The New Era of Intraocular Refractive (IOR) Surgery

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 were always cornea-based and performed by the refractive surgeon practice. Procedures for hyperopia were often laser based cornea procedures.

Around the turn of the century in 2000, there were new lens technologies introduced and approved by the FDA. These new lenses combined rehabilitation of vision in post-cataract surgery and also provided patients with reduced dependence on reading glasses. One issue was that the new lenses were only available as a cash procedure; Medicare did not pay for them. Another issue was that Medicare did not reimburse the hospital or surgical facility that purchased the implants for the surgeons. Despite the challenges, many surgeons started to discuss these technologies with their patients; some patients decided to pay the extra money and have the lens-based refractive procedures with the new implants.

That all changed when Medicare provided technology approval on the new implants and thereby agreed to pay more at the facility level. New lenses that corrected astigmatism, and provided multifocal correction of vision in the distant and near, received new technology approval (NTIOL designation).

New implants for astigmatism correction, multifocal correction and or accommodative optics received NTIOL distinctions at different times. In addition to the facility receiving reimbursement on the new lens implants, the surgeon was also given the right to charge additional fees for the refractive portion of these procedures. This balance billing right was granted to ophthalmologist performing the new implant procedures in May 2005 with Medicare’s CSM ruling.

This date was historical for ophthalmologists since it allowed for the use of the new implants with all patients. In addition it granted partial payment from the Medicare system, so seniors could experience the benefits of the new technology as well.

With the baby boomers now making their way into the surgical age of vision care the new implants, in combination with the laser-based refractive procedures, make for a new and dynamic vision correction business. The 40+ age bracket and senior citizens now have additional alternatives for correction of vision.

With the new implants for the correction of astigmatism, myopia, hyperopia, and presbyopia, and with the transition from only corneal-based laser procedures to more lens-based procedures, we are now in a new era of ophthalmic surgery. Intraocular refractive procedures blend the refractive alternatives for astigmatism, multifocal, and accommodative optics with implants for lens-based refractive procedures. This especially benefits the new, progressive senior patients that 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 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. Your surgeon can then enhance and titrate the refractive outcome with an additional laser-based corneal procedure over the top of the first IOR procedures.

The multiple new technology options available to the refractive patient make it a wonderful time for vision correction. New, improved, second-generation implants are awaiting FDA approval; in addition IOR procedures continue 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. The new technologies will create a greater demand for IOR procedures with Medicare patients, as well as the pre-Medicare patients looking 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, ask about the NTIOL alternatives and the IOR procedures for lens-based refractive surgery.

Vance Thompson Vision

Sioux Falls, SD

Minnesota Eye Consultants

Minneapolis, MN