DESCRIPTION
Transpupillary thermotherapy (TTT) is a technique in which heat is delivered to the choroid and retinal pigment epithelium through the pupil using a modified diode laser. This laser technique contrasts with the laser used in standard photocoagulation therapy, in that TTT uses a lower power laser for more prolonged periods of time and is designed to gently heat the choroidal lesion, thus limiting damage to the overlying retinal pigment epithelium. While photodynamic therapy as a treatment of choroidal neovascularization also involves the use of a laser, in this application, the laser is a non-thermal laser designed to activate verteporfin, the photosensitizing agent.
TTT is currently being evaluated as a treatment for several ophthalmologic conditions. Some of these conditions include classic and occult choroidal neovascularization, choroidal melanoma, and retinoblastoma.
POLICY
Transpupillary thermotherapy for the treatment of all ophthalmologic conditions 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
No controlled studies were found in the published literature that validates the use of transpupillary thermotherapy.
Photodynamic therapy (PDT) may be considered as a treatment for selected cases of choroidal neovascularization in individuals with age related macular degeneration.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2008). Transpupillary thermotherapy for treatment of choroidal neovascularization (9.03.10). Retrieved March 20, 2009 from BlueWeb.
ECRI Institute. Health Technology Information Service. Emerging Technology Evidence Report. (2005, February). Transpupillary thermotherapy (TTT) for choroidal neovascularization (CNV). Retrieved March 20, 2009 from ECRI Institute. (16 articles and/or guidelines)
Finger, P. T., Czechonska, G., Demirci, H., & Rausen, A. (1999). Chemotherapy for retinoblastoma: A current topic. Drugs, 58 (6), 983-996. Abstract retrieved October 19, 2001 from PubMed database.
Godfrey, D. G., Waldron, R. G., & Capone, A. Jr. (1999). Transpupillary thermotherapy for small choroidal melanoma. American Journal of Ophthalmology, 128 (1), 88-93. Abstract retrieved October 19, 2001 from PubMed database.
Keunen, J. E. E., Journee-De Korver, J. G., & Oosterhuis, J. A. (1999). Transpupillary thermotherapy of choroidal melanoma with or without brachytherapy: A dilemma. British Journal of Ophthalmology, 83 (11), 1212-1213.
Newsom, R. S. B., McAlister, J. C., Saeed, M., & McHugh, J. D. A. (2001). Transpupillary thermotherapy (TTT) for treatment of choroidal neovascularization. British Journal of Ophthalmology, 85 (2), 173-178.
Reichel, E., Berrocal, A. M., Ip, M., Kroll, A. J., Desai, V., Duker, J. S. & Puliafito, C. A. (1999). Transpupillary thermotherapy of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration. Ophthalmology, 106 (10), 1908-1914.
Rogers, A. H., & Reichel, E. (2001). Transpupillary thermotherapy of subfoveal occult choroidal neovascularization. Current Opinion in Ophthalmology, 12 (3), 212-215.
ORIGINAL EFFECTIVE DATE: 5/1/2002
MOST RECENT REVIEW DATE: 5/14/2009
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.
This document has been classified as public information.