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Optometric Management

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BUSINESS: technology

Corneal Topography

Optometric Management January 1, 2015
BUSINESS

  technology

Corneal Topography

It’s not just for specialty contact lens fits

KEVIN GEE, O.D.

Most O.D.s think of a corneal topographer as a must-have for difficult contact lens (CL) fittings. Yes, it’s essential to properly design accurate CL curvatures for successful scleral rigid CL wear, but the device is also beneficial for regular CL fittings and in determining a patient’s refractive surgery candidacy.

CL wear

Firstly, these scans provide information on corneal irregularities, such as dryness or astigmatism. Second, while it is obvious that a rigid lens may change corneal shape, the silicone hydrogel modulus may also (and often times does) slightly change the corneal curvature and, in turn, yield a change in refractive error that may not truly be the case.

Further, the latest models can image and aid in detecting early anterior segment diseases, such as meibomian gland disease, and acquire tear film break-up time, tear interferometry and the oxygen transmissibility of a soft CLs. Finally, the device educates patients on the importance of performing annual CL evaluations, as patients can see their pathology.

Indication / Codes*

367.22    Irregular astigmatism

370.07    Corneal Ulcer

371.00    Corneal opacity of cornea

371.01    Minor opacity of cornea

371.02    Peripheral opacity of cornea [post-traumatic scarring]

371.03    Central opacity of cornea

371.23    Bullous keratopathy

371.48    Peripheral degeneration of cornea [Terrien’s marginal degeneration]

371.50 - 371.58    Hereditary corneal dystrophies

371.60 - 371.62    Keratoconus

372.52    Pseudopterygium

For a more extensive list, visit optometricmanagement.com.

Procedural Codes*

CPT
92025    Computerized corneal topography, unilateral or bilateral, with interpretation and report. Related but not necessarily indicated always

HCPCS
S0820    Computerized corneal topography, unilateral

*All tests performed and billed in-office should be based on medical necessity. Check with your Local Carrier Determination (LCD) for Medicare patients and each individual commercial insurer for their approved lists of ICD-9 codes that are reimbursable where indicated.

Refractive surgery candidacy

A 36-year-old male who I had been seeing for four years and successfully fit into soft lenses for astigmatism had a consistent topography that showed no irregularities. As a result, I thought he’d be a good LASIK candidate.

As is our standard protocol, we had him cease lens wear for two weeks and return for a final topographical scan. The scan revealed a significantly different irregular astigmatism that ended up disqualifying him for LASIK. This is a great example of how silicone hydrogel lenses can mask true corneal curvature, and without a corneal topographer, although this refractive error changed slightly, he was for most reasons a good refractive surgery candidate. Corneal topography changed the game plan.

Orienting Statement

“This is called a corneal topographer. It allows the doctor to review the overall shape of your cornea. Much like a topography of the earth’s terrain, it reveals hills and valleys in your visual system. This may aid the doctor in choosing a specific contact lens, but it also reveals any irregularities that may exist on your eye’s surface. The doctor will discuss with you any irregularities.”

Players

    • Bausch + Lomb

    • Carl Zeiss Meditec

    • EyeQuip

    • EyeSys Vision, Inc.

    • i-Optics

    • Marco

    • Nidek

    • Oculus Inc.

    • Medmont Instruments

    • S4Optik

    • Tomey USA

    • Topcon Medical Systems

    • Tracey Technologies

    • Ziemer Ophthalmic Systems

A clear picture

With the emergence of scleral rigid contact lenses for hard-to-fit corneas due to ectasia, post-refractive irregularity or post-corneal transplant irregularity, corneal topographers have risen to popularity with eyecare practitioners who specialize in difficult CL fits. That said, as explained in this column, they can also be beneficial for all fits and for determining one’s refractive surgery candidacy. OM

DR. GEE PRACTICES IN HOUSTON, TEXAS, AND IS AN ASSISTANT CLINICAL PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. E-MAIL HIM AT DRGEE@GEEEYECARE.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.

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