Bulletin

   
Bulletin Number
        4384
Date
        June 15, 2002
Direct inquiries to

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Distribution

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Subject     

Ocular Photodynamic Therapy (PDT) with Verteporfin (Visudyne™)

Diagnostic and Therapeutic Procedures: Ophthalmology

Effective June 15, 2002, ocular photodynamic therapy (PDT) with verteporfin will be an insured service when rendered under specific clinical conditions by an ophthalmologist for treatment of age-related macular degeneration or pathologic myopia.

The following text will be inserted on page J42 (April 2002 edition) of the Ophthalmology subsection of the Diagnostic and Therapeutic Procedures section of the Schedule of Benefits on June 15, 2002 directly as follows:

Ocular photodynamic therapy (PDT) - is, subject to the limitations set out below, an insured service when rendered by an ophthalmologist.  PDT must include completion and submission of patient registration and drug requisition forms, establishment of intravenous access, supervision of drug infusion and personal application of non-thermal diode laser for activation of verteporfin.

PDT is insured only if the patient's clinical condition meets all of the following:

i.          the patient has predominantly classic subfoveal choroidal neovascularization (CNV) secondary to either age-related macular degeneration (AMD) or pathologic myopia. 'Predominantly' means that the area of classic subfoveal CNV is equal to or greater than 50% of the total CNV lesion, as determined by fluorescein angiography and documented by retinal photographs retained on the patient's permanent medical record; and

ii.          treatment is commenced within 30 months after initial diagnosis of predominantly classic subfoveal CNV secondary to either AMD or pathologic myopia; and

iii.         the patient's visual acuity is equal to or worse than 20/40; and

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