CellChek C. High-grade model providing wide-field visualization of the cornea; including from limbus to limbus, endothelium to epithelium. •, High-resolution. Dystrophy, keratoconus, other corneal dystrophies and trauma. Konan’s specular microscopes are the global gold standard for precision assessment of the most. The CellChek XL™ delivers cellular level imaging of the corneal endothelium with the industry’s most comprehensive tools for cellular morphology and trending.
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The primary reason physicians should utilize the Konan CellChek is because it improves patient care. A secondary consideration is that specular microscopy has clear value from a reimbursement perspective. Specular microscopy is performed on all cataract patients as a pre-operative risk assessment because I have discovered that having a precise endothelial cell count assists me in appropriately managing these cases. The CellChek XL has been of benefit in allowing me to proactively prevent problems.
This means that 10, patients experience complications with what is usually a straightforward procedure. For these patients in particular, physicians need to understand the cornea from a morphological viewpoint. Specular microscopy enables you to accurately quantify the endothelial function, identifies patients who are potentially problematic pre-operatively, and facilitates the appropriate treatment of that case.
We know that endothelial cells are not replicated. What cells we’re born with must last a lifetime. This monolayer of cells is unique in that, in order to repair itself, the cells must slide or stretch to fill any gaps. The basic premise of corneal swelling is that the endothelial pump is no longer functioning adequately enough to maintain normal corneal hydration.
If the number of endothelial cells decreases too significantly, the endothelium also loses its ability to act as a barrier to fluid.
Under normal circumstances, healthy cells can be retained, but trauma, inflammation, and heredity are possible factors that can impact the health of the endothelial layer. Physical trauma can occur during cataract surgery or any other anterior segment intraocular surgery. Techniques have evolved to prevent the loss of endothelial cells during cataract surgery such as the development of viscoelastic materials.
However, even with these advancements, corneal swelling associated with cataract surgery still occurs. Definitive Diagnoses It is my view that every patient scheduled for intraocular anterior segment surgery, especially cataract surgery, secondary intraocular lens IOL surgery or IOL exchange should receive a baseline specular microscopy examination.
If the cell count diminishes for whatever reason and the cornea swells, it becomes more challenging to obtain an accurate cell count. In Fuch’s endothelial dystrophy, a genetic disorder more common in females, the endothelial cell count can prematurely decline with ensuing corneal swelling.
The very formation of excrescences, deposits, or guttata alerts us to the fact that this cornea is more susceptible. These lesions signify that they have taken over positions normally occupied by healthy endothelial cells, interfering with optimal function. Following these patients pre- and post-operatively is helpful in monitoring their response to any operative procedure. Distinctions of the CellChek XL Since the CellChek XL is a non-contact device, the examination can be conducted without the use of drops and without causing discomfort.
This instrument offers optical pachymetry readings in addition to providing highly magnified images that are clear and reproducible. This instrument can be used easily and accurately with little training.
Finally, it features a small footprint and comes with a table, computer, monitor, and printer. Using the Konan CellChek XL In a basic specular microscopy examination, there are three ways of interpreting the images: Automated Manual count – a dot is manually placed in each cell or among a group of cells to initiate a count Users can place a box around groups of cells and place a dot in each box. This method is generally reserved for cases where substantial numbers of endothelial cells have been lost The software analysis package provides the: In addition, it provides statistical data including the number of cells used as the basis for the analysis.
Since the screening is entirely automated, the user cannot choose which cells to count, slightly increasing the variability of the output. The results for both eyes are displayed simultaneously and the screening images are not saved. One of the advantages of the screening is that if problems are detected during the test, doctors are alerted to more closely question these patients and to look for associated signs in the tissues.
Clinical Case Report The following case illustrates how specular microscopy makes a difference and can influence clinical decision-making. Following complicated cataract surgery, this patient presented with an aphakic right eye due konna an aborted intraocular lens IOL implantation. The central corneal thickness of this aphakic eye was microns.
A Valuable Tool for the Diagnosis and Management of Ocular Disease: Konan’s CellChek
Specular microscopy revealed an abnormally low cell count in the right aphakic eye and a normal cell count in the left eye see Figure 1. Note that the corneal thickness of the right eye microns is thicker than that of the left eye due to corneal swelling. Critical information such as this can change your treatment plan. Without specular microscopy, you could conceivably cause harm to this patient, leading to a cascade of issues including the eventual need for a corneal transplant.
By obtaining a quantitative measure of corneal function, physicians can definitively determine if the patient’s cornea is more vulnerable. Added Value – Reimbursement and Coding For reimbursement by Medicare, medical necessity must be demonstrated. Specular microscopy may be indicated in situations in which the cornea is suspected of having an endothelial abnormality and in which the accuracy of the estimated cell count from slit lamp biomicroscopy is thought to be less than satisfactory.
Showing medical necessity can be achieved by the following: Patient reports symptoms such as blurry vision, especially in the morning; fluctuating vision; halos around lights; photophobia; foreign body sensation; contact lens intolerance Biomicroscopy findings such as guttata; corneal irregularity; polymegethism; pleomorphism abnormal variation in the shape of the normally hexagonal cells ; reduced cell density; increased corneal thickness; loss of transparency Deficiencies discovered during the CellScreen test In our office, CellScreen tests are billed to the patient for a nominal fee.
If any issues are discovered in the case history, biomicroscopy examination, or during the CellScreen examination, a complete CellChek examination can be performed and billed to the insurance company.
Should the patient be found to have a diagnosed condition, we charge a medical evaluation and management fee and bill the patient’s medical insurance using CPT Special anterior segment photography with interpretation and report; with specular endothelial microscopy and cell count. In order to bill for the procedure, the physician must complete an interpretive report specifying the reason for the test, the cell count, a report of the findings, and the basic treatment plan.
A sample interpretive report can be found in Figure 2. Documentation of specular microscopy should include the following elements: In other words, to bill specular microscopy at the same time that you are performing a pre-surgical eye examination for cataract surgery, the medical record must document at least one of the coverage criteria discussed and the procedure must be reported with a diagnosis code other than a simple cataract.
In instances in which Medicare may not cover the test, the patient should be asked to sign an Advance Beneficiary Notice prior to testing. The claim can be submitted as GA and the fee can be collected from the patient at the time of service or after the Medicare denial.
Konan CellChek XL NSP Specular Microscope – Mandarin Opto-Medic Co
In regards to repeat or follow-up testing, specular microscopy is reimbursable when medically indicated and consistent with locally accepted standards of practice, but the reason for testing must be clearly documented.
This is the reason why it is important to perform this test pre-operatively on all cataract surgery patients. Conservative estimate of return on investment for specular microscopy assuming that a practice completes cataract surgeries per year. Koman specific allowable for each geographic area is determined by adjusting the national rate by the geographical practice cost indices. Embrace New Technology Many physicians may believe that endothelial issues are rare and that technology such as the CellChek is not necessary.
Practicing without the CellChek is like flying a plane with instrumentation only. You simply won’t have a complete grasp of the situation.
Konan Specular Microscope – Sarasota FL | Gulfcoast Eye Center
In today’s high tech environment, we have now been provided with the ability to quantitatively evaluate the endothelium. We can and should examine patients in high definition. The world of ophthalmology is going completely automated.
Diagnosing conditions in complex and difficult cases is happily becoming more commonplace with instruments such as these. Specular microscopy is an essential tool in my practice and should be embraced by every academic institution, corneal surgeon, and anterior segment surgeon. Clearly, for corneal issues, deep lamellar keratoplasty kojan, and cataract surgery patients, specular microscopy is both invaluable and reimbursable.
He can be reached at tfladen FladenEyeCenter. American Academy of Ophthalmology.
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