Medicare News
| For Immediate Release: | Contact: |
| Friday, October 19, 2001 | CMS Office of Public Affairs 202-690-6145 |
For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov. |
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MEDICARE ANNOUNCES ITS INTENTION TO EXPAND COVERAGE OF NEW TREATMENT OF EYE DISEASE AFFECTING MANY ELDERLY
The Centers for Medicare & Medicaid Services (CMS) announced today that it intends to expand the treatment options available for Medicare beneficiaries with age-related macular degeneration, the leading cause of blindness in older Americans.
New Medicare coverage policy will expand coverage of ocular photodynamic therapy with verteporfin for this eye disease. Approximately 35,000 to 70,000 beneficiaries will be affected by this new policy, tripling the number helped by this treatment.
"By expanding access to this important new treatment, we are improving the quality of life for many Medicare beneficiaries, " said HHS Secretary Tommy G. Thompson.
Last year, CMS announced coverage of this therapy for patients with "classic" lesions. This decision extends it to those with "occult" lesions. Occult lesions are less well defined and more difficult to detect than classic lesions.
CMS re-examined its coverage decision at the request of The Vitreous Society, an organizations of physicians specializing in diseases of the retina.
Age-related macular degeneration (AMD) involves the deterioration of the central region of the retina called the macula, which results in a severe and irreversible loss of central vision. The National Institutes of Health estimate that nearly 1.7 million elderly Americans, 5 percent of the total population over 65 years of age, have some degree of vision loss due to AMD.
The underlying cause of AMD is not well understood, but population-based studies have found several risk factors for the disease in addition to old age, including family history of AMD, low dietary intake or plasma concentrations of antioxidant vitamins and zinc, and cigarette smoking. AMD has also been found to occur more frequently in Caucasians.
The form of the disease known as "wet" AMD results from the abnormal growth of blood vessels, a process known as choroidal neovascularization, which leak fluid under the macula, causing the formation of CNV lesions which result in a sudden and severe loss of central vision. The wet form of AMD accounts for the vast majority of cases of severe blindness.
Ocular Photodynamic Therapy (OPT), which is exclusively used in patients with wet AMD, involves the infusion of a light activated drug called verteporfin. Infusion of verteporfin is followed by the use of a non-thermal laser. Upon application of this laser, verteporfin becomes active and begins treating the adjacent lesions, resulting in the temporary closure of leaking blood vessels.
Details of the Decision Memorandum announced today can be found at Medicare Coverage Policy.
