The cornea of the eye is an integral part of proper sight as it protects the iris and pupil and refracts light to allow for focus. In a healthy eye, the cornea is shaped like a dome as it hugs the curved surface of the eyeball, but in some cases, eye disorders can lead to a condition called keratoconus. This condition causes the cornea to bulge, and as it does, the traditional dome shape becomes elongated, leading to difficulty in focus and a reduction in optical power.
It is believed that keratoconus is caused by an enzyme imbalance in the eye that weakens the cornea. As the strength of the cornea wears down, pressure pushes it outward and leads to keratoconus. Additionally, repeated irritation and trauma to the eye, such as excessive rubbing, may weaken the cornea, and some evidence suggests that exposure to ultraviolet rays can also be a cause of cornea damage that leads to keratoconus. Finally, contact lenses that do not fit properly can damage the cornea, thereby weakening it and leaving it susceptible to keratoconus.
How is Kerotoconus Treated?
When in its early stages, keratoconus can sometimes be corrected using special lenses, both traditional and contact. These are used to either strengthen the eye muscles and relieve pressure or to push the cornea back into place while allowing the eye to relax and regain structural soundness after weakening. As the condition worsens, treatment methods may include the addition of prosthetic corneal lenses or the use of lasers to reshape the surface of the cornea. In advanced cases of keratoconus, corneal transplant may be considered if the original cornea deteriorates and can not be saved through other methods of treatment.
Does Medicare Cover Keratoconus Treatment?
In most cases, treatment for keratoconus is covered by Medicare benefits. What’s important to keep in mind is that Medicare does not cover routine eye exams and other checkups for ocular health, so you may have to pay out-of-pocket in order to be examined and diagnosed with keratoconus. With this stated, it may be possible that Medicare benefits will cover corneal topography in diagnosing keratoconus. This procedure is used to scan the surface of the cornea in order to map and analyze it for defects that may suggest keratoconus.
The key in keratoconus coverage under Medicare is whether or not the treatment is medically necessary. If it can be demonstrated that corneal bulging as a result of keratoconus is a threat to overall health or that the condition is expected to medically impact your ability to live a healthy life, treatment will usually be considered medically necessary, and therefore, it will be covered. If, however, it is suspected that someone may be at risk for developing keratoconus and a standard pair of glasses or contacts is prescribed to stave off the disease, the glasses or contacts and eye exam would not be covered. To learn more, consult with your plan to understand the specifics of your Medicare benefits and coverage limitations.
Keratoconus and Genetic Testing
Another point to consider when discussing Medicare’s treatment of keratoconus is that the condition is often hereditary. As such, it may be possible to identify risk factors through genetic testing. In many cases, Medicare will cover genetic testing if the testing is ordered by a physician, but at-home testing and testing at non-Medicare approved facilities will typically not be eligible for coverage. When ordering genetic testing for Medicare consideration, your doctor will need to note that the tests are being sought out to validate a suspicion of a condition that may lead to serious disease or a threat to life. Ordering a genetic test to view things like ancestral heritage data will not be considered under Medicare as these tests do not directly correlate to the detection of factors in disease development.
Does Medicare Cover Genetic Testing?(Opens in a new browser tab)