Glaucoma is characterized by degeneration of the optic nerve (optic disc). Elevated intraocular pressure (IOP) has long been thought to be the primary etiology, but the relation between IOP and optic nerve damage varies among individuals, suggesting a multifactorial origin. The association between glaucoma and other vascular disorders such as diabetes or hypertension suggests vascular factors may play a role in glaucoma.
A comprehensive ophthalmologic exam is required for the diagnosis of glaucoma, but no single test is adequate to establish diagnosis. Standard methods of evaluation include careful direct examination of the optic nerve using ophthalmoscopy or stereophotography, or evaluation of visual fields. There has been interest in developing more objective, reproducible techniques both to document optic nerve damage and to detect early changes in the optic nerve and retinal nerve fiber layer (RNFL) before the development of permanent visual field deficits.
Optic Nerve/Retinal Nerve Fiber Layer (RNFL) Evaluation Techniques:
Confocal Scanning Laser Ophthalmoscopy (CSLO) - A laser based image acquisition which produces a high contrast reproducible image that is used to estimate the thickness of the RNFL.
Scanning Laser Polarimetry (SLP) - A polarized laser beam used to estimate the thickness of the RNFL by comparing the results to a normative database.
Optical Coherence Tomography (OCT) - non contact technique that uses near-infrared light to provide automated, objective images of the retina, optic nerve head, and RNFL.
Techniques to measure ocular blood flow or ocular blood velocity have been proposed as evaluation tools for glaucoma; however, data for these techniques remain limited. Ocular blood flow and pulsatile ocular blood flow involve continuous monitoring of intraocular pressure that is converted into a volume measurement using the known relationship between ocular pressure and ocular volume.
Analysis of the optic nerve (retinal nerve fiber layer) in the diagnosis and evaluation of individuals with glaucoma or glaucoma suspects using the following techniques is considered medically necessary:
Confocal Scanning Laser Ophthalmoscopy (CSLO)
Scanning Laser Polarimetry (SLP)
Optical Coherence Tomography (OCT)
The measurement of ocular blood flow, pulsatile ocular blood flow or blood flow velocity in the diagnosis and evaluation of glaucoma is considered investigational.
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Data regarding ocular blood flow, pulsatile ocular blood flow, and/or blood flow velocity are currently lacking and their relationship to clinical outcomes is not known.
American Academy of Ophthalmology. (2015). Preferred Practice Pattern. Primary open-angle glaucoma. Retrieved June 6, 2016 from http://one.aao.org/ppp.
American Academy of Ophthalmology. (2016). Preferred Practice Pattern. Primary open-angle glaucoma suspect. Retrieved March 22, 2017 from http://www.aaojournal.org.
American Academy of Ophthalmology. (2017, November). Preferred Practice Pattern. Glaucoma summary benchmarks. Retrieved March 5, 2018 from http://one.aao.org/ppp.
BlueCross BlueShield Association. Evidence Positioning System. (3:2018). Ophthalmologic techniques that evaluate the posterior segment for glaucoma. (9.03.06). Retrieved January 29, 2019 from http://www.evidencepositioningsystem.com. (15 articles and/or guidelines reviewed)
CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2018, February) Scanning computerized ophthalmic diagnostic imaging (SCODI) (LCD ID L34431). Retrieved March 5, 2018 from https://www.cms.gov.
Mohindroo, C, Ichhpujani, P., Kumar, S. (2016). Current imaging modalities for assessing ocular blood flow in glaucoma. Journal of Current Glaucoma Practice, 10 (3), 104-112. (Level 4 evidence)
U.S. Food and Drug Administration. (2006, October). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K063191. Retrieved February 24, 2012 from http://www.accessdata.fda.gov.
U.S. Food and Drug Administration. (2009, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K082016. Retrieved February 24, 2012 from http://www.accessdata.fda.gov.
U.S. Food and Drug Administration. (2010, April). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K091404. Retrieved November 11, 2013 from http://www.accessdata.fda.gov.
ORIGINAL EFFECTIVE DATE: 7/14/2012
MOST RECENT REVIEW DATE: 3/28/2019
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