Laser Optical Coherence Tomography LOCT

LOCT is a noninvasive, noncontact imaging technique that produces highresolution longitudinal cross-sectional tomographs of ocular structures in real time, consequently facilitating more precise diagnoses. LOCT has been well documented as an imaging diagnosis in the early detection of glaucoma.22,23 It is also a valuable technique in the evaluation and treatment of patients with retinal disease,24,25 particularly certain macular abnormalities such as cysts, holes, pseudoholes, and puckering. Before LOCT, more limited tools (i.e., clinical examination and fluorescence angiography) were available to evaluate such pathologies. Furthermore, LOCT can aid in making surgical management decisions, such as helping to determine the presence of vitreoretinal traction, which may influence the use of laser vs surgical approaches in diabetic macular edema.

During the routine LCD selection process in 2003, the medical policy team weighed the options of combining individual state-specific policies on LOCT and policy retirement, because contractors need to periodically review existing LCDs to determine whether they are achieving their objectives of high-quality adjudication of claims. After consultations with both general ophthalmologists and retinal specialists, the medical policy team decided to consolidate and refine the existing policies to allow this new technology to target appropriate patient populations properly.26 Although its decision was not driven by RCT data, the medical policy team was quite satisfied that the various emerging applications of LOCT met the threshold of reasonable and necessary.

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