Vision loss due to cataracts can be partially restored with surgical intervention and follow-up procedures, such as YAG laser capsulotomy. This treatment may qualify for coverage with Medicare insurance under certain conditions.

Understanding YAG Laser Capsulotomy             

When a cataract develops, the natural lens in the eye becomes clouded and impairs vision. Cataract surgery removes this lens so that an artificial one can be put in its place. In some cases, complications from this surgery can manifest in the months or years following the procedure. Thickening of the tissue that surrounds the lens is a common issue, which can cause your vision to become blurry or misty, or you may become sensitive to bright lights during the day or night.

YAG Laser capsulotomy involves using a small laser to open a hole in the center of this tissue, which allows light to reach all the way to the back of the eye. This procedure is performed in an outpatient setting and does not require anesthesia. Eye drops to numb and to dilate the eyes will be administered prior to the procedure, which may take around 20 minutes to complete once begun.

Because the effects of the eye drops and the procedure may cause temporarily blurred vision, you will need help with transportation and should avoid driving or riding a bicycle for the time your doctor advises. This is usually just for the rest of the day after the treatment has been administered.

Your recovery after this procedure will need to be assessed during a follow-up appointment. Your doctor will check your vision and decide if the procedure should be repeated or if it was successful the first time.

Side Effects and Risks Associated with YAG Laser Capsulotomy

Complications from YAG laser capsulotomy are considered minimal, but may be serious in rare circumstances. Most commonly, the procedure may result in an increase in eye pressure. Your doctor may treat this rise in pressure by administering medicated eye drops or prescribing medication.

If the procedure is incomplete or does not create a big enough opening in the tissue, the treatment may need to be repeated. This may not be apparent until some time after the first procedure has been performed. Discuss any doubts or vision issues you may continue to have with your doctor to help them assess the efficacy of the procedure.

More rarely, fluid build-up within the eye or retinal detachment may occur. If you experience any extreme pain, see floating particles in your vision, lose vision, sense flashing lights or a severe reddening of the eye, you should seek emergency treatment immediately.

Immediately after the procedure, there may be slight discomfort and a gritty or sticky sensation. While this is common, you should report any excessive or extended discomfort to your doctor.

Medicare Coverage for YAG Laser Capsulotomy

While benefits provided by Medicare insurance do not cover routine vision care, they do cover medically necessary procedures for qualifying conditions such as cataract surgery and treatment to help restore vision due to complications with cataracts. Because this procedure is done in an outpatient setting, Medicare Part B coverage rules apply.  Coverage may encompass diagnostic examinations, treatments and medications administered while in an outpatient setting. You will need to meet any deductible, coinsurance and copayment obligations as described by your Part B coverage terms.

If your doctor prescribes medication or eye drops to be taken at home, this may be covered under a stand-alone Part D Prescription Drug Plan or a Part D benefits included in a Medicare Advantage plan. Each plan may have its own formulary, or list of covered drugs, so recipients need to check with their provider to determine if those prescriptions are covered and in what tier of pricing.

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