BlueCross and BlueShield of Montana Medical Policy/Codes
Intraocular Lens (IOL)
Chapter: Surgery: Procedures
Current Effective Date: December 27, 2013
Original Effective Date: March 01, 1991
Publish Date: September 27, 2013
Revised Dates: August 25, 2004; January 11, 2006; September 1, 2007; November 7, 2008; September 11, 2013
Description

Intraocular lenses (IOLs) are permanent, lenses that are surgically implanted to replace or supplement the eye’s natural crystalline lens. Replacement of the natural lens of the eye is required to restore vision in cases where the lens is surgically removed. These lenses are made of either polymethylmathacrylate (PMMA) with ultraviolet blocking substance in them or of a flexible silicone material which may be folded during the surgical procedure. This procedure is most commonly used to replace the lens after extraction in cataract surgery. However, it is also performed to treat other conditions such as presbyopia.

Monofocal IOLs:

Monofocal lenses are the most commonly implanted ocular lenses today. They have equal power in all regions of the lens and can provide high-quality distance vision, usually with only a light pair of spectacles. Monofocal lenses are in sharpest focus at only one distance. The United States Food and Drug Administration (FDA) approved the monofocal IOL Tecnis®. This lens is an aspheric (molded and precision polished) wavefront design optic that reduces spherical (increased refraction of light rays). Traditional IOLs are spherical (i.e., the front surface is curved); aspheric lenses are slightly flatter and designed to provide better contrast sensitivity. The Tecnis lens is an aspheric wavefront designed optic that reduces spherical aberration and improves functional vision in varying light conditions (e.g., rain, snow, fog, twilight and nighttime). Monofocal IOLs do not restore accommodation. Monofocal lenses are currently considered the standard of treatment for cataract lens replacement. The accommodative capability of the eye which allows variable focusing is usually lost after cataract surgery.

The traditional monofocal IOL is designed with a fixed optical power primarily providing good distance vision, but does not correct near vision simultaneously. The use of monofocal IOLs as replacement for the cataract lens will usually require the use of corrective contact lenses or eyeglasses after surgery for near vision tasks such as reading.

Multifocal IOLs:

Multifocal IOLs, with more than one focal point, are designed to provide distance and near vision simultaneously and are pseudoaccommodative lenses. These lenses are considered an optional lens for patients in need of cataract surgery. The multifocal IOL structure focuses light rays from both near and far distance and generally does not restore good intermediate vision. Presbyopia-correcting (near vision correcting) IOLs, include, but are not limited to, accommodating and multifocal IOLs, these lenses are designed to restore a fuller range of near, intermediate and far distance vision as compared to monofocal IOLs. 

The AcrySof ReStor IOL is one of the multifocal IOLs indicated for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire to have near, intermediate and distance vision without the need for additional contacts or glasses. This type of lens is intended to be placed in the capsular bag, is foldable and is available in a multi-piece (MA60D3) or single-piece design (SA60D3). 

Accommodating IOLs:

Visual accommodation is the ability of the eye to change focus and provide a clear image over a range of distances. During accommodation, the ciliary body applies pressure to the vitreous as it contracts. The pressure, in combination with the an increasing laxity of the zonules, (a series of fibers connecting the ciliary body and lens of the eye) that causes the lens to move forward, increasing its relative optical power, and allowing the eye to focus for close work. After extraction of the cataractous lens contents, the lens capsule will usually retain a certain level of accommodative capability. 

Accommodating IOLs are designed to provide good distance, intermediate and near vision. It is the only type of intraocular lens believed to allow patients to see by providing a continuous range of vision and may be considered an alternative to multifocal lenses. Information from the manufacturer suggests this lens reduces the need for postoperative corrective lenses. The accommodating IOL interacts with the ciliary muscles and zonules. The device has hinges at both ends to facilitate the forward and backward movement allowing variable focus capability.

Crystalens is the first FDA-approved accommodating posterior chamber intraocular lens. This lens is indicated for primary implantation in the capsular bag of the eye for visual correction in adult patients in whom a cataractous lens has been removed and is intended to provide near, intermediate and distance vision without the use of spectacles. The lens is also being used in refractive surgical procedures to correct vision for patients with myopia, hyperopia or presbyopia.

Presbyopia is the aging change of the lens that begins in patients during their early 40’s and results in a need for reading glasses. It affects 100% of the population during the normal human life span. The process results in a farsightedness as a result of decreased stretching involving the lens of the eye. The lens becomes stiff and is unable to change shape. Various forms of treatment may be performed in hopes of restoring the natural focusing ability to the lens and include bifocals, trifocals, monovision contact lenses, bifocal contact lenses and modified monovision. Corrective surgery for presbyopia includes laser-assisted in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK) and a clear lens extraction (CLE) combined with an intraocular lens replacement, all of which are refractive surgeries to correct vision defects.

Toric Lens

A toric IOL is a “premium” IOL that has different optical power and focal length in two orientations perpendicular to each other; it is used to correct astigmatism. The same type of correction can also be done with eyeglasses or contact lenses.

Ultraviolet (UV) Absorbing IOLs

The natural crystalline lens in the eye absorbs UV radiation between 300 and 400 nm and thereby protects the retina from a significant source of photochemical damage. This protection is lost when the lens is removed by cataract surgery, but can be restored by the implantation of an intraocular lens (IOL) that has UV-absorbing chromophores included in the substrate. Not all UV-absorbing IOLs have the same ability and are not all equally effective. However, there are usually positive outcomes for patients with a UV-absorbing IOL. This type of lens may restore normal spectral sensitivity,  

Spectrophotometric data show that the various, commercially available, UV-absorbing IOLs are not equally effective in absorbing UV radiation; thus, a standard, quantitative metric for comparing their performance is proposed. Cytotoxicity and biocompatibility studies have failed to demonstrate that UV-absorbing IOLs are unsafe, even when damaged by Nd: YAG lasers used for photodiscission posterior capsulotomy. There are positive consequences for the pseudophakic patient with a UV-absorbing IOL, in that it may restore normal spectral sensitivity, reduce erythropsia and incident of cystoid macular edema, and will help to stabilize the blood-vitreous barrier.

NOTE: Refer to the table below for a partial listing that includes some of the FDA’s approved intraocular lenses.

FDA Approved Intraocular Lenses

Monofocal

Multifocal

Accommodating

Ultraviolet Absorbing

Advanced Medical Optics [AMO], Santa Anna, CA.   Includes:

Tecnis® 

  • Z9000
  • Z9001
  • Z9002
  • ZA9003

(Advanced Medical Optics [AMO], Santa Ana, CA). Includes:

  • Array® Model SA40
  • ReZoom™
  • Tecnis ZM900
  • ZMAOO

Eyeonics Inc., Aliso Viejo, CA) Includes: 

  • Crystalens

Alcon, Inc., (Fort Worth, TX).Includes:

  • AcrySof Natural blue-light filtering IOL

 

(Bausch & Lomb, Rochester, NY). Includes:

SofPort AO IOL

Sofport L161AO

Alcon, Inc., Fort Worth, TX. Includes:

  • AcrySof ReSTOR
  • Acrysof Restor SA60D3
  • Acrysof Natural ReSTOR SN60D3
  • AcrySof ReSTOR Aspheric IOL model SN6AD1
  • AcrySof ReSTOR Aspheric IOL model SN6AD3

Staar Toric IOL (Star Surgical, Monrovia, CA). Includes:

  • AcrySof Aspheric Toric IOL SN6AT3
  • SN6AT5,
  • AcrySof Toric® Model SA60T
  • STAAR Elastic Toric Lens Model AA4203TL

(Bausch & Lomb, Rochester, NY), Includes:

  • SofPort AO IOL with Violet Shield Technology

(Alcon Surgical, Fort Worth, Texas). Includes: 

  • Hoya PY-60AD
  • Tecnis AMO Aspheric IOL ZCBOO
  • Acrysof IQ SN60WS

 

 

Alcon, Inc., Fort Worth, TX. Includes:

  • AcrySof Toric IOL
  • ACRYSOF Toric Models SA60T3
  • AcrySof Toric®
  • SA60T4,
  • SA60T5
  • AcrySof Toric® Model SA60T,
  • Acrysof IQ Toric
  • Model SN6AQTT

 

Rayner Surgical Inc., Los Angeles, CA) Includes:

  • C-flex IOL model 570C

Implantable Miniature Telescope (IMT)

In July, 2010 the FDA approved the IMT prosthesis (Vision-Care Ophthalmic Technologies, Saratoga, Ca) to improve vision in patients 75 years and older with end-stage AMD (age-related macular degeneration). (51) The device is a small telescope that when surgically implanted replaces the natural lens. The IMT is designed to magnify and project images onto a healthy portion of the retina to allow patients to recognize and identify objects that they could not otherwise see. The device enlarges the retinal image in the patient’s central visual field between 2- and 3-fold, reducing the impact of the central scotoma (spot in the visual field in which vision is absent or deficient). The IMT is available in two models: one that provides 2.2X magnification and another 2.7X magnification (the 3.0X model). Since it reduces peripheral vision, it is intended to be implanted in only one eye; the non-implanted eye provides peripheral vision for spatial orientation and mobility.

Implantation can lead to extensive loss of corneal endothelial cells, resulting in the need for device removal and corneal transplant. To ensure that the risks of IMT implantation are consistently communicated to patients, the FDA and the manufacturer created detailed labeling that includes an Acceptance of Risk and Informed Decision Agreement, which patients must complete prior to IMT implantation. Patients must also have a successful trial with an external telescope before implantation.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coverage

Monofocal (both aspherical and spherical) intraocular lenses (IOLs) may be considered medically necessary when used to replace the natural crystalline lens of the eye when the natural lens becomes cataractous.

Toric, multifocal and/or accommodating intraocular lenses are considered not medically necessary.

The Implantable Miniature Telescope (IMT) may be considered medically necessary for monocular implantation when the following criteria are met:

1.      Patient is 75 years or older with stable severe to profound vision impairment caused by blind spots (bilateral central scotoma) associated with untreatable end-stage AMD (age-related macular degeneration); AND

2.      Patient has evidence of a visually significant cataract (grade 2 or higher); AND

3.      Visual acuity is poorer than 20/160, but not worse than 20/800 in both eyes; AND

4.      Patient has undergone training with an external telescope prior to implantation and has been determined to have adequate improvement in vision, and adequate peripheral vision in the eye that would not be implanted; AND

5.      Patient can achieve at least a 5-letter improvement on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart in the affected eye using an external telescope.

NOTE:  Patient should undergo postoperative training with a low vision specialist after IMT implantation.

NOTE:  Patient should complete the Acceptance of Risk and Informed Decision Agreement prior to IMT implantation. (Because the IMT is a large device, implantation can lead to extensive loss of corneal endothelial cells. Significant losses in corneal endothelial cells may lead to corneal edema, corneal decompensation, and the need for corneal transplant. To ensure that the risks of IMT implantation are consistently communicated to patients, the FDA and the manufacturer created detailed labeling that includes an Acceptance of Risk and Informed Decision Agreement.)

Rationale

The use of toric, multifocal, accommodating and ultraviolet absorbing intraocular lenses as alternatives to monofocal IOLs is considered to be for convenience, (i.e., to eliminate the need for eye-glasses or contact lenses). 

Available peer reviewed literature through August 2011 for other types of IOLs (i.e., toric, multifocal, accommodating, ultraviolet absorbing etc.) as an alternative to monofocal IOLs for replacement of cataract lenses has failed to establish an increase in benefits in terms of safety and long-term benefit over the monofocal IOL and conventional eyewear.  

2012 Update

FDA approval of the Implantable Miniature Telescope (IMT) was based on 1- and 2-year safety and efficacy outcomes in 206 implanted eyes; 1- and 2-year safety and efficacy outcomes from the 28-center pivotal trial have been reported. (49, 50). Patients were at least 55 years of age and had bilateral, stable, central visual acuity loss caused by untreatable end-stage AMD (age-related macular degeneration), with evidence of cataract in the study eye. To be eligible for enrollment, patients had to achieve at least a 5-letter improvement on the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart with an external telescope, and patients were informed that they would experience an overall reduction in field of view because of field restriction in the implanted eye. The other (fellow) eye, which also had to have central visual acuity loss caused by untreatable end-stage AMD, served as a control. Patient exclusion criteria included active choroidal neovascularization (CNV), treatment of CNV in the preceding 6 months, history of intraocular or corneal surgery in the study eye, endothelial cell density < 1600 cells/mm2, and narrow angle (less than Schaffer grade 2). A total of 217 patients (mean age 76 years) with AMD and moderate to profound bilateral central visual acuity loss (mean 20/316; range, 20/80 -20/800) were enrolled in the study. Eleven eyes (5%) did not receive the device because of an aborted procedure, resulting in 206 implanted eyes. Study patients participated in 6 visual rehabilitation visits after surgery. Patients were examined after surgery on days 1 and 7 and at 1, 3, 6, 9, 12, 18 and 24 months. One hundred and ninety-two patients (93%) were available for 12-month follow-up. Seven patients were discontinued due to death, 3 were discontinued because of explant, and 4 patients were lost to follow-up. At 12 months, mean best-corrected distance visual acuity (BCDVA) had improved by 3.5 lines versus 0.8 lines in the untreated (fellow) eye. Best-corrected near visual acuity (BCNVA) had improved by 3.2 lines versus 1.8 lines in the other eye. At 1 year, 67% of 192 implanted eyes achieved a 3-line or more improvement in BCDVA versus 13% of the patients’ other eyes. Ninety percent of implanted patients achieved at least a 2-line improvement in BCDVA or BCNVA (the primary efficacy outcome). At 1 year, loss of > 2 lines was observed in 2.1% of implanted eyes and 8.9% of fellow eyes. Eyes implanted with the 3X device had greater improvement in BCDVA than those implanted with the 2.2X device. Mean quality of life scores from the National Eye Institute 25-item Visual Function Questionnaire improved by 6.1 points from baseline with an improvement of > 7 points from baseline on 7 of 8 relevant subscales (5-point improvement considered clinically significant). Ocular complications and adverse events included an increase in intraocular pressure within 7 days (28%) and inflammatory deposits on the device (21%). Endothelial cell density was reduced by 20% at 3 months and 25% at 1 year.

In the 1-year study, 10 eyes had unresolved corneal edema, with 5 resulting in device removal and corneal transplants. At 2-year follow-up, data from 174 patients (84.5% of 206) were analyzed, with an additional 8 patients (3.9%) who had the device removed. (50) This was out of a reported total of 188 patients who were available for the 2-year assessment; 10 patients (4.9%) had died and 14 (6.8%) were lost to follow-up. Mean best-corrected visual acuity (BCVA) improved 3.6 lines with the 3X model and 2.8 lines with the 2.2X model. Out of 173 telescope implanted eyes, 103 (59.5%) gained > 3 lines of BCVA compared with 18 (10.3%) of 174 fellow control eyes. Loss of > 3 lines occurred in 1 of 173 (0.6%) telescope-implanted eyes compared with 13 of 174 (7.5%) fellow eyes. For 6 of 8 study eyes that had the telescope removed and received an intraocular lens, the mean BCVA line change was -0.2 lines (BCVA not reported for the other 2 eyes). The most common complications were inflammatory deposits (25%) and pigment deposits (11%) on the device, followed by guttae (8%), posterior synechiae (7%), iris transillumination defects (5%), and iritis (6%). The mean endothelial cell density stabilized after the first year of the study with a 2.4% mean cell loss between 1 and 2 years. These results suggest that endothelial cell loss is related to surgical trauma, rather than the device itself. The calculated 5-year risk for unresolved corneal edema, corneal decompensation, and corneal transplant are 9.2 percent, 6.8 percent and 4.1 percent, respectively.

The FDA-approved indications (51) are for use of the IMT in a subset of patients who were included in the pivotal trials, specifically:

  • Patients who are 75 years and older with stable severe to profound vision impairment caused by blind spots (bilateral central scotoma) associated with end-stage AMD. Patients should also have evidence of a visually significant cataract.
  • Patients agree to undergo training with an external telescope prior to implantation to determine whether adequate improvement in vision can be obtained and to verify if the patient has adequate peripheral vision in the eye that would not be implanted.
  • Patients must also agree to undergo postoperative training with a low vision specialist.
  • Because the IMT is a large device, implantation can lead to extensive loss of corneal endothelial cells. Significant losses in corneal endothelial cells may lead to corneal edema, corneal decompensation, and the need for corneal transplant. To ensure that the risks of IMT implantation are consistently communicated to patients, the FDA and the manufacturer created detailed labeling that includes an Acceptance of Risk and Informed Decision Agreement, which patients must complete prior to IMT implantation.

As a condition of approval, the manufacturer was required to conduct two additional studies. In one study, VisionCare must continue follow-up on approximately 70 subjects from its long-term follow-up cohort for an additional two years. Another study of 770 newly enrolled subjects, 75 years of age or older, will include an evaluation of the endothelial cell density and related adverse events for five years after implantation.

In 2011, Brown and colleagues presented results from a phase III clinical trial evaluating 3X model IMT implantation procedure in 76 patients with end-stage AMD and severe vision loss whose disease is refractory to medications. Following the 2-year trial, authors reported, “vision improved from 20/326 to 20/141 (mean values) in 76 patients who received the 3X model IMT. Most patients could once again see people's faces rather than just blurry outlines, and could get around the market or their backyard on their own. Overall, these IMT patients' lives improved substantially and at a reasonable cost. Quality of life was measured using a system called human value gain, with standards based on the actual experiences of people with vision loss.” (52)

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

ICD-9 Codes

11.71, 11.72, 11.73, 11.79, 11.76, 13.11, 13.19, 13.2, 13.41, 13.42, 13.43, 13.51, 13.59, 13.69, 13.70, 13.71, 13.72, 13.8, 13.9, 250.50, 250.51, 250.52, 250.53, 271.1, 275.40, 360.21,  360.24, 364.10, 365.9, 366.00, 366.01, 366.02, 366.03, 366.04, 366.09, 366.10, 366.12, 366.13, 366.14, 366.15, 366.16, 366.17, 366.18, 366.19, 366.20, 366.21, 366.22, 366.23, 366.30, 366.31, 366.32, 366.33, 366.34, 366.9, 366.13, 366.34, 366.41, 366.42, 366.43, 366.44, 366.45, 366.46, 366.50, 366.51, 366.52, 366.53, 366.8, 366.9, 379.31, 743.30, 743.31,743.32, 743.33, 743.34, 743.35, 743.39  

ICD-10 Codes
E09.36 - E13.36  E10.11 - E10.65, E11.311- E11.65, E74.20 - E74.29  E83.50 - E83.50,  H25.011 - H25.019  H20.10 - H20.13, H25.10,  H25.031 - H25.039, H25.041 - H25.049, H25.091 - H25.099, H25.20 - H25.23, H25.031 - H25.039   H25.811 - H25.89    H25.9, H26.001 - H26.009, H26.011 - H26.019, H26.031 - H26.039, H26.041 - H26.049, H26.051 - H26.059, H26.061 - H26.09, H26.30 - H26.33,   H26.101 - H26.109, H26.111 - H26.119, H26.121 - H26.129, H26.131 - H26.139, H26.2, H26.4, H26.8, H26.211 - H26.219,  H28 H26.221 - H26.229, H26.231 - H26.239, H26.411 - H26.419, H26.491 - H26.499, H26.8, H26.9, H27.00 - H27.03,   H40.9, H44.20 - H44.23,  H44.311 - H44.319, Q12.0 - Q12.0, Q12.3 - Q12.3, Q12.9 - Q12.9
Procedural Codes: 0308T, L8609, L8610, Q1004, Q1005, S0596, V2787, V2788, V2630, V2631, V2632
References
  1. Javitt, J.C., Steinert, R.F., et al.  Cataract extraction with multifocal intraocular lens implantation: a multinational clinical trial evaluating clinical, functional, and quality-of-life outcomes.  Ophthalmology (2000 November) 107(11):2040-8.
  2. Packer, M., Fine, I.H., et al.  Refractive lens exchange with the array multifocal intraocular lens.  Journal of Cataract Refractive Surgery (2001 March) 28(3):421-4.
  3. Cummings, J.S., Slade, S.G., et al.  Clinical evaluation of the model AT-45 silicone accommodating intraocular lens:  results of feasibility and the initial phase of a Food and Drug Administration clinical trial.  Ophthalmology (2001 November) 108(11):2005-9.
  4. Koreta, J.F., Cook, C.A., et al.  Aging of the human lens: changes in lens shape upon accommodation and with accommodative loss.  Journal of the Optical Society of America A; Optics, Image, Science and Vision (2002 January) 19(1):144-51.
  5. Kuchle, M., Nguyen, N.X., et al.  Implantation of a new accommodative posterior chamber intraocular lens.  Journal of Refractive Surgery (2002 May-June) 18(3):208-16.
  6. Auffarth, G.U., Martin, M., et al.  Validity of anterior chamber depth measurements for the evaluation of accommodation after implantation of an accommodative Humanoptics 1CU intraocular lens.  Ophthalmologe (2002 November) 99(11):815-9.
  7. Kuchle, M., Nguyen, N.X., et al.  Two years experience with the new accommodative 1 CU intraocular lens.  Ophthalmologe (2002 November) 99(11):820-4.
  8. Dick, H.B., Gross, S., et al.  Refractive lens exchange with an array multifocal intraocular lens.  Journal of Refractive Surgery (2002 September) 18(5):509-18.
  9. FDA – New Device Approval.  CrystaLens™ Model AT-45 Accommodating IOL – P030002. www.fda.gov .
  10. Langenbucher, A., Huber, S., et al.  Cardinal points and image-object magnification with an accommodative lens implant.  Ophthalmic and Physiological Optics (2003 January) 23(1):61-70.
  11. FDA – Summary minutes of the ophthalmic devices panel meeting.  Regulatory and Quality Systems (2003 23 May). http://www.fda.gov .
  12. Leyland, M., and E. Zinicola.  Multifocal versus monofocal intraocular lenses in cataract surgery: a systemic review.  Ophthalmology (2003 September) 110(9):1789-98.
  13. Center for Devices and Radiologic Health. (2003, November 14) <http://www.fda.gov>.
  14. Lehrer, I.E., and M.R. Tetz.  Refractive lensectomy and accommodating lens implantation in a case of hyperopia.  Journal of Cataract and Refractive Surgery (2003 December) 29(12):2430-4.
  15. Langenbucher, A., Seita, B., et al.  Theoretical and measured pseudophakic accommodation after implantation of a new accommodative posterior chamber intraocular lens.  Archives of Ophthalmology (2003 December) 121(12):1722-7.
  16. Eyeonics, Inc.  Evidence-based efficacy of Crystalens™. (2003) http://www.candcvision.com/ .
  17. Mayoclinic.com.  Presbyopia: a normal result of aging. (2003 May 6).
  18. Eyeonics, Inc.  The first and only FDA-approved accommodating intraocular lens (2003) http://www.mayoclinic.com .   
  19. FDA - Crystalens™ Model AT-45 Accommodating IOL P030002. 2004.  Federal Drug Administration – Center for Devices and Radiological Health (CDRH) Consumer Information. (2004 4 January) <http://www.fda.gov>.
  20. Kuchle, N., Seitz, B.  Comparison of 6-month results of implantation of the 1CU accommodative intraocular lens with conventional intraocular lenses.  Ophthalmology (2004 February) 111(2):318-24.
  21. Marchini, G., Pedrotti, E., et al.  Ultrasound biomicroscopic changes during accommodation in eyes with accommodating intraocular lenses:  pilot study and hypothesis for the mechanism of accommodation.  Journal of Cataract and Refractive Surgery (2004 December) 30(12): 2476-82.
  22. Doane, J.F.  Accommodating intraocular lenses.  Current Opinion in Ophthalmology (2004 February) 15(1):16-21.
  23. Sen, J.C., Sarikkola, A.U., et al.  Quality of vision after AMO Array multifocal intraocular lens implantation.  Journal of Cataract and Refractive Surgery (2004 December) 30(12):2483-93.
  24. Emedicine.com – Bashour, Mounir.  Myopia, Clear Lens Extraction. (2004 May 27) http://www.emedicine.com .
  25. Nijkamp, M.D., Dolders, M.G., et al.  Effectiveness of multifocal intraocular lens to correct presbyopia after cataract surgery: a randomized controlled trial.  Ophthalmology (2004 October) 111(10):1832-9.
  26. Stachs, O., Schneider, H., et al.  Potentially accommodating intraocular lenses—an in vitro and in vivo study using three-dimensional high-frequency ultrasound.  Journal of Refractive Surgery (2005 January) 30(12):37-45.
  27. Ophthalmic Hyperguide.  Section:  Refractive Surgery.  Erb, Melanie H.  Accommodating Intraocular Lenses.  The Crystalens™. The 1 CU IOL. (Accessed January 20, 2005). http://www.ophthalmic.hyperguides.com .
  28. Marshall, J., Cionni, R.J., et al.  Clinical results of the blue-light filtering AcrySof Natural foldable acrylic intraocular lens.  Journal of Cataract Refractive Surgery (2005) 31 (12): 2319-2323.
  29. Heatley, C.J., Spalton, D.J., et al. Fellow eye comparison between the 1CU accommodative intraocular lens and the Acrysof MA30 monofocal intraocular lens.  American Journal of Ophthalmology (2005 August) 140(2):207-13.         
  30. Franchini, A.  Compararative assessment of contrast with spherical and aspherical intraocular lenses.  Journal of Refractive Surgery (2006 August) 32(8):1307-19.
  31. Werner, L., Olson, R.J., et al.  New technology IOL optics.  Ophthalmology Clinics of North America (2006 December) 19(4):469-83.
  32. Macsai, M.S., Padnick-Silver, L., et al.  Visual outcomes after accommodating intraocular lens implantation.  Journal of Cataract Refractive Surgery (2006 April) 32(4):628-33.
  33. Kasper, T., Buhren, J., et al.  Visual performance of aspherical and spherical intraocular lenses:  Intraindividual comparison of visual acuity, contrast sensitivity, and higher-order aberrations.  Cataract Refractive Surgery (2006 December) 32(12):2022-9.
  34. Cumming, J.S., Colvard, D.M., et al.  Clinical evaluation of the Crystalens AT-45 accommodating intraocular lens.  Results of the U.S. Food and Drug Administration clinical trial.  Journal of Cataract and Refractive Surgery (2004 December) 30(12):2476-82.
  35. Cataract in the Adult eye.  Preferred practice pattern.  ©2006 American Academy of Ophthalmology. www.aao.org . (Accessed 2008 June 19).
  36. Marcos, S., Rosales, P., et al.  Change in corneal aberrations after cataract surgery with 2 types of aspherical intraocular lenses.  Journal of Cataract Surgery (2007 February) 32(2):217-26.
  37. Kurz, S., Krummenauer, F., et al.  Contrast sensitivity after implantation of a spherical versus an aspherical intraocular lens in biaxial microincision cataract surgery.  Cataract Refractive Surgery (2007 March) 33(3):393-400.
  38. AcrySof IQ.  Product Information.  Alcon Laboratories Inc., www.medcompare.com .  (Accessed on 2008 June 19).
  39. Leyland, M., Zinicola, E., et al.  Multifocal versus monofocal intraocular lenses in cataract surgery: a systemic review.  The Cochrane Database of Systemic Reviews (2007) Issue 2.  
  40. Nationale Institute for Health and Clinical Excellence (NICE).  IPG 209.  Implantation of accommodating intraocular lenses during cataract surgery: Guidance (2007 February 28) http//:guidance.nice.org .
  41. Bausch and Lomb.  SoftPort® Advanced Optics Aspheric Lens System.  ©2008.  Available at www.bausch.com . (Accessed 2008 June 19).
  42. Findl, O., and C. Leydolt.  Meta-analysis of accommodating intraocular lenses.  Journal of Cataract and Refractive Surgery (2007 March) 33(3):522-7.
  43. Denoyer, A., Hakfibm J., et al.  Visual function after cataract surgery in patients with an aspherical lens with spherical aberration.  French Ophthalmology (2007 June) 30(6):578-84.
  44. Tecnis™ foldable lens. Advance Medical Optics.  Santa Ana, California:  http://www.amo-inc.com .  (Accessed on 2008 June 19).
  45. Palmer, M. A., Gomez, F. P., et al.  Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial.  Journal of Refractive Surgery (2008 March) 24(3): 257-64.
  46. Cleary, G., Spalton, D.J., et al.  Pilot study of new focus-shift-accommodating intraocular lens.
  47. Journal of Cataract Surgery (2010 May) 36(5): 762-70.
  48. Cleary, G., Spalton, D.J., et al.  Anterior chamber depth measurements in eyes with an accommodating intraocular lens: agreement between partial coherence interferometry and optical coherence tomography (2010 May) 36(5):790-8
  49. Hudson HL, Lane SS, Heier JS et al; IMT-002 Study Group. Implantable miniature telescope for the treatment of visual acuity loss resulting from end-stage age-related macular degeneration: 1-year results. Ophthalmology 2006; 113(11):1987-2001.
  50. Hudson HL, Stulting RD, Heier JS et al; IMT002 Study Group. Implantable telescope for end-stageage-related macular degeneration: long-term visual acuity and safety outcomes. Am J Ophthalmol 2008; 146(5):664-73.
  51. Summary of safety and effectiveness data [P050034: implantable miniature telescope]. Silver Spring (MD): U.S. Food and Drug Administration (FDA); 48 p. Also available: http://www.fda.gov .
  52. Implantable Miniature Telescope Offers Some Age-Related Macular Degeneration Patients a New Lease on Life. Academy News Release. American Academy of Ophthalmology. San Francisco, CA August 25, 2011. Available at www.aao.org (Accessed October 1, 2012).
  53. Implantable Miniature Telescope Prosthesis. TEC Medical Policy Clearinghouse News. Chicago, Illinois May 13, 2011.
History
December 2010  Removed "the maximum allowance for lenses is $100" and "the maximum allowance for frames is $200". Clarified processing under vision benefit when member has a vision benefit. Also clarified benefits are only payable within six months of cataract surgery. 
September 2013 Policy formatting and language revised.  Title changed from "Lenses and Frames after Cataract Surgery" to "Intraocular Lens (IOL)".  Added coverage criteria for intraocular lenses and the implantable miniature telescope.
BCBSMT Home
®Registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. ®LIVE SMART. LIVE HEALTHY. is a registered mark of BCBSMT, an independent licensee of the Blue Cross and Blue Shield Association, serving the residents and businesses of Montana.
CPT codes, descriptions and material only are copyrighted by the American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. CPT only © American Medical Association.
Intraocular Lens (IOL)