Medical Policy

 

Subject: Anterior Segment Optical Coherence Tomography
Document #: MED.00095 Publish Date:    12/27/2017
Status: Reviewed Last Review Date:    11/02/2017

Description/Scope

This document addresses the use of anterior segment optical coherence tomography (OCT) to obtain high-resolution images and measurements of the anterior segment ocular structures (cornea, anterior chamber, iris and the central portion of the lens) including the angle, without the need for ocular anesthesia.

Position Statement

Investigational and Not Medically Necessary:

Optical coherence tomography of the anterior eye segment is considered investigational and not medically necessary for all indications.

Rationale

Gonioscopy is the gold standard for evaluation of the anterior segment of the eye. Ultrasound biomicroscopy (UBM) and OCT have also been used to measure the anterior segment of the eye. UBM requires a water bath which can be uncomfortable. OCT employs non-invasive, non-contact, low-coherence interferometry to obtain high-resolution images and measurements of the anterior segment ocular structures (cornea, anterior chamber, iris and the central portion of the lens). Several studies have compared OCT and established techniques to measure the anterior segment ocular structure (Dada, 2007; Li, 2007; Pavlin, 2009; Sakata, 2008; Zhao, 2007), but none have established the superiority of OCT. In one study by Radhakrishnan (2007), the researchers found that anterior segment optical coherence tomography (AS-OCT) using their prototype device demonstrated good to excellent reproducibility of the anterior chamber depth measurements when taken from the nasal and temporal quadrants but not the inferior quadrant. This led the researchers to conclude that “further assessment of the commercially available AS-OCT is needed to clarify this finding.”

Mansouri and colleagues (2010) reported on the comparison of UBM to AS-OCT measurements in suspected primary angle closure, primary angle closure, or primary angle-closure glaucoma. It is essential to be able to visualize and measure the anterior chamber (AC) angle for the assessment of individuals with glaucoma. A total of 33 participants (55 eyes) were examined by AS-OCT followed by UBM. Measurement of the trabecular-iris angle (TIA) was made in all four quadrants. In the AS-OCT group, the mean superior TIA was 19.3º and inferior TIA was 17.9º. In the UBM group, the mean superior TIA was 15.7º and inferior TIA was 16.7º. The differences between the two TIA measures were spread out over a range of about ± 20º. This indicates poor agreement between the two methods for measurements. The authors stated “AS-OCT measurements were significantly correlated with UBM measurements but showed poor agreement with high differences in quantifying AC angle in individuals with narrow or closed angles.”

Qui and colleagues (2011) reported on the use of Fourier-domain anterior segment optical coherence tomography (FD-ASOCT) to screen and diagnose dry eye, specifically human tear meniscus. A total of 146 participants with dry eye and 160 control participants were enrolled in the study. Data was gathered using a dry eye questionnaire, measurement of the tear menisci using an AS-OCT system, tear film breakup time, corneal fluorescein staining, and Shirmer I test. Correct diagnosis of dry eye measured using the AS-OCT was 68.95% in tear meniscus height, 70.59% in tear meniscus depth, and 70.92% in tear meniscus area which “suggests limitations in dry eye diagnosis when using only meniscus measurements.” The authors concluded that “dry eye is a complex condition” and “further research will be needed to ascertain the type of dry eye that is best diagnosed with FD-OCT.”

A 2013 Japanese study by Mishima and colleagues reported on the evaluation of iridotrabecular contact of 43 eyes in 43 participants with shallow peripheral anterior chambers who received anterior segment swept-source OCT and compared those results to both UBM and gonioscopy. Participants first underwent gonioscopy, then underwent OCT and UBM at the same time of day on a different day within the next 7 days. At least 1 iridotrabecular contact was found in 40 and 42 eyes by OCT under light and dark conditions. With UBM, at least 1 iridotrabecular contact was found in 22 and 36 of the 43 eyes under light and dark conditions, respectively. The iridotrabecular contact evaluated with OCT included all of the peripheral anterior synechia identified by gonioscopy. The prevalence of iridotrabecular contact in eyes with anterior segment swept-source optical coherence tomography was significantly higher than that with UBM under light conditions, but not under dark conditions (P=0.0001, 0.07, respectively, sign test). This study has limitations including a small sample size; the participants were referred from another facility due to their high risk for developing peripheral anterior synechia or angle closure and may have already received prophylactic treatment.

In 2015, Neri and colleagues reported on the accommodation process of normal eyes using AS-OCT. The authors studied 14 right eyes for central corneal thickness, anterior chamber depth and lens thickness. While there was a decrease in the anterior chamber depth and an increase in the lens thickness during accommodation, the central corneal thickness and anterior chamber width did not change significantly during accommodation. While the study showed that imaging of the anterior segment during accommodation can be completed using AS-OCT, study populations remain small and there has yet to be superiority of AS-OCT compared to the gold standard.

The 2015 updated American Academy of Ophthalmology Preferred Practice Pattern® Summary Benchmarks for primary angle closure, primary open-angle, and primary open-angle suspect recommend gonioscopy as a key element in the workup and management of primary angle and suspect. OCT is not mentioned.

Several devices have received 510(k) clearance from the United States Food and Drug Administration as OCT devices. They have the potential for use as a screening tool for detection of occludable angles. Clinical studies are still needed to demonstrate clinical utility beyond the current standard of care of gonioscopy and ultrasound.

Background/Overview

The AS-OCT devices employ non-invasive, non-contact, low-coherence interferometry to obtain high-resolution images and measurements of the anterior segment ocular structures (cornea, anterior chamber, iris and the central portion of the lens).

The devices are designed to image the shape, size and position of anterior components and make precise measurements of the distances between them, including angle-to-angle, angle size in degrees, pupil diameter, anterior chamber depth, and thickness and radii of curvature of the crystalline lens. The anterior segment is measured pre- and postoperatively for laser surgery in refractive surgeries.

Definitions

Dry eye syndrome: A condition in which there are not enough tears to lubricate and nourish the eye.

Glaucoma: A group of diseases that can damage the eye’s optic nerve and result in vision loss and blindness.

Gonioscopy: An examination using a lens-like device to evaluate the structure of the front part of the eye.

Optical refractive surgery: Surgery to the surface of the eye (cornea) to correct vision problems such as far- or near-sightedness.

Primary angle closure: The closure of the anterior chamber angle caused by multiple mechanisms.

Primary angle-closure glaucoma: A type of glaucoma that is caused by closure of the drainage structure of the eye.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Investigational and Not Medically Necessary:

CPT

 

92132

Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral

 

 

ICD-10 Diagnosis

 

 

All diagnoses

References

Peer Reviewed Publications:

  1. Dada T, Sihota R, Gadia R, et al. Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment. J Cataract Refract Surg. 2007; 33(5): 837-840.
  2. Konstantopoulos A, Hossain P, Anderson DF. Recent advances in ophthalmic anterior segment imaging: a new era for ophthalmic diagnosis? Br J Ophthalmol. 2007; 91(4):551-577.
  3. Li EY, Mohamed S, Leung CK, et al. Agreement among 3 methods to measure corneal thickness: ultrasound pachymetry, Orbscan II, and Visante anterior segment optical coherence tomography. Ophthalmology. 2007; 114(10):1842-1847.
  4. Mansouri K, Sommerhalder J, Shaarawy T. Prospective comparison of ultrasound biomicroscopy and anterior segment optical coherence tomography for evaluation of anterior chamber dimensions in European eyes with primary angle closure. Eye (Lond). 2010; 24(2):233-239.
  5. Mishima K, Tomidokoro A, Suramethakul P, et al. Iridotrabecular contact observed using anterior segment three-dimensional OCT in eyes with a shallow peripheral anterior chamber. Invest Ophthalmol Vis Sci. 2013; 54(7):4628-4635.
  6. Neri A, Ruggeri M, Protti A, et al. Dynamic imaging of accommodation by swept-source anterior segment optical coherence tomography. J Cataract Refract Surg. 2015; 41(3):501-510.
  7. Pavlin CJ, Vásquez LM, Lee R, et al. Anterior segment optical coherence tomography and ultrasound biomicroscopy in the imaging of anterior segment tumors. Am J Ophthalmol. 2009; 147(2):214-219.
  8. Qiu X, Gong L, Sun X, Jin H. Age-related variations of human tear meniscus and diagnosis of dry eye with Fourier-domain anterior segment optical coherence tomography. Cornea. 2011; 30(5):543-549.
  9. Radhakrishnan S, See J, Smith SD, et al. Reproducibility of anterior chamber angle measurements obtained with anterior segment optical coherence tomography. Invest Ophthalmol Vis Sci. 2007; 48(8):3683-3688.
  10. Sakata LM, Lavanya R, Friedman DS, et al. Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle. Ophthalmology. 2008; 115(5):769-774.
  11. Zhao PS, Wong TY, Wong WL, et al. Comparison of central corneal thickness measurements by visante anterior segment optical coherence tomography with ultrasound pachymetry. Am J Ophthalmol. 2007; 143(6):1047-1049.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. American Academy of Ophthalmology (AAO). For additional information visit the AAO website: http://www.aao.org/ppp. Accessed on October 5, 2017.
    • Preferred Practice Pattern Cataract in the Adult Eye. 2016.
    • Preferred Practice Pattern Primary Angle Closure. 2015.
    • Preferred Practice Pattern Refractive Errors & Refractive Surgery. 2013.
    • Preferred Practice Pattern Summary Benchmarks. 2015.
Websites for Additional Information
  1.  National Institute for Health; National Eye Institutes. Available at: http://www.nei.nih.gov/. Accessed on October 5, 2017.
Index

iVue®
Optical coherence tomography
Visante®

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

Document History

Status

Date

Action

Reviewed

11/02/2017

Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Rationale and References sections. The document header wording updated from “Current Effective Date” to “Publish Date.”

Reviewed

11/03/2016

MPTAC review. Updated Rationale and References sections.

Reviewed

11/05/2015

MPTAC review. Updated Rationale and References sections. Removed ICD-9 codes from Coding section.

Reviewed

11/13/2014

MPTAC review. Updated Rationale and References.

Reviewed

11/14/2013

MPTAC review. Updated Rationale and References.

Reviewed

11/08/2012

MPTAC review. Updated Rationale, References and Index.

Reviewed

11/17/2011

MPTAC review. Updated Rationale, Definitions, References and Index.

Reviewed

11/18/2010

MPTAC review. Updated Rationale, References and Index. Updated Coding section with 01/01/2011 CPT changes; removed CPT 0187T deleted 12/31/2010.

Reviewed

11/19/2009

MPTAC review. Clarification of position statement to “Optical coherence tomography of the anterior eye segment is considered investigational and not medically necessary for all indications”. Title change to “Anterior Segment Optical Coherence Tomography”. Updated References and Websites.

Reviewed

11/20/2008

MPTAC review. Updated Background, Rationale, References, Websites and Coding.

New

11/29/2007

MPTAC review. Initial document development.