A Proposed Medicare Policy Would Tie Our Hands in the Fight Against Glaucoma

Chuck Williamson Jr

Glaucoma Today

As an ophthalmic practice administrator, I see every day what it takes to deliver the interventional glaucoma care necessary to preserve sight. It is not a simple cookie-cutter approach. A proposed Medicare policy would make it harder still, replacing physician judgment with a rigid, one-size-fits-all sequence that ignores how differently this disease behaves from patient to patient. What the LCDs Would Restrict Five Medicare Administrative Contractors (MACs) have similar Local Coverage Determinations (LCDs) in the proposal stage and available for comment through July 4. At issue is coverage of the intracameral travoprost implant (iDose TR, Glaukos). If the LCDs become finalized, Medicare would not cover the procedural pharmaceutical unless patients first fail both a trial of selective laser trabeculoplasty (SLT) and two topical medications. The LCD would also bar physicians from placing the implant during a MIGS procedure, whether that MIGS procedure is performed alone or in combination with cataract surgery. If finalized, the LCDs would take decision-making out of the hands of physicians and replace individualized judgment with a fixed treatment sequence applied to every patient. One Treatment Pathway Does Not Fit Every Patient Glaucoma is a heterogeneous disease. It presents and progresses differently in each patient, and physicians need a full range of options to treat each case individually.

Ocular Syphilis: the Great Imitator

Learn some of the different ways this increasingly common disease can present and proven ways to manage it.

Connor Kortright, OD

Modern Optometry

Ocular syphilis, often dubbed the great imitator because it can present as several other conditions, continues to challenge clinicians with its diverse and often misleading presentations. With incidence rates rising annually,1 optometrists are increasingly likely to encounter this elusive disease in practice. In my home state of New York, new cases of syphilis have steadily increased to reach more than 10,000 in 2022, after essentially no new cases were reported in 2000.2 This article presents five cases that show the diverse presentations of ocular syphilis and just how difficult it can be to detect this tricky, and increasingly common, disease. CASE NO. 1: A MISDIAGNOSED KERATITIS A 33-year-old Black man presented with bilateral eye pain persisting for 1 month.3 It was initially treated as conjunctivitis by a previous provider. He had a pustular facial rash, and his vision was reduced to 20/70 OD and 20/60 OS. Examination revealed bilateral peripheral ulcerative keratitis. Workup later confirmed syphilis infection with HIV coinfection. The patient was initially treated with steroids but was transitioned to 4 million units of intravenous (IV) penicillin every 4 hours for 14 days after confirmation of syphilis infection, leading to remarkable visual recovery (20/20 OU). CASE NO.

Bayer Acquires Perfuse in $2.45 Billion Deal

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Bayer expands ophthalmology pipeline with acquisiton of Perfuse Therapeutics; Viridian announces new phase 3 data for its investigational subcutaneous injection for chronic thyroid eye disease; and Steven Dell, MD discusses the impact of declining reimbursement could on ophthalmic practices. Learn more about your ad choices. Visit megaphone.fm/adchoices