GLAUCOMA 52 EWAP SEPTEMBER 2022 there are a few things patients tend to hone in on. They do notice if a stent is left behind. I would say patients are 50/50 on whether they would prefer to have a stent because of their positive affiliation with heart disease, or if they would prefer to not have something left behind in their eye, and ultimately I think most patients will look to the doctor for their advice. Laser is generally looked upon with favor by patients, but some are concerned. With all of these, I think most of the time, the patient is looking for a recommendation. Dr. Okeke: Fortunately, through my practice, I’m able to stay up to date with current technologies as they come out, so it’s rare for a patient to come in requesting a technology that we don’t have access to. However, if it does come up that patients are requesting something that is within one’s reach to be able to provide, that can drive the desire to adopt new technology or get training for it. EyeWorld: What are the reimbursement considerations that go into adopting new treatment options? Dr. Radcliffe: Reimbursement considerations do matter in a variety of ways. Sometimes insurances simply won’t pay for certain procedures. That’s an issue I deal with quite a bit in New York City, and I have no choice but to adapt. It’s not reasonable to ask patients to pay out of pocket when the alternative options are so similar, so you simply have to do the best procedure that the insurance company is allowing you to do and in some cases explaining that to the patient, if you’ve had to make a change. Dr. Okeke: If it’s an old code vs. a new code, old codes are more desirable because they’re more stable and reimbursement is less questionable. The newer codes can take some time to be adopted. … Reimbursement delays can sometimes slow down the onset of starting a device. It’s now routine for us to go through who will be best covered by this device and trial those limited insurances to make sure that with the particular procedure, the reimbursement will come back and be paid adequately. Once that happens, we can establish a level of experience with the device and reimbursement and go full speed ahead. Case examples Dr. Okeke shared a couple of examples of how she’s brought new treatment options into her practice. She said the XEN Gel Stent (Allergan), for example, came out with a new code, presenting a problem for reimbursement. She also said she was initially deterred from adopting the technology because of hearing about the high needling rate. “Because of my busy practice, the idea of having to do a lot of needling was not something I was excited about,” she said. But after learning from others’ experience, more research, more time on the market, and other pearls, she later adopted it, and it has become a useful tool in her practice. She said she’s become quite experienced with the device and has begun teaching about it with videos and at conferences. “I’m now doing that procedure quite a bit and getting outcomes I’m happy with. This is a good example of a device that we had to pause on initially for about a year; after we knew the reimbursement was going to be acceptable and I had learned more about the surgical technique from others, I was ready to adopt it. Then once I did, I was comfortable mastering it and offering it to patients quite readily,” Dr. Okeke said. Durysta (bimatoprost, Allergan) is another example. She said that surgeon interest is ultimately what drove its adoption in the practice. They had a trial for the practice but had some difficulty collecting patients, so it was smaller than anticipated. There was also confusion with billing, there were staffing and management changes in the process, and challenges due to COVID-19 didn’t help. “We had to reinvent the wheel and start all over. The timeframe of being able to adopt it took more than a year, but it goes to the interest of the surgeons; we kept persisting in our interest to adopt it. That’s why it eventually came to the point where we were able to bring it on board,” she said. EWAP Editors’ note: Dr. Okeke is Assistant Professor of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, and has interest with Alcon, Allergan, Glaukos, MST, Nova Eye Medical, New World Medical, and Sight Sciences. Dr. Radcliffe practices at New York Ophthalmology, New York Eye Surgery Center, New York, New York, and has interests with Alcon, Allergan, Glaukos, New World Medical, and Sight Sciences.
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