Leung and colleagues (2014) noted that cataract formation often occurs in people with uveitis. Cataract removal surgery is considered not medically necessary for the The AAOs Preferred Practice Pattern on Cataract in the adult eye (2016) stated that Capsular tension rings can be useful adjunctive devices when weak zonules are present, reducing the likelihood of intraoperative zonular separation and capsular complication, and they may improve postoperative IOL centration. Cochrane Database Syst Rev. These can be either multi-focal lenses, which enable both near and distance vision by virtue of the design of the lens itself, or accommodating lenses, which are intended to move within the eye in a manner similar to a natural human lens. A-mode ultrasonography (A-scan) can be used to determine the appropriate pseudophakic power of the IOL. Phakic IOLs are used to achieve refractive correction when the native lens is not removed, similar to the effect of LASIK or laser eye surgery. The authors reported that, based on 10 studies that compared DCNVA, accommodating IOLs were favored but failed the test of heterogeneity (I(2) = 94 %). OL OL OL OL LI { 2004;15(1):16-21. Indian J Ophthalmol. 2001;67(2):196-198. The alternative lens was then implanted in the second eye 4 to 6 weeks later. The member's decision is based on: Note: Functional impairment due to cataracts refers to lost or diminished ability to perform everyday activities, participate in hobbies or other leisure-time activities, or to work in ones occupation. Accessed May 31, 2012. de Silva and colleagues (2016) stated that good unaided distance VA is now a realistic expectation following cataract surgery and (IOL implantation. Rahti et al (2020b) stated that IC antibiotic in cataract surgery has shown level I evidence as prophylaxis for post-operative endophthalmitis. J AAPOS. Moreover, these researchers stated that in order to achieve more significant findings, RCTs with larger sample size are needed. The AAO and ASCRS claim that Aetna's only reason for the new policy was that 4-5% of cataract surgeries were unnecessary. in which cataract surgery will not improve the members independence). Findl O, Drexler W, Menapace R, et al. Ophthalmology. American Academy of Ophthalmology. Will vision insurance cover cataract surgery? WebIs cataract surgery covered by health insurance? Obstbaum SA. Probability of Nd:YAG laser capsulotomy after cataract surgery in Olmsted County, Minnesota. The authors stated that a drawback of the study was that there was no standardized pre-operative IOL calculation method, instead relying on surgeon's best choice. Patients without historical data (n = 39) were compared using 3 methods (Haigis-L, ORA, and Optovue), and patients with historical data (n = 20) were compared using all methods (Masket regression formula, Haigis-L, ORA, and Optovue). The mean diameter of the manual and the femtosecond laser capsule disk group were not statistically significantly different (manual 4.91 0.34; femtosecond: 4.93 0.03; p = 0.58). color: red The authors concluded that there is no evidence from RCTs or quasi-RCTs on which to base clinical recommendations for surgery for post-vitrectomy cataract. The studies were small, not all lens materials were compared in all studies, and not all lens materials were available in all study sites. The following are considered medically American Academy of Ophthalmology. Preoperative evaluation for elective cataract surgery - systematic review. EyeNet Magazine. These investigators performed a separate analysis comparing 1CU and AT-45 IOL. In a prospective, consecutive cohort study, Bali and colleagues (2012) described the intra-operative complications and evaluated the learning curve with femtosecond laser-assisted cataract surgery (FLACS). # font-weight: bold; The Panel found inadequate evidence that potential vision testing can help the ophthalmologist in predicting the outcome of cataract surgery. In a retrospective consecutive case-series study, Fram and colleagues (2015) compared the accuracy of intra-operative aberrometry technology and the Fourier-domain optical coherence tomography (OCT)-based intra-ocular lens (IOL) formula for IOL power calculation in eyes undergoing cataract surgery after previous laser vision correction (LVC) compared with established methods. A meta-analysis by Takakura et al (2010) found no clear evidence of near visual acuity improvement with accommodating IOLs compared to monofocal IOLs. An Nd:YAG laser posterior capsulotomy was performed in 153 (3.07 %) of the 4,970 eyes. They searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 4), MEDLINE (January 1950 to April 2012), EMBASE (January 1980 to April 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to April 2012), the metaRegister of Controlled Trials (mRCT), ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). The time for surgery and the amount of fluid that went into the eye were similar to those of a standard procedure. Do DV, Gichuhi S, Vedula SS, Hawkins BS. The surgery is also covered by Medicare (under Medicare Part B). Dick (2005) stated that the potential clinical benefits of accommodative IOL technology for both cataract patients and refractive patients may place accommodative IOLs in a competitive position with multi-focal IOL technology. Zhang Z, Thomas LW, Leu SY, et al. Most cases relied on the Holladay 1 formula, with some preference to SRK/T for eyes with longer axial length, and Hoffer Q for eyes with shorter axial length. You can receive basic lens replacement, paid in There is a clear need for RCTs to address this evidence gap. list-style-type: lower-roman; Policy statement on cataract surgery in the otherwise healthy adult second eye. Intraoperative refractive biometry for predicting intraocular lens power calculation after prior myopic refractive surgery. The authors concluded that multi-focal IOLs were effective at improving near vision relative to mono-focal IOLs although there was uncertainty as to the size of the effect. 2010;36(4):603-608. Does Aetna Medicare Cover Glasses After Cataract Surgery? In 23 eyes undergoing surgery without the use of OVDs, no complications were observed within a 1-month follow-up period. In a Cochrane review, these investigators defined. Two review authors independently assessed abstracts to identify possible trials for inclusion. Improved prediction of intraocular lens power using partial coherence interferometry. Regarding the few instances where ORA gave several different IOL powers during aphakic measurements, the IOL was selected to closely match that of the initial prediction by the IOL master. Cochrane Database Syst Rev. 1995;21(2):132-135. In the group with historical data (n = 20), 35 % to 70 % of eyes were within 0.25 D, 60 % to 85 % of eyes were within 0.50 D, 80 % to 95 % of eyes were within 0.75 D, and 90 % to 95 % of eyes were within 1.00 D of targeted refractive IOL power prediction error. People with accommodative lenses were more likely to be spectacle-independent but the estimate was very uncertain (RR 8.18; 95 % CI: 0.47 to 142.62, 1 study, 40 people, very low quality evidence). Aliso Viejo, CA; Eyeonics; 2003. 2019;19(1):78. The member's best correctable Snellen visual acuity is 20/40 Snellen or better in the affected eye, There is a significant loss of visual acuity in bright ambient light thatisconfirmed bythe use of (but not limited to) procedures such as glare testing, brightness acuity testing (BAT), or contrast sensitivity testing, or, Complaints of monocular diplopia or polyopia, or, Visual disparity existing between the two eyes (anisometropia),and. At 3 months, there were no statistical or clinical differences between hydrophobic and hydrophilic acrylic IOL types in the proportions of participants with 2 or more Snellen lines of visual improvement (RR 1.03, 95 % CI: 0.87 to 1.22). Second, several studies in this meta-analysis did not report sufficient data on risk assessment, especially random sequence generation, allocation concealment and setting blinding, which may have led to bias. 1995;21(1):99-102. Decision of CTR implant was intra-operative in 42 patients. These researchers concluded that no measurable variable distinguished eyes that developed functional reading vision from those that did not. Filkorn and associates (2012) compared IOL power calculation and refractive outcome between patients who underwent laser refractive cataract surgery with a femtosecond laser and those with conventional cataract surgery. First Coast Service Options, Inc.Local Coverage Determination (LCD): Cataract Extraction (L33808). One specialized ophthalmologic service is frequently needed prior to cataract surgery in routine cases. 1995;8(9):6-7. Keay L, Lindsley K, Tielsch J, et al. background: #5e9732; This was of particular relevance against the background of the significantly higher costs. Hsuan JD, Brown NA, Bron AJ, et al. San Francisco, CA: AAO;modified March 21, 2019. The authors stated that this meta-analysis had several drawbacks. In a prospective, consecutive, single-surgeon, case-control study, Abell and colleagues (2013) compared effective phacoemulsification time after femtosecond laser pre-treatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss. They examined whether these tests would indicate the presence or severity of a cataract, or predict the benefits or negative outcomes a patient may experience from the surgery. While some surgeons already use this technology for LRIs, further studies to elucidate the value of intra-operative aberrometry specifically for toric IOL implantation, rotation, and residual post-operative cylinder would be useful. The Alcon CZ70BD is a single-piece polycast polymethylmethacrylate (PMMA) intra-ocular lens (IOL; posterior chamber). In a prospective, interventional case-series study, Roberts and co-workers (2013) reported the surgical outcomes and safety of FLACS with greater surgeon experience, modified techniques, and improved technology. Cataract in children. BMC Ophthalmol. The lens design (1-piece versus 3-piece and varying haptic angles) did not affect the PCO rate. J Cataract Refract Surg. Spectacles only correct lower order aberrations such as sphere and cylinder. 2000;44(6):541. Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Although trifocal and bifocal IOLs are designed to restore 3 and 2 focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia. 1999;44(2):123-147. Landmarks in the evolution of cataract surgery. An inpatient setting for cataract removal surgery generally is not considered medically necessary. There was no statistically significant difference among the methods. Results from Impact of Vision Impairment (IVI) questionnaires suggested that the immediate surgery group fared better with quality of life outcomes than the delayed surgery group (MD in IVI logit scores 1.60, 95 % CI: 0.61 to 2.59). 2015;38(10):955-959. Scott A. This accounted to a 72.22 % reduction, from the earlier 0.126 % to 0.035 %, of post-cataract surgery acute endophthalmitis. Curr Opin Ophthalmol. Comparison of immersion ultrasound biometry and partial coherence interferometry for intraocular lens calculation according to Haigis. Note: The use of capsular tension rings is considered integral to the ocular surgery and is not separately reimbursed. This limited the reliability of the conclusions. These researchers included randomized clinical trials (RCTs) in which routine pre-operative medical testing was compared to no pre-operative or selective pre-operative testing prior to age-related cataract surgery. 4, AHCPR Publication no. 1993;19(6):673. Nd:YAG laser capsulotomy in any of the following situations because of insufficient evidence in the peer-reviewed literature: If performed concurrently with cataract surgery; If scheduled routinely after cataract surgery without regard to whether there is clinically significant opacification of the posterior capsule. Dick and Schultz (2014) stated that employing a femtosecond laser as an initial step in cataract surgery has the clear potential to provide more precise capsulotomies and full lens fragmentation in cases of pre-existing astigmatism in conjunction with relaxing corneal incisions. October 9, 1995: 20-21. This testing, however, may be useful for corroborating glare symptoms in a small percentage of cataract patients who complain of glare, yet measure good Snellen visual acuity. McClellan MB. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but 2 studies found the mean number of medications used post-operatively at 1 year was about 1 less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95 % CI: -1.28 to -0.10; 301 eyes); 5 studies showed that participants in the combined surgery group were about 50 % less likely compared with the cataract surgery alone group to use 1 or more IOP-lowering medications 1 year post-operatively (RR 0.47, 95 % CI: 0.28 to 0.80; 453 eyes). Medicare coverage of Nd:YAG capsulotomy would be restricted. } Adelaide, Australia: Adelaide Health Technology Assessment (AHTA) on behalf of National Horizon Scanning Unit (HealthPACT and MSAC); 2004. In the group with IOLMaster without ORA measurements, 80 % of eyes were within 0.5D of target refraction. Typically, cataract surgery is covered by insurance and Medicare. Mundy L, Merlin T, Parrella A. CrystaLens: An accommodating intraocular lens replacement for patients with cataracts. In general, the surgeon looked for agreement in various formulas when choosing an IOL. Main outcome measure was intra-operative complication rates. CPB 0130 - Computerized Corneal Topography. Cataract surgery is usually performed under local anesthesia. Retina. In 2 studies, these researchers observed that subjects' satisfaction or spectacle independence may be higher in the trifocal group at 6 months, although another study found no evidence of a difference in subject satisfaction or spectacle independence between groups; AEs reporting varied among studies 2 studies reported information on AEs at 1 year; and 1 study reported that subjects showed no intra-operative or post-operative complications, while the other study reported that 4 eyes (11.4 %) in the bifocal and 3 eyes (7.5 %) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The authors concluded that a 3.6-fold reduction in post-cataract surgery endophthalmitis was observed upon the use of IC antibiotics in rural India. Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. Use of Nd:YAG laser capsulotomy. J Cataract Refract Surg. Surv Ophthalmol. The authors concluded that femtosecond laser pre-treatment results in a significant reduction in EPT, including the possibility of 0 EPT. In a Cochrane review, these investigators examined the safety and effectiveness of implantation with trifocal versus bifocal IOLs during cataract surgery among subjects with presbyopia. In a retrospectivestudy, Zhang et al (2017) compared the outcomes of intra-operative wavefront aberrometry (e.g., optiwave refractive analysis (ORA)) versus optical biometry alone for intra-ocular lens (IOL) power calculation in eyes undergoing cataract surgery with mono-focal IOL implantation. 2012;119;891-899. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (5 years or more). Preferred Practice Pattern. The Panel concluded that posterior capsulotomy should never be scheduled at the time cataract surgery is performed because one can not predict whether a cataract surgery patient will develop posterior capsular opacification or predict the time at which opacification will occur. The authors concluded that in this study, eyes with acrylic hydrophilic IOLs were more likely to develop PCO than those with acrylic hydrophobic IOLs. Erbium:YAG laser-assisted cataract surgery. The health insurance provider said it believes up to 20% of all cataract surgeries may be unnecessary, but ophthalmology groups disagree. Patients with refractive ReZoom had also recommended near addition more frequently than the 2 diffractive groups. Copyright Aetna Inc. All rights reserved. Patients underwent IRB for IOL power estimation. A total of 39 eyes of 29 patients without historical data were analyzed separately from 20 eyes of 20 patients with historical data. At long-term follow-up there was heterogeneity of effect with 18-month data in 2 studies showing that CDVA was better in the mono-focal group (MD 0.12 logMAR; 95 % CI: 0.07 to 0.16, 2 studies, 70 people, 100 eyes) and 1 study that reported data at 12 months finding similar CDVA in the 2 groups (-0.02 logMAR units, 95 % CI: -0.06 to 0.02, 51 people) (low quality evidence). The only way a patient can be billed extra is if he or she is receiving an additional service, such as a premium refractive IOL, and in this case, a doctor must first discuss the extra out-of-pocket costs with the patient and gain consent in advance. In Cataract Surgery: Technique, Complications, and Management. RF Steinert, ed. Waldron (2012) stated that B-scan ultrasound is most useful when direct visualization of intra-ocular structures is difficult or impossible. height:2px; Ophthalmology. The procedure was completed by phacoemulsification and insertion of an IOL. The authors concluded that as per the results CTR was used very infrequently (0.75 %); however, it remained useful in cataract surgeries with difficult pre- and intra-operative conditions. Two authors independently extracted data and assessed risk of bias for included studies. Celik E, Koklu B, Dogan E, et al. Day care versus in-patient surgery for age-related cataract. Multiple optic (multi-focal) IOLs are available which claim to allow good vision at a range of distances. The images are then computed to give the local slope and character of the wavefront of light. 2013;120(2):227-233. Do and colleagues (2018) stated that cataract formation or acceleration can occur after intra-ocular surgery, especially following vitrectomy, a surgical technique for removing the vitreous that is used in the treatment of many disorders that affect the posterior segment of the eye. This difference was possibly due to a more precise capsulorrhexis, resulting in a more stable IOL position. These researchers used the Science Citation Index to search for references to publications that cited the studies included in the review. There are a number of strategies available to surgeons wishing to exceed these outcomes, the most promising of which are the use of strict-tolerance IOLs and second eye prediction refinement. In cases with capsulorrhexis extension, CTR was not implanted. 2015;7:CD008671. They assessed the certainty of the evidence using GRADE. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Medicare is a U.S. federal government healthcare program that covers the health needs of people who are 65 years old and older. While Medicare doesnt cover routine vision screening, it does cover cataract surgery for people over age 65. You may need to pay additional costs such as hospital or clinic fees, deductibles, and co-pays. Medicare proposal to restrict medical necessity for cataract surgery. Stevens G Jr, Long B, Hamann JM, Allen RC. list-style-type: decimal; ul.ur li{ Therefore, reimbursement for a cataract procedure would be the same whether a femtosecond laser or another method is used. The axis of the toric IOL on each visit was measured by SLEx in retro-illumination and analyzed digitally. Unfortunately, the answer to this question is not Slit-lamp examination provides more details about the character, location, and extent of the opacity. } The most common cataract that produces this type of light-related visual loss is a centrally located posterior subcapsular plaque (PSCP). In a Cochrane review, these investigators evaluated the relative safety and effectiveness of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. This may influence the data by introducing confounding and bias. Requests for Nd:YAG laser capsulotomy performed within 6 months of cataract extraction should be forwarded for medical review; Combined glaucoma and cataract surgery for persons with a visually significant cataract with uncontrolled glaucoma despite maximal medical therapy and/or laser trabeculoplasty; Standard posterior chamber IOL for hyperopia (e.g., Clariflex, Sensar AR40e, Advanced Medical Optics, Santa Ana, CA); Standard anterior chamber IOLs (e.g., ALcon MTA2UO, MTA3UO, MTA4UO, MTA5UO, MTA6UO, and MTA7UO); Standard fixed monofocal posterior chamber IOLs (e.g., Akreos posterior fixed monofocal IOL (Bausch & Lomb, Rochester, NY), Akreos AO Micro Incision Lens (Model MI60L), AcrySof SA60AT monofocal IOL (Alcon Surgical, Fort Worth, TX), AcrySof MA60AC, AcrySof MA60MA, AcrySof SN60AT, Alcon MZ30BD, CeeOn Edge (Pharmacia Corp., Peepack, NJ), Tecnis monofocal IOL (Model PCB00), and the Hydroview hydrogel foldable posterior IOL (Bausch & Lomb, Rochester, NY)); Aspheric monofocal posterior chamber IOLs (e.g., AcrySof IQ IOL (Alcon Surgical, Fort Worth, TX), Alcon CZ70BD, Alcon SA60WF, SN6CWS, Tecnis (Z9000, Z9001, Z9002, ZA9003, Abbott Medical Optics, Santa Ana, CA), SofPort AO IOL (Bausch & Lomb, Rochester, NY), Sofport LI61AO, Staar Model CC4204A, Akreos AO Aspheric IOL (Bausch & Lomb, Rochester, NY), Akreos SA 060, Hoya PY-60AD (Hoya Surgical Optics GmbH, Frankfurt, Germany), Abbott ZCB00, Tecnis AMO Aspheric IOL ZCB00 (Abbott Medical Optics, Santa Ana, CA), and Acrysof IQ SN60WS (Alcon Surgical, Fort Worth, TX)); Standard fixed monofocal posterior chamber ultraviolet absorbing IOLs for aphakia (e.g., AcrySof Natural blue-light filtering IOL including the AcrySof MN60MA (Alcon Surgical, Fort Worth, TX), AcrySof SN60WF, SofPort AO IOL with Violet Shield Technology (Bausch & Lomb, Rochester, NY), C-flex IOL model 570C (Rayner Surgical Inc., Los Angeles, CA), EC-3 PAL (Aaren Scientific, Ontario, CA), iSpheric Model YA-60BB IOL (Hoya Surgical Optics, Chino Hills, CA), Softec HD (Lenstec Inc., St. Petersburg, FL); and XACT Foldable Hydrophobic Acrylic Ultraviolet Light-Absorbing Posterior Chamber IOLs (Bausch & Lomb); Femtosecond laser-assisted cataract surgery is considered an equally effective alternative to standard methods of cataract removal. Such instances include differentiating iris or ciliary body lesions; ruling out ciliary body detachments; and differentiating intra-ocular tumors, serous versus hemorrhagic choroidal detachments, rhegmatogenous versus exudative retinal detachments, and disc drusen versus papilledema. Several instruments such as the VF-14, the activities of daily vision scale and the visual activities questionnaire are available for assessing functional impairment related to cataract. 2001;27(3):437-444. They also contacted investigators and experts in the field to identify additional trials. Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: A meta-analysis. 2008;24(3):257-264. In general, driving an automobile is the limiting life-style activity with visual acuity in the 20/50 to 20/60 range. However, the clinical benefits must be put into perspective due to the subsequent surgical manipulation of the incisions (during lens emulsification, aspiration and IOL injection), the lacking possibility to visualize the crystalline lens equator as the reference for correct capsulotomy centration and the relativity of US energy consumption on the corneal endothelial trauma. margin-top: 38px; The histologic examination combined with prospective video analysis revealed respiratory movement of the eye during the capsulotomy as a potential risk factor for redial tears. Better DCNVA was seen in the accommodative lens group at 12 to 18 months in the 3 trials that reported this time-point but considerable heterogeneity of effect was seen, ranging from 1.3 (95 % CI: 0.98 to 1.68; 20 people, 40 eyes) to 6 (95 % CI: 4.15 to 7.85; 51 people, 51 eyes) Jaeger units and 0.12 (95 % CI: 0.05 to 0.19; 40 people, binocular) logMAR improvement (low quality evidence). Subjects' mean age ranged from 58 to 64 years. Ophthalmic Surg Lasers. Cochrane Database Syst Rev. And yes, most health insurance plans cover cataract surgery when your doctor considers it to be medically necessary. /* aetna.com standards styles for templates */ 2011;(7):CD004242. Standard mono-focal IOLs correct only distance vision; patients require spectacles for near vision. WebThe response from physicians to Aetnas prior authorization requirement for cataract surgery was overwhelming, and it strengthened efforts to influence the insurer to change its decision. background-color: #cc0066; Cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the Alcon/LenSx FS laser (Alcon/LenSx, Aliso Viejo, CA). Aslam TM, Devlin H, Dhillon B. The initial 200 eyes undergoing cataract surgery between April 2011 and June 2011 by 6 surgeons were included in the study. } 2006;32(4):628-633. Am J Ophthalmol. Zamora-de La Cruz and colleagues (2020) noted that presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. A prospective study. All studies compared trifocal versus bifocal IOL implantation on VA outcomes measured on a LogMAR scale. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of post-operative complications and compromise the success of either surgery. The authors concluded that based on the trials identified in this review, there is uncertainty as to which type of IOL provides the best visual and clinical outcomes in people with uveitis undergoing cataract surgery. Implantation of multifocal (non-accommodative) intraocular lenses during cataract surgery. These pre-operative tests include contrast sensitivity testing, glare testing, potential vision testing, and specular photographic microscopy (endothelial cell photography). 2012;(3):CD007293. 2020a;68(5):819-824. 2000;238(9):765-773. The authors concluded that laser refractive cataract surgery with a femtosecond laser resulted in a significantly better predictability of IOL power calculation than conventional phacoemulsification surgery. In the future, additional studies to optimize these variables may be needed to determine the best conditions for intra-operative biometry. They graded 2 studies with high risk of detection bias and 1 study with high risk of selection bias. Schultz T, Joachim SC, Tischoff I, Dick HB. Cost-effectiveness of femtosecond laser-assisted cataract surgery versus phacoemulsification cataract surgery. Guidance on multi-focal IOLs from the National Institute for Health and Clinical Excellence (NICE, 2008) concluded: "The evidence on the implantation of multifocal (non-accommodative) intraocular lenses (IOLs) during cataract surgery raises no major safety concerns. Medicare Program; Limitations on Medicare Coverage of Cataract Surgery.

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