The New Era of Intraocular Refractive Surgery (IOR)
Author: Jay Greiling, Reviewed by Richard L. Lindstrom, M.D.
As recently as the early 1990’s the industry of surgical eye care was divided and well defined. The ophthalmologist usually specialized in the surgical treatment of the eye for degenerative vision issues such as cataract, glaucoma and other intraocular vision conditions or the practice was a specialist in the corneal treatment of vision for refractive surgery with procedures like PRK, LASIK, RK, AK, ALK, CK, and others representing the correction of vision and reduced dependency on glasses.
The division between lens based procedures and corneal-based procedures meant also that the lens was operated on, only for vision degeneration cataract surgery, and the cornea was operated on, only when refractive issues were present. Procedures for myopia or nearsightedness were always cornea based and performed by the refractive surgeon practice. Procedures for hyperopia or far sightedness were often laser based cornea procedures.
Sometime around the turn of the century in 2000 there were some new lens technologies introduced and approved by the US FDA. These new lenses combined rehabilitation of vision in post-cataract surgery and also provided the patients with reduced dependence on reading glasses. The problem was that these new lenses were only available as a cash procedure as Medicare did not pay for them. The other issue was this new technology was not reimbursed by Medicare to the facility that purchased the implants for the surgeons to use within the hospital or surgical facility. Despite the challenges, many surgeons started to discuss these technologies with their patients and some decided to pay the extra money and actually have the lens based refractive procedures with these new implants.
That all changed when the Medicare system provided a new technology approval on these new technology implants and thereby agreed to pay more at the facility level for these new implant technologies. New lenses that corrected astigmatism and provided multifocal correction of vision in the distant and near received the new technology approvals (NTIOL designation).
New technology implants for astigmatism correction, multifocal correction and or accommodative optics received these NTIOL distinctions at different times from early 2000 to as recently as 2005. In addition to the facility receiving additional reimbursement on these new technology lens implants, the surgeon also was given the right to charge additional fees for the refractive portion of these procedures with the new implants. This balance billing right was granted to the ophthalmologist performing these new procedures and implants in May of 2005 with the CSM ruling from Medicare.
This date was historical to say the least for ophthalmology as it was the true beginning of the ophthalmologist being able to use the new technology implants with all patients and still have partial payment from the Medicare system for the seniors wanting the new technology implants to reduce their dependence on glasses and improved reading vision.
With the baby boomers now making their way into the surgical age of vision care, the new technology implants in combination with the laser based refractive procedures makes for a totally new and dynamic vision correction business. Seniors and new 40 something age brackets now have more alternatives for correction of vision and refractive surgery with lens based alternatives.
With all the new technology implants for correction of astigmatism, correction of myopia, hyperopia and presbyopia (loss of near vision)…the transition from only corneal based laser procedures to more lens based procedures we now have a new Era in ophthalmic surgery. Intraocular refractive procedures (IOR) blend the refractive alternatives for astigmatism, multifocal and accommodative optics with implants for lens based refractive procedures for the new progressive senior patients who desire a post-surgical life with less or no dependence on glasses for reading and functional daily vision needs.
To make things even more confusing, the combination of IOR procedures and Laser based cornea procedures can be performed to enhance the treatment of refractive errors. Your eye surgeon can now treat to a much wider range of correction needs with these new combination technology surgeries and can enhance the patients refractive results by performing a first tier IOR procedure and then enhance and titrate the refractive outcome with an additional laser based corneal procedure over the top of the first IOR procedures.
It is a wonderful time for vision correction. The new technology is now available to the refractive patient and there are multiple options available. New improved second generation implants are in process of FDA approvals right now and we see the IOR procedures continuing to grow with new alternatives for lenses placed in the cornea, new accommodative implants, light adjusted optics and new multifocal alternatives with improved optical designs. These new technologies will produce even more demand for these IOR procedures with Medicare senior patients as well as the pre-Medicare patients who look to reduce or eliminate their dependence on glasses for active lifestyles.
If you seek to reduce your dependence on glasses and improve your functional vision for active lifestyles you need to look at the alternatives now available with IOR procedures. If your surgeon only performs laser based refractive procedures, you need to ask about the NTIOL alternatives and the IOR procedures for lens based refractive surgery.
- Phakic Lens Implants
- Multifocal Implants
- Accommodative Implants
- Conductive Keratoplasty (CK)
- Clear Lens Procedures (CL)
- Presbyopia Correction
It’s just beginning!
There is a pretty strong interest in and trend toward new intraocular refractive procedures being introduced by many new refractive companies. The leading refractive surgeons throughout the country have returned to the operating room to refine their surgical skills in intraocular surgery and have started to offer new approaches to clear lensectomy techniques and strategies for the high hyperopic and now even the mid to high range myopic patients.
The exciting thing is that all these new intraocular procedures will work well in combination with other non-intraocular refractive procedures. The bioptics approach to LASIK and LASEK have already taken center stage at the international refractive seminars over the last few years. New approaches with CK, Crystalens, and other new accommodative techniques and implants will all work in concert with current laser procedures and techniques.
Author: Jay Greiling, ©Copyright 2007, Improve Your Vision
