Policyholder Services

Do I need a special endorsement on my policy to be covered for clear lens extraction for the treatment of glaucoma?

While clear lens extraction for refractive purposes (refractive lens exchange; RLE) is excluded under the policy unless coverage is specifically added by endorsement following underwriting review and approval of a supplemental questionnaire and adherence to OMIC’s underwriting requirements for refractive surgery, lens extraction for therapeutic purposes is not subject to this exclusion or underwriting conditions. Coverage is automatically included under the standard Surgery Class 3 rating classification.

Lens extraction may be indicated for the treatment of glaucoma in certain situations. For example, lens extraction may be appropriate for angle closure glaucoma when narrow angles were not relieved by laser peripheral iridotomy. Additionally, it may be indicated in the treatment of secondary angle closure due to nanophthalmos. Some prominent cataract surgeons have suggested in the ophthalmic press that clear lens extraction is warranted as a primary glaucoma procedure based on their experience with better IOP control after standard cataract surgery. It should be noted, however, that lens extraction to lower intraocular pressure in open angle glaucoma carries greater risk and may be more difficult to support than lens extraction for angle closure glaucoma.

Although some studies involving therapeutic lens extraction have been reported in peer-reviewed literature in recent years, there have been no randomized controlled trials that compare lens extraction with other proven treatments. Because there is little scientific evidence in support of clear lens extraction for the treatment of glaucoma, ophthalmologists who are considering performing this procedure should follow basic risk management principles. If practical, attempt more conventional methods of treatment first. If a decision to proceed with lens extraction is made, carefully document in the patient’s medical record the rationale for selecting this as the procedure of choice, especially if it will be performed in lieu of other proven treatments. Obtaining appropriate informed consent is also critical. Advise the patient of alternative treatment options available as well as the potential risks, side effects and benefits of the procedure. Use a special consent form specific to therapeutic lens extraction which outlines the issues discussed. Although OMIC does not offer a sample consent form for this procedure at this time, our risk management staff are available to review your consent form upon request.

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