Medical Policy: 08.01.24 

Original Effective Date: September 2016 

Reviewed: June 2021 

Revised: June 2021 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

Dry eye disease (DED) is a multifactorial disease of the ocular surface with loss of homeostasis of the tear film and ocular symptoms. Tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. DED is also known as keratoconjunctivitis sicca, dry eye syndrome (DES), and dysfunctional tear syndrome.

 

In epidemiological studies performed globally, the prevalence of dry eye syndrome (DES) ranges from 5 to 50 percent. Based on data from the National Health and Wellness Survey, 6.8 percent of the United States adult population (approximately 16.4 million people) have been diagnosed with DES. The prevalence increased with age (2.7 percent in those 18 to 34 years old versus 18.6 percent in those ≥75 years old) and was higher in women than men (8.8 versus 4.5 percent).

 

Risk Factors

Risk Factors for DES include:

  • Systemic medications including antihistamines, anticholinergics, estrogen, isotretinoin, selective serotonin receptor antagonists, amiodarone and nicotinic acid
  • Advanced age 
  • Female sex
  • Hormonal changes primarily due to decreased androgens
  • Systemic diseases (e.g., diabetes mellitus, Parkinson disease, Sjorgren’s syndrome)
  • Windy, smoky, or dry environments increase tear evaporation.
  • Contact lens wear
  • Ocular medications especially those containing preservatives
  • Nutritional deficiencies (e.g. vitamin A deficiency)
  • Decreased corneal sensation
  • Ophthalmic surgery (especially corneal refractive surgery)
  • Low-humidity environments

 

Dry eye syndrome (DES), particularly when severe, can have a significant impact on visual acuity, daily activities, social and physical functioning, and workplace productivity.

 

DES has a complex and multifactorial etiology. The tear film of the eye consists of aqueous, mucous, and lipid components. A healthy tear film relies on a synergistic interaction of the lacrimal glands, eyelids, and ocular surface, which together comprise the lacrimal functional unit. Dysfunction of any component in the lacrimal functional unit can lead to DES.

 

DES has been classified into two general groups: decreased tear production (resulting in aqueous deficient DES) and abnormal meibomian gland physiology (resulting in evaporative DES). However, it is now believed that both mechanisms are present in most patients, although one may be predominant. For all patients, tear film hyperosmolarity and subsequent ocular surface inflammation lead to the variety of symptoms and signs associated with DES.

 

Symptoms in DES result from activation of sensory nerves of the ocular surface, either due to tear hyperosmolarity, the presence of inflammatory mediators, or hypersensitivity of the sensory nerves.

 

Causes

  • Decreased tear production: Impaired lacrimal tear production can be caused by any form of lacrimal gland destruction or dysfunction. The reduced volume of aqueous fluid leads to hyperosmolarity of the tear film and subsequently the ocular surface, which incites inflammation of the ocular surface cells
  • Deficiency of aqueous tear production can be subclassified into two subtypes:
    • Sjogren’s syndrome: Sjogren's syndrome is a chronic autoimmune inflammatory disorder characterized by diminished lacrimal and salivary gland function with resultant dryness of the eyes and mouth. The onset of Sjögren's syndrome is rare after age 65 years.
    • Dry eye syndrome not due to Sjogren's syndrome – This syndrome refers to patients with aqueous tear-deficient DES involving lacrimal dysfunction without associated systemic findings. The most common form is age-related DES in which it is believed that there is lacrimal ductal obstruction over time, leading to decreased lacrimal gland function. Lacrimal gland obstruction can also be due to conjunctival scarring conditions such as trachoma, pemphigoid, vitamin deficiency, post-viral syndromes, and ocular burns. This syndrome can also be caused by lacrimal gland infiltration due to sarcoidosis, lymphoma, graft versus host disease, and episcleritis. Other causes include contact lens use, which is associated with reduced corneal sensitivity and subsequent reduced reflex sensory tear secretion, and diabetes mellitus
  • Increased evaporative loss: Excessive water loss from the ocular surface leads to tear film instability and a cycle of tear hyperosmolarity and lacrimal functional unit inflammation. Increased tear evaporation is most commonly caused by meibomian gland dysfunction, also known as posterior blepharitis, in which the accessory lacrimal glands responsible for the lipid component of the tear film are dysfunctional. In a normally functioning eye, the nature of the mucin allows even spreading of the tear film to form a membrane, and the lipid layer provides a barrier to minimize evaporation of tears. Abnormalities of the lipid layer are associated with a higher rate of tear film evaporation. Structural abnormalities of eyelid position or decreased blink function also increase evaporation of the tear film by increasing the area or the time of tear film exposure. Lastly, topical medicated or preserved eye drop use, chronic contact lens wear, and ocular allergy syndromes can cause ocular surface irritation and increased tear film evaporation

 

Symptoms

Most patients will present with symptoms of chronic eye irritation associated with mild to moderate discomfort. However, there is considerable variability in patient-reported symptoms and clinically measurable signs over time, as well as a recognized lack of correlation between these signs and symptoms. Common eye complaints include:

  • Dryness
  • Red eyes
  • General irritation
  • Gritty sensation
  • Burning sensation
  • Paradoxical excessive testing
  • Light sensitivity
  • Blurred vision

 

Questionnaires

Due to the variability of findings on clinical evaluation of dry eye syndrome (DES), some clinicians base their assessment of DES on the results of validated questionnaires. These can also be used for monitoring DES and can be useful for standardizing the identification and classification of DES.

 

Available questionnaires used specifically for the evaluation of DES symptoms include:

 

  • Ocular Surface Disease Index (OSDI) – Twelve-item questionnaire validated in patients with DES. The OSDI can be useful clinically, particularly in patients with more severe symptoms, to monitor the response to therapy and variability in symptoms over time.
  • Dry Eye Questionnaire (DEQ-5) – Five-item questionnaire reduced from the Dry Eye Questionnaire and validated to determine DES symptom severity.
  • Impact of Dry Eye on Everyday Life (IDEEL) – Fifty-seven questions in three modules validated in patients with DES.
  • Salisbury Eye Evaluation Questionnaire (SEE) – Six-item questionnaire used in self-reported, population-based prevalence surveys to determine visual impairment among older adult subjects

 

Diagnosis

The diagnosis of dry eye syndrome (DES) is based on characteristic patient symptoms and supporting findings on the physical examination, both of which can vary considerably in intensity over time and under different environmental conditions.

 

There is no single diagnostic test or set of tests to confirm or rule out DES. Examples of methods often used to evaluate ocular surface include, but are not limited to:

  • InflammaDry: Uses a tear sample to detect the inflammatory marker matrix, metalloproteinase-9 (MMP-9), which may be elevated in the tears of individuals with dry eye syndrome (DES). The evidence is insufficient is insufficient to determine that the technology results in an improvement in the net health outcome.
  • Meibography: Is the imaging and study of the morphology (structure and function) of meibomian glands. Near-infrared dual imaging uses reflective and transilluminated light purportedly to improve meibography techniques (i.e., reduce time and discomfort) and enhance results. The LipiScan is one example of biography device. The LipiView II is an example of a meibography device capable of ocular surface interferometry involving a three- mode ophthalmic camera for imaging the lipid layer of the tear film, meibomian glands, ocular surface and eyelids. In the ocular imaging mode, the device captures high resolution images or video of the ocular surface or eyelids. The lipid imaging- mode uses white light interferometry to provider a video color assessment of the tear film distribution over the cornea during blinking. The gland imaging mode relies on near-infrared illumination reflected by the meibomian glands to obtain an image. The evidence is insufficient is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Treatment

Current treatment for DES is aimed at improving symptoms by increasing or supplementing tear production, slowing tear evaporation, reducing tear resorption, or reducing ocular surface inflammation. In addition to symptomatic relief, treatment with artificial tears may improve visual acuity and prevent against ocular damage.

 

First line treatments may include the following:

  • Tear supplementation
  • Environmental coping strategies
  • Amelioration of eyelid abnormalities including blepharitis
  • Application of warm compresses to soften secretions in obstructed meibomian gland excretory ducts
  • Discontinuation of systemic or ocular medications that can contribute to dryness, if possible

 

Other treatments are available for DES and are discussed below.

 

Clinical Context and Therapy Purpose

The purpose of therapy in patients who have dry eye syndrome (DES) is to provide a treatment option that is an alternative to or an improvement on existing therapies.

 

Population

The relevant population of interest is individuals with dry eye syndrome (DES). DES is often classified into the aqueous-deficient subtype or the evaporative subtype, although classification is not mutually exclusive. Dry eye syndrome is a multifactorial disease of the ocular surface that may require a combination approach to treatment. Meibomian gland dysfunction (MGD), characterized by changes in gland secretion with or without concomitant gland obstruction, is recognized as the most common cause of evaporative dry eye and may also play a role in aqueous-deficient dry eye.

 

Interventions

The therapy being considered is LipiFlow Thermal Pulsation System, iLux Thermal Pulsation System, Systane iLux2 Thermal Pulsation System, intranasal neurostimulation (TureTear), autologous eye drops (autologous serum tears), intraductal probing (Maskin Device), intense pulsed light (IPL) and electrothermal heat (TearCare System).

 

Comparators

The following practices are currently being used to treat dry eye syndrome (DES): standard treatment with warm compresses and eyelid massage. Current treatment options for meibomian gland dysfunction (MGD) include physical expression to relieve the obstruction, administration of heat (warm compresses) to the eyelids to liquefy solidified meibomian gland contents, eyelid scrubs to relieve external meibomian gland orifice blockage, and medications (eg, antibiotics, topical corticosteroids) to mitigate infection and inflammation of the eyelids.

 

Outcomes

The general outcomes of interest are symptoms, morbid events, and functional outcomes.

 

The LipiFlow Thermal Pulsation System

The LipiFlow Thermal Pulsation System (TearScience) is a new device developed to address the limitations of current treatment options to relieve MGD. This device is designed to heat the palpebral surfaces of both the upper and lower eyelids, while applying graded pulsatile pressure to the outer eyelid surfaces. The LipiFlow® System is composed of a disposable ocular component and a handheld control system. Following application of a topical anesthetic, the heated inner portion of the LipiFlow eyecup is applied to the conjunctival surface of the upper and lower eyelids. The outer portion of the device covers the skin surface of the upper and lower eyelids. The device massages the eyelids with cyclical pressure from the base of the Meibomian glands in the direction of the gland orifices, thereby expressing the glands during heating. It is proposed that a single 12-minute session is at least as effective as twice daily lid warming and massage over 3 months.

 

In 2017 and 2020, two eyelid thermal pulsation systems (iLux® System and Systane iLux2®) were also cleared by the FDA. These devices were identified by FDA as a "battery-operated, handheld device that the physician uses in an in-office procedure to control the application of warmth and massage to the eyelids. The handheld device connects to a single-use disposable unit made of biocompatible polycarbonate and silicone that is inserted around the patient's eyelids. The device provides controlled warmth to the inner eyelid surface, close to the location of the meibomian glands, and intermittent massage to the outer eyelid surface to facilitate release of lipid from the cystic meibomian glands." The devices are indicated for "the application of localized heat and pressure therapy in adult patients with meibomian gland dysfunction (MGD), which is associated with evaporative dry eye." The Systane iLux2® system is also indicated "to capture/store digital images and video of the meibomian glands."

 

For individuals who have dry eye syndrome (DES) who receive LipiFlow eyelid thermal pulsation, the evidence includes 4 randomized controlled trials (RCTs,) a nonrandomized comparison study, and longer- term follow-up of patients from RCTs and observational studies. The trials do not provide strong evidence of long-term efficacy. Two RCTs have demonstrated positive findings for most outcome measures over the short term (up to 3 months). Observational studies have shown sustained treatment effects for most outcomes up to 3 years. The nonrandomized study showed similar outcomes for eyelid thermal pulsation and standard treatment. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Intranasal Neurostimulation (TrueTear)

TrueTear is a handheld stimulator with a prolonged hydrogel-containing disposable tip with a reusable cover. The tip provides the contact for conducting the stimulation current, produced by the base unit, to the target site inside the nasal passages. The device is inserted into the nostrils where a tingling sensation is felt. The stimulation intensity is adjustable, and the device automatically turns off after one minute. The process purports to stimulate a nerve that innervates the lacrimal glands, causing tear production. The device has a usage limit of 30 minutes in a 24- hour period and the disposable tip should be discarded after 24 hours. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Autologous Eye Drops (Autologous Serum Tears)

Autologous eye drops (autologous serum tears) have been proposed for dry eye syndrome (DES) and are made by mixing the individual’s serum with other substances. There is not strong evidence for long-term or significant benefit over artificial tears and access to these eye drops and the cost are additional barriers to its use. Additional large, high-quality RTCs are needed in different severities of dry eye and using standardized questionnaires to measure participant-reported outcomes and objective clinical tests as well as objective biomarkers to assess the benefit of autologous eye drops (autologous serum tear) therapy for (DES). The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Intraductal Probing (Maskin Device)

Intra-ductal probing is performed using local or topical anesthetic and introduces a thin stainless-steel wire probe into the meibomian gland orifices to forcefully expel any obstructing material and restore patency. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Electothermal Heat (TearCare System)

The TearCare® system is intended as an alternative to warm compresses to reduce dry eye syndrome (DES) symptoms caused by meibomian gland blockages. The system comprises four components: a smart hub to control thermal energy emission, a charger for the hub, two pairs of single-use thermal emitters (SmartLid™ devices), and a single use, blunt-tipped, tweezer-like device (Clearance Assistant™).

 

An optometrist or ophthalmologist delivers the TearCare treatment during an office visit. The clinician applies the SmartLid devices to the patient’s upper and lower eyelids over the meibomian glands and activates the hub. The connected emitters heat the eyelids to 41°C to 45°C for 12 minutes. During treatment, patients keep their eyes open and blink normally; blinking is intended to help clear meibomian gland obstructions and re-lubricate eyes. After removing emitters, the clinician applies a drop of 0.5% tetracaine to each eye and expresses any remaining meibomian gland blockages from the patient’s eyelids using the Clearance Assistant. The system is currently undergoing clinical trials. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Intense Pulsed Light (IPL)

Delivers bursts of light at specific wavelengths. The light energy is converted to heat. IPL therapy has been suggested as a treatment for DES. While study results of intense pulsed light therapy treatment for dry eye syndrome (DES) caused by meibomian gland dysfunction (MGD) may be promising, further multi-center clinical trials with a larger sample, treatment comparison groups, and randomized controlled trials are needed. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

 

Guidelines and Position Statements

American Academy of Ophthalmology

In 2018, the American Academy of Ophthalmology (AAO) updated preferred practice patterns guidelines on dry eye syndrome (DES).  These guidelines list "In-office, physical heating and expression of the meibomian glands (including device-assisted therapies, such as LipiFlow, or intense pulse light treatment)" as 1 of several step-up treatments for patients who do not respond to conventional management, including the elimination of environmental factors and offending medications, dietary modifications, ocular lubricants, and lid hygiene and warm compresses.

 

In 2018, the American Academy of Ophthalmology updated preferred practice patterns guidelines on blepharitis. These guidelines cover the three clinical subcategories of blepharitis: staphylococcal, seborrheic, and meibomian gland dysfunction (posterior blepharitis specifically affects the meibomian glands). The following statements are made relevant to thermal pulsation treatment:

 

"There are also several in-office procedural treatments available that may theoretically unclog the inspissated meibomian gland orifices using intense pulsed light (IPL) or mechanical means (e.g., microblepharoexfoliation of the eyelid margin, meibomian gland probing, and/or devices using thermal pulsation). Although there have been industry-sponsored studies, independent, randomized, masked clinical trials have yet to be performed to assess efficacy of these costly, primarily fee-for-service treatments.”

 

Regulatory Status

 

In 2011, the LipiFlow® Thermal Pulsation System (TearScience; assigned the generic name of eyelid thermal pulsation system) was cleared by the U.S. Food and Drug Administration (FDA). In 2017 and 2020, 2 eyelid thermal pulsation systems (iLux® System and Systane® iLux2®, respectively) were also cleared by the FDA. The FDA classified these devices as class II (special controls) to provide a “reasonable assurance of safety and effectiveness” of the device. All 3 devices were identified by FDA as a "Battery-operated, handheld device that the physician uses in an in-office procedure to control the application of warmth and massage to the eyelids. The handheld device connects to a single-use disposable unit made of biocompatible polycarbonate and silicone that is inserted around the patient's eyelids. The device provides controlled warmth to the inner eyelid surface, close to the location of the meibomian glands, and intermittent massage to the outer eyelid surface to facilitate release of lipid from the cystic meibomian glands." All 3 devices are indicated for "the application of localized heat and pressure therapy in adult patients with Meibomian Gland Dysfunction (MGD), which is associated with evaporative dry eye." The Systane® iLux2® system is also indicated "to capture/store digital images and video of the meibomian glands."

 

Prior Approval:

Not applicable

 

Policy:

The following diagnostic tests are considered investigational for the diagnosis of dry eye syndrome (DES), because the evidence is insufficient to determine that the technology results in an improvement in the net health outcome:

 

  • InflammaDry
  • Imaging studies using near-infrared dual imaging (i.e., simultaneous reflective and transilluminated light) or interferometry of meibomian glands

 

Therapies including but not limited to the following for the treatment of dry eye syndrome (DES) due to decreased tear production and/or increased evaporation loss is considered investigational, because the evidence is insufficient to determine that the technology results in an improvement in the net health outcome:

 

  • LipiFlow Thermal Pulsation System
  • iLux Thermal Pulsation System
  • Systane iLux2 Thermal Pulsation System
  • Intranasal Neurostimulation (TrueTear)
  • Intense Pulsed Light (IPL)
  • Autologous eye drops (autologous serum tears)
  • Intraductal probing (Maskin Device)
  • Electrothermal heat (TearCare System)

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes and / or diagnosis codes.

  • 0207T Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral.
  • 0330T Tear film imaging, unilateral or bilateral, with interpretation and report.
  • 0507T Near-infrared dual imaging (ie, simultaneous reflective and trans-illuminated light) of Meibomian  glands, unilateral or bilateral, with interpretation and report
  • 0563T Evacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual gland expression, bilateral
  • 68899 Unlisted procedure, lacrimal system

 

Selected References:

  • Fiscella RG. Understanding dry eye disease: a managed care perspective. Am J Manag Care. Dec 2011;17 Suppl 16:S432-439. PMID 22435675
  • The definition and classification of dry eye disease: report of the Definition and ClassificationSubcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. Apr 2007;5(2):75-92. PMID 17508116
  • American Academy of Opthalmology. Dry Eye Syndrome Preferred Practice Pattern Guidelines – Limited Edition 2011
  • American Academy of Ophthalmology. Dry Eye Syndrome, Preferred Practice Pattern Guideline 2013
  • Medical devices; ophthalmic devices; classification of the eyelid thermal pulsation system. Final rule. Fed Regist. Aug 19 2011;76(161):51876-51878. PMID 21894651
  • Lane SS, DuBiner HB, Epstein RJ, et al. A new system, the LipiFlow, for the treatment of Meibomian gland dysfunction. Cornea. Apr 2012;31(4):396-404. PMID 22222996
  • Zhao Y, Veerappan A, Yeo S, et al. Clinical trial of thermal pulsation (Lipiflow) in meibomian gland dysfunction with preteatment meibography. Eye Contact Lens. Jan 27 2016. PMID 26825281
  • Finis D, Hayajneh J, Konig C, et al. Evaluation of an automated thermodynamic treatment (LipiFlow(R)) system for meibomian gland dysfunction: a prospective, randomized, observer-masked trial. Ocul Surf. Apr 2014;12(2):146-154. PMID 24725326
  • Greiner JV. Long-Term (3 Year) Effects of a Single Thermal Pulsation System Treatment on Meibomian Gland Function and Dry Eye Symptoms. Eye Contact Lens. Mar 2016;42(2):99-107. PMID 26222095
  • Blackie CA, Coleman CA, Holland EJ. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol. 2016;10:1385-1396. PMID 27555745
  • Hagen, KB, Bedi, R, Blackie, CA, and Christenson-Akagi, KJ. Comparison of a single-dose vectored thermal pulsation procedure with a 3- month course of daily oral doxycycline for moderate-to-severe meibomian gland dysfunction. Clin Ophthalmol. 2018;12:161-168. PubMed: 29398903
  • Blackie, CA, Coleman, CA, Nichols, KK, Jones, L, Chen, PQ, Melton, R, Kading, DL, O'Dell, LE, et al. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Ophthalmol. 2018;12:169-183. PubMed: 29398904
  • Geerling, G & Baudouin, Christophe & Aragona, Pasquale & Rolando, Maurizio & Boboridis, Kostas & M. Benítez-del-Castillo, José & A. Akova, Yonca & Merayo-Lloves, Jesus & Labetoulle, Marc & Steinhoff, Martin & Messmer, Elisabeth. (2017). Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting. The Ocular Surface. 15. 10.1016/j.jtos.2017.01.006.
  • C. Mun, S. Gulati, S. Tibrewal, Y. Chen, Seungwon An, et al. A Phase I/II Placebo-Controlled Randomized Pilot Clinical Trial of Recombinant Deoxyribonuclease (DNase) Eye Drops Use in Patients With Dry Eye Disease. Translational Vision Science & Technology, 2019; 8 (3): 10 DOI: 10.1167/tvst.8.3.10
  • Marko Oydanich, Maureen G. Maguire, Maxwell Pistilli, Pedram Hamrah, Jack V. Greiner, Meng C. Lin, Penny A. Asbell. (2019) Effects of Omega-3 Supplementation on Exploratory Outcomes in the Dry Eye Assessment and Management Study. Ophthalmology.
  • Joel A. Silbert, Etty Bitton, Kriti Bhagat. (2019) Advances in Diagnosis and Management of Dry Eye Disease. Advances in Ophthalmology and Optometry 4, 13-38
  • Blackie CA, Coleman CA, Holland EJ. The sustained effect (12 months) of a single-dose vectored thermal pulsation procedure for meibomian gland dysfunction and evaporative dry eye. Clin Ophthalmol. Jul 26 2016; 10:1385-1396. PMID 27555745
  • Greiner JV. Effects of a single thermal pulsation system treatment on meibomian gland function and dry eye symptoms. Eye Contact Lens. Mar 2016; 42(2):99-107. PMID 26222095
  • National Eye Institute: Dry Eye
  • Akpek, E. K., Amescua, G., Farid, M., Garcia-Ferrer, F. J., Lin, A., Rhee, M. K., Mah, F. S. (2018). Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2018.10.023
  • TrueTear Intranasal Tear Neurostimulator (Allergan plc) for Treating Moderate to Severe Dry Eye Syndrome. 2020 Jan 22. Ecri.com
  • TearCare (Sight Sciences, Inc.) for Treating Dry Eye Disease. Health Tech Assessment (Product Brief) March 2020. Ecri.com
  • Jie, Y., Sella, R., Feng, J., Gomez, M. L., & Afshari, N. A. (2019). Evaluation of incomplete blinking as a measurement of dry eye disease. Ocul Surf, 17(3), 440-446. doi:10.1016/j.jtos.2019.05.007
  • Maskin SL, Testa WR. Growth of meibomian gland tissue after intraductal meibomian gland probing in patients with obstructive meibomian gland dysfunction.  Br J Ophthalmol. 2018;102(1):59-68.
  • Up to Date. Dry Eye Disease. Roni M. Shtein M.D., topic last updated May 24, 2021. 
  • Dry Eyes. Mayo Clinic
  • Simsek C, Dogru M, Kojima T et. al. Current management and treatment of dry eye disease. Turk J Ophthalmol 2018 Dec;48{6): 309-313. PMID 30605938
  • Tauber J. A 6-week prospective, randomized single-masked study of Lifitegrast Ophthalmic Solution 5% versus thermal pulsation procedure for treatment of inflammatory meibomian gland dysfunction. Cornea 2020 Apr;39(4):403-407. PMID 31895884

 

Policy History:

  • June 2021 - Annual Review, Policy Revised
  • June 2020 - Annual Review, Policy Revised
  • September 2019 - Annual Review, Policy Revised
  • September 2018 - Annual Review, Policy Revised
  • September 2017 - Annual Review, Policy Revised
  • September 2016 - New Policy

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.