Weigh whether surgical intervention for vitreous opacities is warranted

As discussed in last issue’s Lindstrom’s Perspective, some ocular media opacities warrant surgical intervention and some do not.

To me an opacity in the vitreous is no different from an opacity in the cornea, natural lens or posterior capsule. If the opacity is visually significant and causing a meaningful negative impact on quality of vision and quality of life, interfering with a patient’s ability to read, drive, work or enjoy their preferred recreational activities, treatment is a consideration.

The ICD-10-CM code for vitreous opacities is H43.3. The treatments for vitreous opacities today include YAG laser vitreolysis using CPT code 67031 or vitrectomy, mechanical, pars plana using CPT code 67036. Similar to an opacity of the cornea, natural lens or posterior capsule, it is the surgeon’s responsibility to confirm that a meaningful visual disability exists, that the cause of the visual disability is vitreous opacities and that a YAG laser vitreolysis or pars plana vitrectomy is the appropriate treatment. As in any surgery, a discussion of risks, benefits and alternatives is necessary, as well as patient consent for surgery. In addition, in many cases, third-party insurance will not pay for the treatment of vitreous opacities. Therefore, insurance coverage preauthorization or a Medicare Advance Beneficiary Notice of Non-coverage is appropriate.

As discussed before, if we look carefully at any patient’s cornea, natural lens or intact posterior capsule, there are always some opacities. Most are not visually significant and do not require surgical intervention. The same is true with vitreous opacities. In one U.S. survey of 603 patients, 76% said they had vitreous opacities that were visible to them, and 33% said they caused some visual disability. After discussing the cause of their symptoms, most of these patients will be reassured and desire no further treatment. However, for those with significant visual dysfunction from vitreous opacities, offering treatment with surgical intervention is in my opinion a discussion no different from the one we use for corneal opacity, cataract or posterior capsule opacity.

It is time to stop putting vitreous floaters in our charts as a diagnosis and replace it with the appropriate diagnosis: vitreous opacities. Then we can deal with the patient’s problem in a similar fashion to any other opacity in the ocular media.

Reference:

• Webb BF, et al. Int J Ophthalmol. 2013;doi:10.3980/j.issn.2222-3959.2013.03.27.

For more information:

Richard L. Lindstrom, MD, can be reached at rllindstrom@mneye.com.

Click here to read the Cover Story, “Vitrectomy offers relief for vitreous opacities.”

Published by:

Sources/Disclosures

Collapse

Source:

Expert Submission

Disclosures:
Lindstrom reports having disclosures for Alcon, Bausch + Lomb, Johnson & Johnson Vision, Minnesota Eye Consultants, Unifeye Vision Partners and Zeiss.

Read more about

This post was originally published on this site