nearly $500 ($465 per 4 ml vial, the drug's average sales price, plus 6%)
to cover the drug's per-case expense. When the pass-through status
went away, Omidria suddenly became cost-prohibitive.
On Oct. 1, however, CMS reinstated Omidria's pass-through status
and extended it through Oct. 1, 2020. Dr. Hovanesian is encouraged
that Omidria is once again widely accessible.
"Cataract surgeons need to work with innovative products," he says.
"For that reason, the pass-through mechanism is essential."
3
Adding glaucoma surgery
There's growing interest in combining cataract surgery with ab
interno glaucoma techniques, according to Steven Sarkisian,
MD, a clinical professor and glaucoma specialist at the Dean McGee
Eye Institute in Oklahoma City, Okla. He says there are several mini-
mally invasive glaucoma surgeries that can be used to lower intraoc-
ular pressure when clouded lenses are removed:
• Canaloplasty. Surgeons use a microcatheter (the iTrack from
Ellex or the Visco 360 from Sight Sciences) to increase outflow of
aqueous fluid through viscodilation of Schlemm's canal and distal col-
lector channels.
• Trabeculotomy. Surgeons can also remove allo or some of the tra-
becular meshwork, which is the greatest resistance to fluid outflow,
with the Trab 360 from Sight Sciences or the Kahook Dual Blade from
New World Medical and NeoMedix's Trabectome.
Dr. Sarkisian says clinical evidence and his own experience shows a
360° trabeculotomy is more effective than a partial trabeculotomy. He
also prefers to combine cataract surgery with the Trab 360 procedure
to effectively remove the entire trabecular meshwork.
"It's a relatively quick and efficient way of performing a trabeculoto-
my," says Dr. Sarkisian.
5 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 8
