedly find ourselves in this same position." He added that glaucoma is perhaps the worst disease in which to accept that kind of delay. "Glaucoma does not pause while reim- bursement catches up," he said. "When reim- bursement policy delays intervention, narrows procedural choices, or pushes physicians toward the reimbursable treatment rather than the treatment they think is most appropriate, reimbursement policy has crossed over into the practice of medicine." Dr. Radcliffe said the new Category III code should ultimately provide a clearer pathway for cyclodialysis with scleral reinforcement. "But I hope we do not simply congratulate ourselves on solving this particular coding problem and move on," he said. "The larger challenge is developing a reimbursement system capable of accommodating innovation without creating pe- riods in which clinically reasonable treatments become functionally inaccessible. "We have spent decades asking innovators to give us more ways to preserve vision in glau- coma, and they finally are. Our reimbursement system should not be the reason we have to tell patients that they cannot have them," he said.

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