Specialist reviews evidence in support of goniotomy reimbursement
Click Here to Manage Email Alerts
WAILEA, Hawaii — There is plenty of evidence in the literature to support reimbursement for goniotomy, according to a speaker at Hawaiian Eye 2024.
The drastic cutbacks proposed by Medicare Administrative Contractors on MIGS — eventually withdrawn following the unanimous reaction of the ophthalmology community and patient advocacy groups — cited a paucity of literature on the role of goniotomy in adult glaucoma. But that assumption is far from the truth.
“There are well over 100 publications just on goniotomy alone. If we include Kahook Dual Blade and Trabectome, it goes to well over 200,” Leonard K. Seibold, MD, said.
One of the first studies was from Seibold’s group at the University of Colorado, retrospectively looking at almost 200 eyes of patients with primary open-angle glaucoma treated with stand-alone or combined Kahook Dual Blade (New World Medical) and cataract surgery. A 70% success rate was achieved in terms of a 20% reduction in IOP or fewer medications. Soon after, a prospective study conducted in seven clinical sites showed 100% success of the combined procedure in lowering IOL in patients with high pressure and a drop of at least one medication in 85% of patients with low pressure at baseline.
Among other papers, Seibold mentioned a multicenter trial in patients with severe glaucoma and one in angle-closure glaucoma, both with a high rate of success. Individual surgeons now have long-term experience, with data up to 5 years, and equivalence to another procedure was shown in a comparative study with iStent (Glaukos).
“So, there’s evidence to support goniotomy reimbursement,” Seibold said. “There’s been over 100, perhaps 200, [publications] depending on how you define goniotomy. And this includes level 1 evidence, randomized control trials. ... We have long-term efficacy out to 5 years. It is effective in other types of glaucoma, across disease severity, so not even just mild to moderate, but we have data on severe and advanced disease, and it’s effective whether it’s stand-alone or in combination with cataract surgery.”
References:
• Dorairaj SK, et al. Adv Ther. 2018;doi:10.1007/s12325-018-0755-4.
• ElMallah MK, et al. Adv Ther. 2019;doi:10.1007/s12325-019-01025-1.
• Salinas L, et al. J Glaucoma. 2018;doi:10.1097/IJG.0000000000001019.
• Sieck EG, et al. Ophthalmol Glaucoma. 2018;doi:10.1016/j.ogla.2018.06.006.
Collapse
Seibold LK. The evidence supporting goniotomy reimbursement. Presented at: Hawaiian Eye 2024; Jan. 13-19, 2024; Wailea, Hawaii.
Click Here to Manage Email Alerts