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Am I covered for performing bilateral same-day RLE or bilateral same-day phakic implant procedures?

Updated 6/5/2014

If your policy has been endorsed to include coverage for the designated procedure, coverage will apply at full policy limits for such procedures performed within OMIC’s underwriting requirements or any exceptions to the requirements granted in writing by OMIC.

OMIC recently modified its underwriting requirements to extend coverage to immediately sequential bilateral intraocular refractive surgery procedures. To qualify for coverage, insureds must comply with each of the following requirements:

  • Patients undergoing immediately sequential bilateral intraocular refractive surgery (ISBIRS) must be at low risk for surgical complications. Treatment of both eyes on the same day is not permitted for “complex” surgical cases, such as in patients with amblyopia, pseudoexfoliation syndrome, high hyperopes with axial length <20.0 mm, eyes with previous ocular trauma, or eyes with active macular SRNVM with leakage or significant diabetic retinopathy, or in patients at higher risk of infection, such as patients who are immunocompromised or have poorly controlled diabetes.
  • ISBIRS is not recommended in patients for whom there is a greater than normal risk of having difficulties calculating or selecting the appropriate IOL power. These types of patients include those who have previously undergone refractive surgery (e.g., LASIK, PRK, CK, and RK), have significant corneal scarring or keratoconus, have extremely long or short axial lengths, or have conditions that make it difficult to cooperate for the Optical or Ultrasonic Biometry (e.g., nystagmus or dementia).
  • Immediately sequential bilateral patients must read and sign the applicable Addendum for Bilateral Same Day Surgery developed by OMIC or an equivalent bilateral consent addendum.  Click here to access the Addendum for Bilateral Same Day Refractive Lens Exchange Surgery or here to access the Addendum for Bilateral Same Day Phakic Implant Surgery.
  • The physician must develop and follow appropriate protocols to reduce the risks for right-left eye errors and errors in IOL insertion.
  • There must be complete aseptic separation of the first and second eye surgeries, including use of separate instrument trays that have undergone separate sterilization cycles; complete, repeat surgical scrub and draping; and separate intraocular irrigating fluids and drops with different lot numbers.
  • Antibiotics must be appropriately administered at sufficient dosages to reduce the risk of endophthalmitis. Consideration should be given to use of intracameral antibiotics, either in the irrigating solution or injected into the anterior chamber.
  • Any complication with the first eye must be resolved before proceeding with surgery on the second eye.
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