When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
American Academy of Ophthalmology. EyeWiki™. Corneal Epithelial Defect. Last modified 12/19/2017. Available at: http://eyewiki.aao.org/Corneal_Epithelial_Defect. Accessed June 12, 2018.
Baran I, Bradley JA, Alipour F, et al. PROSE treatment of corneal ectasia. Cont Lens Anterior Eye. 2012;35(5):222-227.
Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 80.1: Hydrophilic contact lens for corneal bandage. [CMS Web site]. ND. Available at:
http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=136&ncdver=1&bc=AAAAQAAAAAAA&. Accessed June 8, 2018.
Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 80.5: Scleral Shell. [CMS Web site]. ND. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=235&ncdver=1&bc=AgAAQAAAAAAA&. Accessed June 8, 2018.
Ciralsky JB, Chapman KO, Rosenblatt MI, et al. Treatment of Refractory Persistent Corneal Epithelial Defects: A Standardized Approach Using Continuous Wear PROSE Therapy. Ocul Immunol Inflamm. 2015;23(3):219-24.
Gungor I, Schor K, Rosenthal P, et al. The Boston Scleral Lens in the treatment of pediatric patients. J AAPOS. 2008;12(3):263-267.
Jacobs DS, Rosenthal P. Boston sclera lens prosthetic device for treatment of severe dry eye in chronic graft-versus host disease. Cornea. 2007; 26(10):1195-9.
Jupiter DG, Katz HR. Management of irregular astigmatism with rigid gas permeable contact lenses. CLAO J. 2000; 26(1):14-7.
Kok JH, Visser R. Treatment of ocular surface disorders and dry eyes with high gas-permeable scleral lenses. Cornea.1992;11(6):518-522.
Pecego M, Barnett M, Mannis MJ, et al. Jupiter Scleral Lenses: the UC Davis Eye Center experience. Eye Contact Lens. 2012; 38(3):179-82.
Puangsricharern V, Tseng SC. Cytologic evidence of corneal diseases with limbal stem cell deficiency. Ophthalmology.1995;102(10):1476-1485.
Pullum KW, Buckley RJ. A study of 530 patients referred for rigid gas permeable scleral contact lens assessment. Cornea.1997;16(6):612-622.
Romero-Rangel T, Stavrou P, Cotter J, et al. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol. 2000;130(1):25-32.
Rosenthal P, Cotter J. The Boston Scleral Lens in the management of severe ocular surface disease. Ophthalmol Clin North Am. 2003;16(1):89-93.
Rosenthal P, Cotter JM, Baum J. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens. Am J Ophthalmol. 2000;130(1):33-41.
Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens. 2005;31 (3):130-134.
Rosenthal P, Jacobs DS, Johns L. Fluid-ventilated gas permeable scleral lens: a new paradigm for the management of irregular corneal astigmatism and severe ocular surface disease. Contemporary Ophthalmology.2006;5(22):1-7.
Segal O, Barkana Y, Hourovitz D, et al. Scleral contact lenses may help where other modalities fail. Cornea. 2003;22(4):308-310.
Shipra Gupta S, Gupta P, Sayegh R. Healing a Persistent Corneal Epithelial Defect. EyeNet Magazine. August 2014. Available at: https://www.aao.org/eyenet/article/healing-persistent-corneal-epithelial-defect. Accessed June 12, 2018.
Schornack MM, Patel SV. Scleral lenses in the management of keratoconus. Eye Contact Lens. 2010; 36(1):39-44.
Schornack MM, Pyle J, Patel SV. Scleral lenses in the management of ocular surface disease. Ophthalmology. 2014;121(7):1398-1405.
Smith GT, Mireskandari K, Pullum KW. Corneal swelling with overnight wear of scleral contact lenses. Cornea. 2004;23(1):29-34.
Stason WB, Razavi M, Jacobs DS, et al. Clinical benefits of the Boston Ocular Surface Prosthesis. Am J Ophthalmol. 2010; 149(1):54.61.
Steele CF. Fitting and management of therapeutic contact lenses. Hospital optometrists information series. November 2000. Available at: http://www.spitjudms.ro/_files/protocoale_terapeutice/oftalmologie/fm-tcl-info1.pdf. Accessed June 8, 2018.
Tan DT, Pullum KW, Buckley RJ. Medical applications of scleral contact lenses: 2. Gas-permeable scleral contact lenses. Cornea. 1995;14(2):130-137.
Tappin MJ, Pullum KW, Buckley RJ. Scleral contact lenses for overnight wear in the management of ocular surface disorders. Eye (Lond). 2001;15(Pt 2):168-172.
Tseng SC, Tsubota K. Important concepts for treating ocular surface and tear disorders. Am J Ophthalmol. 1997;124(6):825-835.
US Department of Health and Human Services, Health Care Financing Administration (HCFA). Hydrophilic contact lens for corneal bandage. Medicare Coverage Issues Manual §45-7. Baltimore, MD: HCFA; 1999. Revised 2010.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. BOSTON(R) EQUALENS (R) SCLERAL CONTACT LENS DESIGN. Premarket Approval (PMA) Database. [FDA Web site]. 03/19/03. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P860022S040. Accessed June 12, 2018.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. NIGHT & DAY 30 NIGHT EXTENDED WEAR SOFT CONTACT LENS. Premarket Approval (PMA) Database. [FDA Web site]. 03/19/03. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P010019S002. Accessed June 12, 2018.
US Food and Drug Administration (FDA): Product classification: Rigid gas permeable contact lens. [FDA website]. Updated June 4, 2018. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=4286.Accessed June 8, 2018.
Visser ES, Visser R, van Lier HJ, et al. Modern scleral lenses part I: clinical features. Eye Contact Lens. 2007;33(1):13-20.
Policy: 07.13.13c:Prescription Lenses and Visual Devices