Policyholder Services

Will OMIC cover me for implantation of a multifocal intraocular lens?

Updated 10/17/2016

Yes. OMIC covers claims against insured ophthalmologists who implant multifocal intraocular lenses in conjunction with cataract surgery or refractive lens exchange (RLE) (subject to standard policy terms and conditions). If a patient has visually significant cataracts, OMIC considers the procedure cataract surgery for underwriting purposes. However, if the patient’s cataracts are not visually significant, or if the patient does not have cataracts, the procedure is considered RLE, an intraocular refractive surgery procedure. Because the OMIC policy excludes coverage for intraocular refractive surgery procedures, physicians who perform RLE must be specifically approved and their policies endorsed to cover RLE. In addition, patients undergoing RLE with insertion of a multifocal intraocular lens must fall within OMIC’s underwriting requirements with respect to degree of myopia and hyperopia.* While multifocal intraocular lenses are FDA-approved for use in cataract surgery, they are used off-label for RLE. OMIC requires that surgeons advise RLE patients of this off-label use.

*OMIC’s underwriting requirements for RLE extend coverage only for cases involving patients with at least 3.5 diopters of myopia and at least 1 diopter of hyperopia (4 diopter minimum for hyperopic patients under age 40). Hyperopic patients must also have uncorrected visual acuity of 20/40 or worse and axial length of at least 20 mm. While OMIC is willing to consider exceptions to these patient selection criteria on a patient-by-patient basis, insureds are encouraged to limit their performance of RLE to cases that fall within our standard guidelines. OMIC is concerned by the risk-benefit ratio for patients with lower degrees of myopia/hyperopia than our requirements permit. Such cases may be difficult to defend should the outcome be less than optimal. The fact that use of a multifocal intraocular lens in such patients would be considered “off-label” could also impact the defensibility and ultimate resolution of resulting claims.

Risk Management Advice: OMIC recommends that the surgeon discuss with the patient the option of monovision with monofocal implants, demonstrate monovision in the office with contact lenses, and document that the patient does not accept this alternative. OMIC also recommends that the surgeon discuss with the patient the less expensive option of undergoing surgery with treatment of both eyes for distance, with continued use of reading glasses following surgery. Discussion of both options and demonstration of monovision should be carefully documented in the patient’s medical record. OMIC believes that the discussion and demonstration of monovision as an option is an important component of a complete informed consent process and that it should be done on all patients considering multifocal intraocular lenses. As discussed above, surgeons must advise patients of the off-label use of multifocal lenses for RLE. OMIC recommends that physicians document this discussion in the patient’s medical record and informed consent form.

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