2020 Huntington Dr, San Marino, CA 91108

Questions and Answers | Q&As

Canaloplasty Cost

Can You Advise the Availability of Costs for Performing Canaloplasty Surgery?

QUESTION:

David,

I am from Australia and have advanced glaucoma – I have been advised by Dr Richard Lewis of Sacramento that I am a suitable candidate for getting Canoplasty surgery. I haven’t been able to secure an appointment date. Can you advise the availability of costs for performing this surgery for me.

‎P****** Glindemann via Facebook


ANSWER:

‎P******,

I’d be happy to set up an appointment date if you are interested in traveling to Southern California for surgery. As I have a number of patients who travel significant distances to have canaloplasty glaucoma surgery I’ve created an international patient guide which can be access using the following link: http://david-richardson-md.com/patient-guide/patient-travel-guide/

For costs or inquiries, please send an email to: [email protected]

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: December 31, 2013

 

The Good, Bad, and Ugly With Ab-interno Canaloplasty (ABiC™)

November 5, 2018

QUESTION [from an eye surgeon]:

I’m planning to start trying iTrack, after using iStents for 4 years now. Any advice on the good, bad, and ugly with this type of canaloplasty?

Thanks,

via Email


ANSWER:

When it comes to canaloplasty, I’m a bit of an “old dog” in that I still prefer the Ab-Externo technique as I primarily treat moderate to severe glaucoma in my practice and need all four IOP lowering elements of the surgery: dilation and stenting of the canal, and trans-scleral percolation into both the suprachoroidal space and subconjunctival space. That being said, I’ve been using Ab-Interno canaloplasty with the Ellex iTrack microcatheter more frequently as I’ve been impressed with how easy and effective it has been in my patients with mild to moderate glaucoma. I’ve even recently used it in patients with advanced glaucoma (who for other reasons were not candidates for ab-externo procedures).

My experience is that when combined with cataract surgery it’s about as effective as the other available (and previously available) MIGS options: an average of 1-3 mmHg IOP reduction beyond what cataract surgery alone would be expected to do. Where ABiC seems to shine is in the phakic or pseudophakic patients. It’s not tied to cataract surgery as with other MIGS procedures as the code was approved prior to MIGS existing.

As an important aside, it’s worth noting that the code for ABiC (66174, canaloplasty without stent) can be used with all forms of “primary or chronic open angle glaucoma” (mild, moderate, or severe) and is payable regardless of phakic status. For those who are already comfortable with the iStent but would like to offer their pseudophakic patients a MIGS option (for which they won’t be on the financial hook). ABiC is a great option. Medicare and most commercial insurances (payment from Blue Cross varies by state) will pay for the procedure. Indeed, this is the route I generally recommend for those considering ABiC. We all have patients who have already had cataract surgery but would likely benefit from MIGS. Ab-Interno canaloplasty is a great option for these patients.

Given that my experience is anecdotal, I’ve copied the results section from a recently published study by Mark Gallardo, Richard Supnet, and Ike Ahmed:

“The study included 75 eyes of 68 patients (mean age: 73.7±9.9 years) with a mean base-line IOP of 20.4±4.7 mmHg on 2.8±0.9 medications, which reduced to 13.3±1.9 mmHg (n=73) on 1.1±1.1 medications at 12 months postoperative (both P,0.0001). At 12 months, 40% of eyes were medication free. In the ABiC/phacoemulsification subgroup (n=34 eyes), the mean IOP and medication use decreased from 19.4±3.7 mmHg on 2.6±1.0 medications preoperatively to 13.0±1.8 mmHg on 0.8±0.2 medications at 12 months (both P,0.001). In the stand-alone ABiC subgroup (n=41), the mean IOP and medication use decreased from 21.2±5.3 mmHg on 3.0±0.7 medications preoperatively to 13.7±1.9 mmHg on 1.3±1.1 medications at 12 months (P=0.001 and ,0.001, respectively). No serious adverse events were recorded.”

No doubt there will be surgeons (many of whose opinion I greatly respect) who currently see no benefit to ABiC over GATT. With regard to the use of GATT, however, I strongly disagree. When the Ab-Externo form of trabeculotomy was initially studied decades ago it was given up because although it had an impressive initial effect, it eventually failed in adults. In peds the trabecular meshwork has a congenital obstruction so it works in that population. However, in adults the trabecular leaflets tend to scar down over time potentially worsening the outflow issue beyond pre-trabeculotomy. Thus, innovations such as the Trabectome and Kahook Dual Blade (KDB) were developed, the purpose of which is to remove the leaflets left by GATT that can obstruct outflow over time.

Even Trabectome and KDB, however, suffer from destruction of the trabecular meshwork. There is growing evidence that the trabecular meshwork is far from just a drainage grate and should be preserved if possible. Indeed, there is an impressive amount of work from Murray Johnstone demonstrating dynamic pulsatile flow (TM as pump) with direct connections via cylindrical attachments to collector channel flaps that act to open and close access to the collector channel system. Removal of the TM could potentially result in the flaps obstructing the collector channel openings (which may be one reason other than scarring of the trabecular leaflets that trabeculotomy eventually seems to fail in adults). Additionally, the elegant work of Darryl R. Overby has demonstrated a complex system of mechanosensory regulation of outflow that is dependent on the trabecular meshwork. Finally, there are multiple new pharmaceutical agents (one already available: Rhopressa) that would be unlikely to have any beneficial effect if the trabecular meshwork has been destroyed. Why eliminate an entire class (or future classes) of TM-dependent treatment options unless there are no other reasonable options?

 

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Will My Insurance Cover Canaloplasty?

ANSWER:

The good news with regard to insurance coverage is that canaloplasty is covered by most major insurances including Medicare. Although there are some smaller insurance companies and HMOs that do not currently cover canaloplasty as of early 2012, more are adding canaloplasty as a covered benefit every month. Simply because, it works so well, and it is a safer option compared to other glaucoma surgeries. I’ve also had patients who have paid for canaloplasty without their insurance helping them, simply because the cost of drops was so high for them, that overtime, canaloplasty was an option that actually paid for itself.

 

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Aug 29, 2013

 

What Would the Approximate Total Cost for Canaloplasty Be?

QUESTION:

What would the approximate total cost for canaloplasty be ?


ANSWER:

Dear Mr. ******,

You can find the self-pay fee schedule here: Schedule of Fees.

If you have PPO insurance it might reimburse you for a portion of the cost of surgery.

If you have Medicare that has not been signed over to an HMO then Medicare will cover the majority of the Hospital Fee and Anesthesiologist’s fee. Medicare will not cover my surgeon’s fee as I have opted out of Medicare.

If you have an HMO or Medicare HMO (such as SCAN or Secure Horizons or a “Medicare Advantage” plan) then none of the fees listed will be covered by your insurance.

I’ve copied my billing specialist, Helah, on this email. If you provide her with your insurance information she can research this for you.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date:Thu, Jan 29, 2015 at 3:39 AM

 

Are You “In-Network” with My Insurance Plan?

QUESTION:

Dr. Richardson:

Thank-you for this information. I am a resident of Northern California (Mendocino County). I will soon have a new Covered California Silver 87 plan that will provide much better coverage. The plan is through Anthem Blue Cross. I am currently visiting my mother on an extended stay in SW Florida, but will be returning to the west coast in late April or early May, and can route myself through SOCAL on my return trip. Are you “in network” for my plan?

Attached is a letter of referral from my local ophthalmologist.

******, Ph.D.
Fort Bragg, CA


ANSWER:

Dear ******,

I’ve reviewed the note you forwarded from Dr. ******. I can’t be 100% certain that you are a candidate for Canaloplasty without examining what is called “the angle” at the slit lamp (microscope). That being said, it does appear that you would be a candidate for this surgery. If you are considering Canaloplasty then I would avoid ALT as it can make Canaloplasty more challenging to complete. Selective laser trabeculoplasty (SLT), on the other hand, would not be expected to interfere with Canaloplasty.

I am out-of-network for all insurances. Some insurances, however, may reimburse you for a significant portion of my fees. I’ve copied my billing specialist, Helah, on this email. If you forward your new insurance information she can do some research and may be able to tell you what reimbursement you might expect from your insurance.

I’ve also copied my nurse, Ana, on this email so that she may create a record and upload ******’s note in anticipation of a possible future consultation with me. Please let me or my staff know if there is anything else with which we may be of assistance.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Tue, Feb 10, 2015 at 2:16 PM

 

What Is the Cost of the Canaloplasty Surgery?

ANSWER:

My surgeon’s fee for canaloplasty surgery is dependent upon the anticipated complexity of the operation. When prior glaucoma surgery (such as trabeculectomy and glaucoma drainage device placement) has already been performed, the surgery is significantly more challenging and time consuming. As such, my fee is adjusted in proportion to the anticipated demands on me and my staff. In addition to my surgeon’s fee, are the surgery center fee and anesthesiologist’s fee. Although my surgeon’s fee may not be reimbursed by insurance, most commercial insurances and Medicare will cover the surgery center and anesthesiologist’s fees. My staff can provide you with updated fees as the surgery center changes them from time to time. [Note: Click here for the Latest Cataract Surgery Fees]

 

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Jul 5, 2013

 

What Is The Cost Of Canaloplasty Treatment?

QUESTION:

What Is The Cost Of Canaloplasty Treatment?


ANSWER:

The fees for exams, testing, and surgery are available here: http://david-richardson-md.com/insurance/payment-options/ There is a downloadable PDF link on that page which outlines the fees associated with Canaloplasty.

Warm regards,
David Richardson, MD
Patient-Focused Ophthalmologist

San Marino Eye
2020 Huntington Drive
San Marino, CA 91108
626.289.7856

Patient-Focused Websites:
New-Glaucoma-Treatments.com
About-Eyes.com

Date: Thu, Jan 15, 2015 at 1:53 AM

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