In a policy reversal, corneal allogenic intrastromal ring segments (CAIRS) surgery can now be performed under Medicare item numbers 42653 and 42656.
CAIRS is an effective treatment for complex cases of keratoconus, including patients who suffer from allergies, who have a physical or mental disability, or live in remote communities without town water, which makes the contact lens approach unsuitable.
“Patients with Down syndrome, for example, often have steep corneas and they can’t physically manage contact lenses. Indigenous children living in remote communities that rely on bore water are at increased risk of acanthamoeba keratitis when wearing contact lenses to control keratoconus,” Queensland corneal and laser eye surgeon Dr Brendan Cronin explained.
‘This is a pretty big win for patients with keratoconus and the result of a concerted, collaborative effort
Until the development of CAIRS, options for these patients included laser treatment (which is typically not as successful for patients with severe keratoconus), corneal transplantation for advanced keratoconus or corneal scarring, or intracorneal ring surgery – a procedure that involves the insertion of a plastic ring segment into the cornea.
Dr Cronin said intracorneal ring surgery is unsuited to thin corneas and must be implanted deep into the cornea to be safe, which reduces its effectiveness. Additionally, he said, being an artificial material, plastic intracorneal ring segments can trigger foreign body reactions and can cause vision issues for night driving.
A Safer, More Effective Solution
Conceived by Dr Soosan Jacob, Head of the Department of Ophthalmology at Dr Agarwal’s Eye Hospital in Chennai, India, CAIRS implants segments of donor cornea instead of the plastic rings. Implanted at a depth of 200–250 microns, the implant is much shallower than when using acrylic segments, making the procedure safer and more effective.
The procedure uses non-viable corneas that would otherwise have been used for research or training, meaning that precious viable tissue is preserved for full-thickness corneal transplants.
Reversal “a Pretty Big Win”
Dr Cronin said the reversal of Medicare’s initial decision that CAIRS could not be used under item number 42653 as a corneal transplant is “a pretty big win for patients with keratoconus” and the result of a concerted, collaborative effort.
“Because this was a significant funding issue for patients, we mounted a written argument against the reasoning that Medicare gave in their original decision. The process took quite a long time, and we were very lucky to have the support of all of the Eye Banks in Australia as well as RANZCO (Royal Australian and New Zealand College of Ophthalmologists) and the ASO (Australian Society of Ophthalmologists).
“The Department of Health has now advised us that they support our reasoning and have confirmed that CAIRS can be performed under the item numbers 42653 and 42656, effective immediately. This means the procedure is eligible for funding by Medicare and private health insurance in Australia.”
The CAIRS procedure is supported by a free Australian-designed online tool that helps surgeons plan and map the surgery for an individual patient, then supports them through the surgery process. Developed by Dr Cronin and his colleague, Dr David Gunn, it is available at CAIRSPlan.com.
