Coverage Policy Manual
Policy #: 2008004
Category: Medicine
Initiated: January 2008
Last Review: April 2024
  Optical Coherence Tomography Anterior Eye Segment Imaging
Description:
Optical coherence tomography (OCT) is a non-invasive, high-resolution imaging method that can be used to visualize ocular structures. OCT creates an image of light reflected from the ocular structures. In this technique, a reflected light beam interacts with a reference light beam. The coherent (positive) interference between the two beams (reflected and reference) is measured by an interferometer, allowing construction of an image of the ocular structures. This method allows cross-sectional imaging at a resolution of 6 to 25 microns.
 
The Stratus OCT™ (Carl Zeiss Meditec), which utilizes a 0.8 micron wavelength light source, was designed for evaluating the optic nerve head, retinal nerve fiber layer and retinal thickness in the posterior segment. The Zeiss Visante OCT™ and anterior chamber Cornea OCT uses a 1.3 micron wavelength light source designed specifically for imaging the anterior eye segment. Light of this wavelength penetrates the sclera, allowing high-resolution cross-sectional imaging of the anterior chamber angle and ciliary body. The light is, however, typically blocked by pigment, preventing exploration behind the iris. Ultrahigh resolution OCT can achieve a spatial resolution of 1.3 microns, allowing imaging and measurement of corneal layers.
 
An early application of optical coherence tomography technology was the evaluation of the cornea before and after refractive surgery. Because this noninvasive procedure can be conducted by a technician, it has been proposed that this device may provide a rapid diagnostic and screening tool for detecting angle-closure glaucoma.
 
Optical coherence tomography of the anterior eye segment is being evaluated as a noninvasive diagnostic and screening tool with a number of potential applications. One proposed use of anterior segment optical coherence tomography is to determine whether there is a narrowing of the anterior chamber angle, which could lead to angle-closure glaucoma. Another general area of potential use is as a presurgical and postsurgical evaluation tool for anterior chamber procedures. This could include assessment of corneal thickness and opacity, calculation of intraocular lens power, guiding surgery, imaging intracorneal ring segments, and assessing complications following surgical procedures such as blockage of glaucoma tubes or detachment of Descemet membrane following endothelial keratoplasty. A third general category of use is to image pathologic processes such as dry eye syndrome, tumors, noninfectious uveitis, and infections. It is proposed that anterior segment optical coherence tomography provides better images than slit-lamp biomicroscopy/gonioscopy and ultrasound biomicroscopy due to higher resolution. In addition, anterior segment optical coherence tomography does not require probe placement under topical anesthesia.
 
Alternative methods of evaluating the anterior chamber are slit-lamp biomicroscopy or ultrasound biomicroscopy. Slit-lamp biomicroscopy is typically used to evaluate the anterior chamber; however, the chamber angle can only be examined with specialized lenses, the most common being the gonioscopic mirror. In this procedure, a gonio lens is applied to the surface of the cornea, which may result in distortion of the globe. Ultrasonography may also be used for imaging the anterior eye segment (Wolffsohn, 2006). Ultrasonography uses high-frequency mechanical pulses (10 to 20 MHz) to build a picture of the front of the eye. An ultrasound scan along the optical axis assesses corneal thickness, anterior chamber depth, lens thickness, and axial length. Ultrasound scanning across the eye creates a 2-dimensional image of the ocular structures. It has a resolution of 100 μm but only moderately high intraobserver and low interobserver reproducibility. Ultrasound biomicroscopy (»50 MHz) has a resolution of 30 to 50 μm. As with slit-lamp biomicroscopy with a gonioscopic mirror, this technique requires placement of a probe under topical anesthesia.
 
Glaucoma is characterized by degeneration of the optic nerve.
 
The classification of glaucoma as open-angle or angle-closure relies on assessment of the anterior segment anatomy, particularly that of the anterior chamber angle. Angle-closure glaucoma is characterized by obstruction of aqueous fluid drainage through the trabecular meshwork (the primary fluid egress site) from the eye’s anterior chamber. The width of the angle is a factor affecting the drainage of aqueous humor. A wide unobstructed iridocorneal angle permits sufficient drainage of aqueous humor, whereas a narrow-angle may impede the drainage system and leave the patient susceptible to an increase in intraocular pressure and angle-closure glaucoma.
 
A comprehensive ophthalmologic examination for glaucoma includes assessment of the optic nerve and retinal nerve fiber layer. The presence of characteristic changes in the optic nerve or abnormalities in visual field, together with increased intraocular pressure, is sufficient for a definitive diagnosis of glaucoma.
 
Regulatory Status
Multiple optical coherence tomography systems have been cleared for marketing by the U.S. Food and Drug Administration (FDA) through the 510(k) process. Examples of approved systems are the Visante™ OCT (Carl Zeiss Meditec; FDA product code: HLI); the RTVue® (Optovue; FDA product code: OBO) and the Slitlamp optical coherence tomography (SL-OCT; Heidelberg Engineering;FDA product code: MXK).
 
The microscope-integrated optical coherence tomography devices for intraoperative use include the ReScan 700 (Zeiss; FDA product code: OBO) and the iOCT® system (Haag-Streit).
 
Portable devices for intraoperative use include the Bioptigen Envisu™ (Bioptigen; FDA product code: HLI) and the Optovue iVue® (Optovue; FDA product code: OBO). Ultrahigh-resolution optical coherence tomography devices include the SOCT Copernicus HR (Optopol Technologies; FDA product code OBO).
 
Commercially available laser systems, such as the LenSx® (Alcon), Catalys® (OptiMedica), and VICTUS® (Technolas Perfect Vision), include optical coherence tomography to provide image guidance for laser cataract surgery. FDA product code: OOE.
 
Custom-built devices, which do not require FDA approval, are also used.
 
The anterior chamber Cornea optical coherence tomography (Ophthalmic Technologies) is not cleared for marketing in the United States.
 
Coding
In January 2011, CPT 0187T was deleted.  The new CPT code 92132, which was added in 2011, should now be used for this service.
 
92132: Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral.
Policy/
Coverage:
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
 
Optical imaging of the anterior eye segment does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness.
 
For members with contracts without primary coverage criteria, optical imaging of the anterior eye segment is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
 
Rationale:
This policy was originally developed in 2008. Clinical research at the time appeared to be at an early stage of development. The rationale is being replace with a literature search through February 2013. Numerous studies have been identified that use OCT to evaluate the anatomy of the anterior segment and report qualitative and quantitative imaging and detection capabilities. Although these studies provide evidence for the technical performance of OCT, assessment of a diagnostic technology typically focuses on 3 parameters: 1) technical performance; 2) diagnostic performance (sensitivity, specificity, and positive and negative predictive value) in appropriate populations of patients; and 3) demonstration that the diagnostic information can be used to improve patient outcomes. This policy focuses specifically on evidence for diagnostic performance of the technology and the effect on health outcomes (clinical utility).
 
Diagnostic Performance
Optical Coherence Tomography versus Gonioscopy
Several studies have compared OCT with gonioscopy for the detection of primary angle closure. For example, Nolan and colleagues assessed the ability of a prototype of the Visante OCT to detect primary angle closure in 203 Asian patients (Nolan, 2007). The patients, recruited from glaucoma clinics, had been diagnosed with primary angle closure, primary open-angle glaucoma, ocular hypertension, and cataracts; some had previously been treated with iridotomy. Images were assessed by 2 glaucoma experts, and the results compared to an independently obtained reference standard (gonioscopy). Data were reported from 342 eyes of 200 individuals. A closed angle was identified in 152 eyes with gonioscopy and 228 eyes with OCT; agreement was obtained between the 2 methods in 143 eyes. Although these results suggest low specificity for OCT, it is noted that gonioscopy is not considered to be a gold standard. The authors suggest 3 possible reasons for the increase in identification of closed angles with OCT: lighting is known to affect angle closure, and the lighting conditions were different for the 2 methods (gonioscopy requires some light); placement of the gonioscopy lens on the globe may have caused distortion of the anterior segment; and landmarks are not the same with the 2 methods. The authors noted that longitudinal studies will be required to determine whether eyes classified as closed by OCT, but not by gonioscopy, are at risk of developing primary angle closure glaucoma.
 
Narayanaswamy et al. conducted a community-based cross-sectional study of glaucoma screening (Narayanaswamy, 2010). The study population consisted of individuals 50 years or older who underwent anterior segment OCT by a single ophthalmologist and gonioscopy by an ophthalmologist who was masked to the OCT findings. Individuals were excluded if they had a history of intraocular surgery, any evidence of aphakia/pseudophakia, or penetrating trauma in the eye; previous anterior segment laser treatment; a history of glaucoma; or corneal disorders such as corneal endothelial dystrophy, corneal opacity, or pterygium, all of which could influence the quality of angle imaging by OCT. The angle opening distance (AOD) was calculated at 250, 500, and 750 microns from the scleral spur. Of 2,047 individuals examined, 28% were excluded due to inability to locate the scleral spur (n=515), poor image quality (n=28), or software delineation errors (n=39). Of the remaining 1,465 participants, 315 (21.5%) had narrow angles on gonioscopy, defined as having a narrow angle if the posterior pigmented trabecular meshwork was not visible for at least 180 degrees on nonindentation gonioscopy with the eye in the primary position. Out of those who had an acceptable image, the area under the receiver operating characteristic curve was highest at 750 microns from the scleral spur in the nasal (0.90) and temporal (0.91) quadrants. A noted limitation of this quantitative technique for screening of angle closure glaucoma was the inability to define the scleral spur in 25% of the study population.
 
A 2009 publication also examined the sensitivity and specificity of the Visante OCT when using different cut-off values for the AOD measured at 250, 500, and 750 microns from the scleral spur (Pekmezci, 2009). OCT and gonioscopy records were available for 303 eyes of 155 patients seen at a glaucoma clinic. The patients were asked to look at prepositioned targets to prevent image distortion with low- and high-resolution OCT. The parameters analyzed could not be measured by commercially available software at the time of the study, so the images were converted to a format that could be analyzed by ultrasound biomicroscopy software. Blinded analysis showed sensitivity and specificity between 70% and 80% (in comparison with gonioscopy), depending on the AOD and the cut-off value. Correlation coefficients between the qualitative gonioscopy grade and quantitative OCT measurement ranged from 0.75 (AOD 250) to 0.88 (AOD 750). As noted by these investigators, “a truer measure of occludable angles is whether an eye develops angle-closure glaucoma in the future.” Long-term follow-up of patients examined with these 2 methods would be informative.
 
A prospective observational study (n=26) evaluated imaging of the anterior angle chamber with the Stratus OCT, which had been developed for retinal imaging (Kalev-Landoy, 2007). Ten eyes with normal open angles and 16 eyes with narrow or closed angles or plateau iris configuration, as determined by gonioscopy, were assessed. The OCT image was rated for quality, ability to demonstrate the anterior chamber angle, and for ability to visualize the iris configuration; patients were classified as having open angles, narrow angles, closed angles, or plateau iris configuration. Ultrasound biomicroscopy was performed for comparison if plateau iris configuration was diagnosed. The investigators reported that the Stratus OCT provided high-resolution images of iris configuration and narrow or closed angles, and imaging of the angle was found to be adequate in cases of acute angle-closure glaucoma, in which the cornea was too cloudy to enable a clear gonioscopic view. Open angles and plateau iris configurations could not be visualized with the 0.8-micron wavelength Stratus OCT.
 
Optical Coherence Tomography versus Ultrasound
Garcia and Rosen evaluated the diagnostic performance of AC Cornea OCT (Ophthalmic Technologies Inc., Toronto, Ontario, Canada) by comparing image results with ultrasound biomicroscopy (UBM) in patients with conditions of the anterior segment (Garcia, 2008). The patients were recruited from various specialty clinics, and imaging with OCT and ultrasound was performed sequentially after obtaining informed consent. Eighty eyes with pathologic conditions involving the anterior ocular segment were included in the study; 6 cases were reported in detail to demonstrate the imaging capabilities of OCT and UBM. Comparison of OCT and UBM images shows that while the AC Cornea OCT has high resolution for the cornea, conjunctiva, iris, and anterior angle, ultrasound biomicroscopic images are also clear for these areas. In addition, ultrasound biomicroscopy was found to be superior at detecting cataracts, anterior tumors, ciliary bodies, haptics, and posterior chamber intraocular lenses. OCT was found to be superior at detecting a glaucoma tube and a metallic foreign body in the cornea when imaging was performed in the coronal plane.
 
Mansouri and colleagues published a study that compared the accuracy in measurement of the anterior chamber (AC) angle by anterior segment OCT and UBM in European patients with suspected primary angle closure (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG) (Mansouri, 2010). In this study, 55 eyes of 33 consecutive patients presenting with PACS, PAC, or PACG were examined with OCT, followed by UBM. The trabecular-iris angle (TIA) was measured in all 4 quadrants. The angle-opening distance (AOD) was measured at 500 microns from the scleral spur. In this comparative study, the authors concluded that OCT measurements were significantly correlated with UBM measurements but showed poor agreement with each other. The authors do not believe that anterior segment OCT can replace UBM for the quantitative assessment of the anterior chamber angle.
 
Bianciotto et al. reported a retrospective analysis of 200 consecutive patients who underwent both anterior segment OCT and UBM for anterior segment tumors (Bianciotto, 2011). When comparing the image resolution for the 2 techniques, UBM was found to have better overall tumor visualization.
 
Optical Coherence Tomography versus Slitlamp Biomicroscopy
Jiang et al. reported a cross-sectional, observational study of the visualization of aqueous tube shunts by high-resolution OCT, slitlamp biomicroscopy, and gonioscopy in 18 consecutive patients (23 eyes) (Jiang, 2012). High resolution OCT demonstrated the shunt position and patency in all 23 eyes. Compared to slitlamp, 4 eyes had new findings identified by OCT. For all 16 eyes in which the tube entrance could be clearly visualized by OCT, growth of fibrous scar tissue could be seen between the tube and the corneal endothelium. This was not identified in the patient records (retrospectively analyzed) of the slitlamp examination.
 
Clinical Utility (Effect on health outcomes)
In addition to the evaluation of anterior chamber angle, OCT is being evaluated to assess corneal thickness and opacity, evaluate pre-surgical and postsurgical anterior chamber anatomy, calculate intraocular lens power, guide laser-assisted cataract surgery, assess complications following surgical procedures (e.g., blockage of glaucoma tubes, detachment of Descemet membrane, disrupted keratoprosthesis-cornea interface), and to image intracorneal ring segments. It is also being studied in relation to pathologic processes such as dry eye syndrome, tumors, uveitis, and infections.
 
Cauduro et al. provided a retrospective review of 26 eyes of 19 pediatric patients (range, 2 months to 12 years) who presented with a variety of anterior segment pathologies (Cauduro, 2012). OCT was used to clarify the clinical diagnosis. No sedation was needed for this non-contact procedure, and only 1 eye of a 2-month-old patient required topical anesthesia. The impact of the procedure on patient care was not reported.
 
Angle-closure Glaucoma
There are no studies that provide direct evidence on the clinical utility of OCT for diagnosing narrow angle glaucoma. The clinical utility of OCT for diagnosing glaucoma is closely related to its ability to accurately diagnose glaucoma, since treatment is generally initiated upon confirmation of the diagnosis. Therefore, if OCT is more accurate in diagnosing glaucoma than alternatives, it can be considered to have clinical utility above that of the alternative tests. While the available evidence does suggest that OCT is more sensitive than ultrasound or gonioscopy, the specificity and predictive value cannot be determined.
 
Cataract Surgery
As of 2013, studies that compare the risk-benefit of OCT-laser assisted cataract surgery vs. traditional phacoemulsification are ongoing (Nguyen, 2013). Anterior segment OCT is also being reported for preoperative evaluation of intraocular lens power, postoperative assessment of intraocular stability of phakic lens and optic changes related to intraocular lens or ocular media opacities (Nguyen, 2013).  
 
Endothelial Keratoplasty
Shih and colleagues reported on the use of OCT to predict primary failure in Descemet stripping automated endothelial keratoplasty (DSAEK) (Shih, 2009). This study was conducted to determine if central donor lenticule thickness, as measured by slit-lamp optical coherence tomography (SL OCT) is predictive of primary donor failure in patients undergoing DSAEK. In this retrospective study, 93 eyes of 84 consecutive patients who underwent DSAEK surgery also underwent postoperative SL OCT. After 2 months of follow-up, 82 (88%) procedures were successful and 11 (12%) procedures were failures. The average donor lenticule thickness in successful DSAEK eyes was 314 +/- 128 microns on postoperative day 1 as compared with failed DSAEK eyes, which averaged 532 +/- 259 microns (p=0.0013). Statistically significant differences in SL OCT thickness measurements were seen between successful and failed DSAEK cases at all examinations after postoperative week 1. The study concluded that corneal thickness measurements made with SL OCT are an important predictor of DSAEK failure in both attached and detached lenticules within the first week of surgery.
 
In 2011, Moutsouris et al. reported a prospective comparison of anterior segment OCT, Scheimpflug imaging, and slit-lamp biomicroscopy in 120 eyes of 110 patients after Descemet membrane endothelial keratoplasty (DMEK) (Moutsouris, 2011). All slit-lamp biomicroscopy and OCT examinations were performed by the same experienced technician, and all images were evaluated by 2 masked ophthalmologists. From a total of 120 DMEK eyes, 78 showed a normal corneal clearance by all of the imaging techniques. The remaining 42 eyes showed persistent stromal edema within the first month, suggesting (partial) graft detachment. Biomicroscopy was able to determine the presence or absence of a graft detachment in 35 eyes. Scheimpflug imaging did not give additional information over biomicroscopy. In 15 eyes, only OCT was able to discriminate between a “flat” graft detachment and delayed corneal clearance. Thus, out of the 42 eyes, OCT had an added diagnostic value in 36% of cases. This led to further treatment in some of the additional cases. Specifically, a secondary DSAEK was performed for total graft detachment, while partial graft detachments were rebubbled or observed for corneal clearing. There were no false negatives (graft detachment unrecognized) or false positives (an attached graft recognized as a graft detachment). Additional studies are needed to further evaluate these results and to demonstrate the clinical utility of using OCT in this situation.
 
Uveitis of the Anterior Segment
In a study from India, Agarwal et al. evaluated the anterior chamber inflammatory reaction by anterior segment high-speed OCT (Agarwal, 2009). This was a prospective, nonrandomized, observational case series of 62 eyes of 45 patients. Hyper-reflective spots suggesting the presence of cells in the anterior chamber from the OCT images were counted manually and by a custom-made automated software package and correlated with clinical grading using Standardization of Uveitis Nomenclature criteria. Of 62 eyes, grade 4 aqueous flare was detected by OCT imaging in 7 eyes and clinically in 5 eyes. The authors concluded that anterior segment (AS)-OCT can be used as an imaging modality in detecting inflammatory reaction in uveitis and also in eyes with decreased corneal clarity. Additional studies are needed to further evaluate these results and to demonstrate the clinical utility of using OCT in this situation.
 
Summary
Ideally, a diagnostic test would be evaluated based on its technical performance, diagnostic performance (sensitivity, specificity, and predictive value), and clinical utility (effect on health outcomes). Current literature consists primarily of assessments of qualitative and quantitative imaging and detection capabilities. Technically, the anterior segment optical coherence tomography (OCT) has the ability to create high-resolution images of the anterior eye segment. In addition, studies indicate that the anterior segment OCT detects more eyes with narrow or closed angles than gonioscopy, suggesting that the sensitivity of OCT is higher than gonioscopy. However, because of the lack of a true gold standard, it is not clear to what degree these additional cases are true-positives versus false-positives, and therefore the specificity and predictive values cannot be determined. Evaluation of the diagnostic performance depends, therefore, on evidence that the additional eyes identified with narrow angle by OCT are more likely to progress to primary angle closure glaucoma. OCT imaging may be less sensitive in comparison with ultrasound biomicroscopy for other pathologic conditions of the anterior segment, such as cataracts, anterior tumors, ciliary bodies, haptics, and posterior chamber intraocular lenses.
 
Evaluation of the clinical utility of anterior segment OCT depends on demonstration of an improvement in clinical outcomes. For example, outcomes will be improved if OCT detects additional cases of primary angle closure glaucoma, which represent true cases of glaucoma and not false-positives, and if these cases are successfully treated for glaucoma. It is not currently possible to determine the frequency of false-positive results with OCT, therefore it cannot be determined whether health outcomes are improved. For other potential indications (e.g., cataract surgery, endothelial keratoplasty, anterior uveitis) evidence is currently limited.
  
2014 Update
A literature search conducted in Medline database through February 2014 did not reveal any new information that would prompt a change in coverage statement.
 
2017 Update
A literature search conducted through February 2017 did not reveal any new information that would prompt a change in the coverage statement.
 
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2018. No new literature was identified that would prompt a change in the coverage statement.
 
2019 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2019. No new literature was identified that would prompt a change in the coverage statement. The key literature is summarized below.
 
Venincasa et al reported on combining grayscale and color images captured using AS OCT for of preparing for eye surgery (/venuncasam 2017). Viewing an image in different colors provides different perspectives. The authors of this retrospective study determined that while grayscale is good for mapping extraocular muscle structures, the addition of color can improve the accuracy in finding the ideal point of insertion. Accuracy was measured as being within 1.00 mm of the intraoperative caliper measurement. One hundred thirty-nine AS OCT images were collected from 74 patients. When using grayscale and color imaging, AS OCT accuracy increased from 77% to 87%. Accuracy was lower (ie, falling outside the 1.00-mm range) when applying this practice to reoperations. The authors concluded that, especially for first time surgeries, use of combination imaging could be clinically useful.
 
2020 Update
A literature search was conducted through January 2020.  There was no new information identified that would prompt a change in the coverage statement.  
 
2021 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2021. No new literature was identified that would prompt a change in the coverage statement.
 
2022 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2022. No new literature was identified that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
Desmond et al performed a systematic review and meta-analysis of literature that compared the accuracy of anterior segment optical coherence tomography against gonioscopy in detecting eyes with angle closure (Desmond, 2021). A literature search was performed in April 2020 resulting in the inclusion of 23 studies (N=5663). Only studies that provided enough data to determine the sensitivity and specificity of anterior segment optical coherence tomography and assessed the ability to detect an eye with angle closure were included. Eighteen studies were conducted in Asia, 3 in the United States, and 2 in the United Kingdom. There was substantial variation in the assessed parameters and methodology among the studies including the use of different optical coherence tomography devices, gonioscopy diagnostic criteria, and anterior segment optical coherence tomography positivity threshold. The sensitivity of anterior segment optical coherence tomography ranged from 46% to 100% (median, 87%) with a specificity ranging from 55.3% to100% (median, 84%). Of the 4 studies with the best diagnostic accuracy for anterior segment optical coherence tomography, all used a case-control study design with a high risk of bias. Overall, the authors concluded that anterior segment optical coherence tomography demonstrates "good sensitivity for detecting angle closure"; however, it is not yet "able to replace gonioscopy" and further studies are required to better determine its utility.
 
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2023. No new literature was identified that would prompt a change in the coverage statement.
 
2024 Update
Annual policy review completed with a literature search using the MEDLINE database through February 2024. No new literature was identified that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
Dhanaseelan et al reported on the role of AS-OCT in assessing preoperative posterior capsular dehiscence in patients undergoing planned cataract surgery in a retrospective, single-center study (Dhanaseelan, 2023). One hundred patients who underwent cataract surgery were included. Of those 100, AS-OCT preoperatively identified 14 (14%) to have preoperative posterior capsular defect. Intraoperatively, posterior capsular rupture was observed in 13 patients and cortex drop was noted in 1 among those 13. Out of the 13 posterior capsular rupture cases, 12 were identified by AS-OCT to have preoperative posterior capsular dehiscence. The sensitivity of AS-OCT for detection of posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value (PPV) and negative predictive value (NPV) were 85.7% and 98.8%, respectively. Another study by Sarkar and Das conducted a similar, observational study undergoing planned cataract surgery (Sarkar, 2023). Forty-four eyes were included; out of those, AS-OCT found that 9 (20.5%) had preoperative posterior capsular dehiscence. Of those 9 eyes, 7 (77.8%) had intraoperative posterior capsule rupture and 2 (22.2%) did not. The sensitivity, specificity, PPV, and NPV for AS-OCT detecting dehiscence were 94.4%, 87.5%, 97.1%, and 77.8%, respectively. The authors calculated that the diagnostic accuracy of AS-OCT was 95.45%. The small sample sizes and the lack of a comparator limit the conclusions that can be drawn from these studies.
 
2024 Update
Annual policy review completed with a literature search using the MEDLINE database through March  2024. No new literature was identified that would prompt a change in the coverage statement. The key identified literature is summarized below.
 
The role of AS-OCT in assessing preoperative posterior capsular dehiscence was reported on in patients undergoing planned cataract surgery in a retrospective, single-center study (Dhanaseelan, 2023). One hundred patients who underwent cataract surgery were included. Of those 100, AS-OCT preoperatively identified 14 (14%) to have preoperative posterior capsular defect. Intraoperatively, posterior capsular rupture was observed in 13 patients and cortex drop was noted in 1 among those 13. Out of the 13 posterior capsular rupture cases, 12 were identified by AS-OCT to have preoperative posterior capsular dehiscence. The sensitivity of AS-OCT for detection of posterior capsule dehiscence was 92.3% and specificity was 97.7%. The positive predictive value (PPV) and negative predictive value (NPV) were 85.7% and 98.8%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 85.7% and 98.8%, respectively. Another study conducted a similar, observational study undergoing planned cataract surgery (Sarkar, 2023). Forty-four eyes were included; out of those, AS-OCT found that 9 (20.5%) had preoperative posterior capsular dehiscence. Of those 9 eyes, 7 (77.8%) had intraoperative posterior capsule rupture and 2 (22.2%) did not. The sensitivity, specificity, PPV, and NPV for AS-OCT detecting dehiscence were 94.4%, 87.5%, 97.1%, and 77.8%, respectively. The authors calculated that the diagnostic accuracy of AS-OCT was 95.45%. The small sample sizes and the lack of a comparator limit the conclusions that can be drawn from these studies.
CPT/HCPCS:
0412UBeta amyloid, Aß42/40 ratio, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS) and qualitative ApoE isoform-specific proteotyping, plasma combined with age, algorithm reported as presence or absence of brain amyloid pathology
92132Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral
References: Agarwal A, Ashokkumar D, Jacob S et al.(2009) High-speed optical coherence tomography for imaging anterior chamber inflammatory reaction in uveitis: clinical correlation and grading. Am J Ophthalmol 2009; 147(3):413-16 e3.

Bianciotto C, Shields CL, Guzman JM et al.(2011) Assessment of anterior segment tumors with ultrasound biomicroscopy versus anterior segment optical coherence tomography in 200 cases. Ophthalmology 2011; 118(7):1297-302.

Cauduro RS, Ferraz Cdo A, Morales MS et al.(2012) Application of anterior segment optical coherence tomography in pediatric ophthalmology. J Ophthalmol 2012; 2012:313120.

Desmond T, Tran V, Maharaj M, et al.(2022) Diagnostic accuracy of AS-OCT vs gonioscopy for detecting angle closure: a systematicreview and meta-analysis. Graefes Arch Clin Exp Ophthalmol. Jan 2022; 260(1): 1-23. PMID 34223989

Dhanaseelan T, Odayappan A, Vivekanandan VR, et al.(2023) Retrospective analysis of the role of anterior segment optical coherence tomography and outcomes of cataract surgery in posterior polar cataract. Indian J Ophthalmol. May 2023; 71(5): 1913-1917. PMID 37203055

Ehlers JP, Dupps WJ, Kaiser PK, et al.(2014) The Prospective Intraoperative and Perioperative Ophthalmic ImagiNg With Optical CoherEncE TomogRaphy (PIONEER) Study: 2-Year Results. Am J Ophthalmol. Nov 2014;158(5):999-1007 e1001. PMID 25077834

Ehlers JP, Kaiser PK, Srivastava SK.(2014) Intraoperative optical coherence tomography using the RESCAN 700:preliminary results from the DISCOVER study. Br J Ophthalmol. Oct 2014;98(10):1329-1332. PMID 24782469

Garcia JP, Jr., Rosen RB.(2008) Rosen RB. Anterior segment imaging: optical coherence tomography versus ultrasound biomicroscopy. Ophthalmic Surg Lasers Imaging 2008; 39(6):476-84.

Jiang C, Li Y, Huang D et al.(2012) Study of anterior chamber aqueous tube shunt by fourier-domain optical coherence tomography. J Ophthalmol 2012; 2012:189580.

Kalev-Landoy M, Day AC, Cordeiro MF et al.(2007) Optical coherence tomography in anterior segment imaging. Acta Ophthalmol Scand 2007; 85(4):427-30.

Kalev-Landoy M, Day AC, et al.(2007) Optical coherence tomography in anterior segment imaging. Acta Ophthal Scand, 2007; 85:427-30.

Mansouri K, Sommerhalder J, Shaarawy T.(2010) 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):233-9.

Medina CA, Plesec T, Singh AD.(2014) Optical coherence tomography imaging of ocular and periocular tumours. Br J Ophthalmol. Jul 2014;98 Suppl 2:ii40-46. PMID 24599420

Memarzadeh F, Tang M, Li Y et al.(2007) Optical coherence tomography assessment of angle anatomy changes after cataract surgery. Am J Ophthalmol. 2007 Jan; 114(1):33-39.

Moutsouris K, Dapena I, Ham L et al.(2011) Optical coherence tomography, scheimpflug imaging, and slit-lamp biomicroscopy in the early detection of graft detachment after descemet membrane endothelial keratoplasty. Cornea 2011; 30(12):1369-75.

Narayanaswamy A, Sakata LM, He MG et al.(2010) Diagnostic performance of anterior chamber angle measurements for detecting eyes with narrow angles: an anterior segment OCT study. Arch Ophthalmol 2010; 128(10):1321-7.

Nguyen P, Chopra V.(2013) Applications of optical coherence tomography in cataract surgery. Curr Opin Ophthalmol 2013; 24(1):47-52.

Nolan WP, See JL, et al.(2007) Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology, 2007; 114:33-9.

Pekmezci M, Porco TC, Lin SC.(2009) Anterior segment optical coherence tomography as a screening tool for the assessment of the anterior segment angle. Ophthalmic Surg Lasers Imaging 2009; 40(4):389-98.

Radhakrishnan S, See J, Smith SD et al.(2007) Reproducibility of anterior chamber angle measurements obtained with anterior segment optical coherence tomography. IOVS. August 2007, Vol 48(8): 3683-3688.

Sarkar S, Das S.(2023) Role of preoperative anterior segment optical coherence tomography in identifying intraoperative posterior capsular dehiscence in posterior polar cataract. Oman J Ophthalmol. 2023; 16(2): 244-251. PMID 37602161

Shih CY, Ritterband DC, Palmiero PM et al.(2009) The use of postoperative slit-lamp optical coherence tomography to predict primary failure in descemet stripping automated endothelial keratoplasty. Am J Ophthalmol 2009; 147(5):796-800, 00 e1.

Thomas BJ, Galor A, Nanji AA, et al.(2014) Ultra high-resolution anterior segment optical coherence tomography in the diagnosis and management of ocular surface squamous neoplasia. Ocul Surf. Jan 2014;12(1):46-58. PMID 24439046

Venincasa MJ, Osigian CJ, Cavuoto KM, et al.(2017) Combination of anterior segment optical coherence tomography modalities to improve accuracy of rectus muscle insertion location. J AAPOS. Jun 2017;21(3):243-246. PMID 28526283

Wolffsohn JS, Peterson RC.(2006) Anterior ophthalmologic imaging. Clin Exp Optom, 2006; 89:205-14.
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