Eyeworld

45 EW FEATURE April 2018 • Intersection of refractive surgery and MIGS he said. "Other procedures such as the Kahook Dual Blade, Trabectome [NeoMedix, Tustin, California], ab interno canaloplasty, and GATT can be performed as standalone procedures." Hopefully, as more evidence-based information be- comes available, MIGS devices will be available for standalone surgery as well, he said, adding that patients may sometimes be willing to pay out of pocket for some of the procedures that are currently not covered by insurance or Medicare. Reimbursement for MIGS Dr. Patterson thinks that some of the biggest barriers are insurance and re- imbursement patterns. Surgeons will have to reassess if it's worth their time to continue putting in these devices, he said. He noted that in his area, the prices of the stents and devices re- main the same, but reimbursement has decreased to just a few hundred dollars. This change happened just this year, Dr. Patterson said, and he noted it will have a particular im- pact on his practice, where he does 300–400 MIGS procedures in a year. Reimbursement for MIGS pro- cedures utilizing devices remains a significant barrier for adoption, according to Dr. Samuelson. "CyPass coverage is still difficult in my area, and XEN coverage is even more of a challenge," he said. "Fortunately, our Schlemm's canal-based surgery, such as the iStent, is now routinely covered." He said the CyPass recent- ly received a favorable ruling in his region, so coverage for supraciliary surgery should improve. The XEN remains uncovered in Dr. Samuel- son's area. Initially all MIGS procedures have had this challenge, Dr. Brubak- er said. "After an initial battle, the iStent has developed great cover- age," he said. "The CyPass and XEN Gel Stent have had their challenges as well." He added that the coverage for the CyPass has improved greatly in his area, and the XEN has also improved as of late. "Reimburse- ment will always be a challenge with early adopters," he said. "If I think a particular device is the best treatment for my patient, I usually have a detailed discussion about the benefits of the procedure and how it compares to the older, typically risk- ier but covered procedure. I give my patients a detailed cost breakdown for the new procedure and let them decide what they would like to do. It is surprising how often my patients elect to pay out of pocket for the newer procedure." Dr. Brubaker think it is import- ant to give patients all their options and let them decide what they would like to have done. "I think it is important to have multiple treatment options for one's patients," he said. "If the only MIGS you know how to do is not covered by the patient's particular carrier and they can't afford to pay out of pocket, having an alternative MIGS option that is covered can greatly improve the care of patients." EW Editors' note: Dr. Brubaker has finan- cial interests with Alcon, Allergan, Glaukos, and New World Medical. Dr. Patterson has financial interests with Allergan and New World Medical. Dr. Samuelson has financial interests with Alcon, Allergan, Glaukos, Ivantis, MicroOptx (Maple Grove, Minnesota), New World Medical, and Sight Sciences (Menlo Park, California). Dr. Huang has no financial interests related to her comments. Contact information Brubaker: jacobbrubaker@me.com Huang: physicians@glaucomainstitute.com Patterson: michaelp@ecotn.com Samuelson: twsamuelson@mneye.com Surgical gonio prism with handle • Single piece design – no risk of instrument failure Single mirror lens with handle • Allows patient's eye and surgeon's microscope to be perpendicular Left hand and right hand handle options Scan to view a MIGS surgery video utilizing the surgical gonio prism 800 -225-1195 • www.sensormedtech.com Contact us now to arrange a no-risk evaluation MKT-0078-03/2016 These lenses: • Feature vaulted bottom for instrument access • Eliminate the need for post-operative sterilization • Are a Joint Commission accepted replacement for reusable lenses Single use surgical lenses for MIGS Get a better view of the angle

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