BlueCross BlueShield of Tennessee Medical Policy Manual

LASIK (laser in situ keratomileusis)

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

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The American Academy of Ophthalmology issued a Preferred Practice Pattern® position statement in 2013 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.

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. (2013, July) Preferred Practice Pattern® Refractive errors & refractive surgery. Retrieved June 26, 2015 from http://www.aao.org/preferred-practice-pattern/refractive-errors--surgery-ppp-2013.

American Academy of Ophthalmology. (2013, June). Summary recommendations for keratorefractive laser surgery. Retrieved February 28, 2017 from American Academy of Ophthalmology.

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%.

Chalkiadakis, 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)

Messmer, J. J. (2010). LASIK: A primer for family physicians. American Family Physician, 81 (1), 42-47. (Level 5 evidence - Independent study)

National Institute for Health and Clinical Excellence. (2006, March). Photorefractive (laser) surgery for the correction of refractive errors. Retrieved June 26, 2015 from http://www.nice.org.

Sasse, A. C., Shajari, M., & Kohnen, T. (2016). Influence of blurred vision, accommodation, and target laser settings on eye movements during LASIK. Journal of Cataract and Refractive Surgery, 42 (10), 1424-1430. Abstract retrieved February 28, 2017 from PubMed database.

Settas G., Settas C., Minos E., & Yeung IYL. (2009). Photorefractive keratectomy (PRK) versus laser assisted in situ keratomileusis (LASIK) for hyperopia correction. Cochrane Database of Systematic Reviews, 2009, Issue 2.

Shen, Z., Shi, K., Yu, Y., Yu, X., Lin, Y., & Yao, K. (2016). Small incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia: A systematic review and meta-analysis. PloS One, 11 (7), e0158176. Abstract retrieved February 28, 2017 from PubMed database.

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. (Level 4 evidence – Independent study)

U. S. Department of Health & Human Services. Center for Medicare & Medicaid Services (May 1997) National Coverage Determination (NCD) for refractive keratoplasty (80.7). Retrieved June 26, 2015 from: http://www.cms.gov/medicare-coverage-database.

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.

Zhang, Y., Shen, Q., Jia, Y., Zhou, D., & Zhou, J. (2016). Clinical outcomes of SMILE and FS-LASIK used to treat myopia: A meta-analysis. Journal of Refractory Surgery, 32 (4), 256-265. Abstract retrieved February 28, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  5/1998  

MOST RECENT REVIEW DATE:  4/13/2017  

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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