DESCRIPTION
LASIK (laser in situ keratomileusis) is a refractive surgery technique that is intended to correct myopia, hyperopia and/or astigmatism, thereby reducing or eliminating the need for contact lens or glasses for vision correction. The procedure involves the creation of a flap in a portion of the cornea that is peeled back to expose the inner portions of corneal tissue. Next, a process called photoablation, for which an excimer laser is used, removes microscopic amounts of the internal corneal tissue that changes the curvature of the cornea. Upon completion of this process, the flap is returned to its original position.
POLICY
LASIK (laser in situ keratomileusis) for vision correction is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The American Academy of Ophthalmology has issued two ophthalmic technology assessments that found LASIK safe and effective for certain individuals with myopia, hyperopia and/or astigmatism, but cautions that not all individuals are good candidates for this procedure. While this technology has shown promise, long-term studies showing continued effectiveness are lacking.
SOURCES
Alio, J. L., Muftuoglu, O., Ortiz, D., Perez-Santonja, J. J., Artola, A., Ayala, M.J., et al. (2008). Ten-year follow-up of laser in situ keratomileusis for myopia of up to - 10 diopters. American Journal of Ophthalmology, 145 (1), 46-54. (Level 2 Evidence - Independent study)
American Academy of Ophthalmology. (2008). Ophthalmic Technology Assessment. Wavefront-guided LASIK for the correction of primary myopia and astigmatism. Retrieved March 15, 2011 from http://one.aao.org/CE/PracticeGuidelines/Ophthalmic_Content.aspx?cid=10146ab9-76ab-41f9-b8ad-79fca65017ec.
American Academy of Ophthalmology. (2008, January). Summary recommendations for LASIK. Retrieved March 15, 2011 from http://one.aao.org/CE/PracticeGuidelines/ClinicalStatements_Content.aspx?cid=1d8a8b79-4952-4140-9680-50bd53da3f55.
American Academy of Ophthalmology. (2009). Ophthalmic Technology Assessment. LASIK for hyperopia, hyperopic astigmatism, and mixed astigmatism. Retrieved March 15, 2011 from http://one.aao.org/CE/PracticeGuidelines/Ophthalmic_Content.aspx?cid=37352920-9bde-42ed-b6fa-3a43fb93aa92.
American Academy of Ophthalmology. (2011, March). Preferred practice pattern. Refractive errors & refractive surgery. Retrieved March 15, 2011 from http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=e6930284-2c41-48d5-afd2-631dec586286.
American Academy of Optometry. (2009, February). Position paper on refractive surgery. Section on cornea, contact lenses, and refractive technologies. Information for eye care practitioners. Retrieved March 15, 2011 from http://www.aaopt.org/content/docs/imagesPOSITION_PAPERS_CL/AAO%20CCLRT%20Refractive%20Surgery.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Refractive keratoplasty (9.03.02). Retrieved March 15, 2011 from BlueWeb. (0 articles and/or guidelines reviewed)
Chalkjadakis, S. E., Amariotakis, G. A., Parikakis, E. A., & Peponis, V. G. (2010). Axial eye length measurements pre-and post-laser-assisted in situ keratomileusis using the IOL Master: A pilot study. Clinical Ophthalmology, 4, 1267-1269. (Level 3 Evidence - Independent study)
Complete Guide to Medicare Coverage Issues [Computer software]. (2010, April). Refractive keratoplasty - not covered (NCD 80.6, p. 2-43, 2-44). Ingenix.
Messmer, J. J. (2010). LASIK: A primer for family physicians. American Family Physician, 81 (1), 42-47.
National Guideline Clearinghouse. (2007, September). Refractive errors and refractive surgery. Retrieved March 4, 2011 from http://www.guidelines.gov.
National Institute for Health and Clinical Excellence (NICE). (2006, March). Photorefractive (laser) surgery for the correction of refractive errors. Retrieved March 15, 2011 from http://www.nice.org.uk/nicemedia/live/11251/31560/31560.pdf.
Settas G., Settas C., Minos E., Yeung IYL. Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007112. DOI: 10.1002/14651858.CD007112.pub.2.
Tomita, M., Watabe, M., Ito, M., & Tsuru, T. (2011). Conductive keratoplasty for the treatment of presbyopia: Comparative study between post- and non-LASIK eyes. Clinical Ophthalmology, 5, 231-237.
U. S. Food and Drug Administration. (2009, April). Center for Devices and Radiological Health. Medical devices. What is LASIK? The eye and vision errors. Retrieved March 15, 2011 from http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/LASIK/ucm061358.htm.
U. S. Food and Drug Administration. (2011, February). Center for Devices and Radiological Health. Medical devices. FDA-approved lasers for LASIK. Retrieved March 15, 2011 from http://www.fda.gov/cdrh/LASIK/lasers.htm.
ORIGINAL EFFECTIVE DATE: 5/1998
MOST RECENT REVIEW DATE: 4/14/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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