Keratoconus, Telehealth Visits, and Senior Wellness

Young adults living with keratoconus may experience only a slight impact on their eyesight. However, the abnormal shape of the cornea characterized in keratoconus typically leads to visual disturbances and other symptom until around age 40. Mild keratoconus is linked to only a 5-8 degree deviation of the horizontal axis, but the deviation can increase over time leading to worsened eyesight.

During this Covid-19 pandemic time period, telehealth (also called telemedicine) has increased in the healthcare arena including ophthalmology. For a keratoconus-afflicted senior with a weakened immune system who has hardly ever experienced any keratoconus symptoms, telehealth may be beneficial for an “eye health” check-up so that potential Covid-19 exposure can be minimized.

The following describes the benefits of telehealth for seniors, and how “high-risk” seniors with keratoconus may encounter telehealth in the ophthalmologic arena.

Insurance Coverage and Telehealth Visits

Insurance plan coverage documents provided to the enrollee often specify that “medical necessity” is a prerequisite for a healthcare-related service to be eligible for coverage. Along with Rigid Gas Permeable (RGP) contact lenses as typically worn by people with mild-to-moderate keratoconus, many private health insurance companies consider services rendered as part of a keratoconus evaluation to be “medically necessary” – as well as corrective lenses for keratoconus-afflicted enrollees (according to the National Keratoconus Foundation [NKF]).

Traditional Medicare (now commonly-called Original Medicare) does not normally cover the cost of routine eye appointments, but some Medicare Advantage health plans do include both an annual eye exam and one pair of eyeglasses or contact lenses per year as covered services for any of its enrollees. However, even Original Medicare will normally cover annual eye exams for a person already diagnosed with keratoconus.

The Centers for Medicare and Medicaid Services (CMS) has allowed expanded coverage of telehealth by traditional Medicare and Medicare Advantage plans due to the Covid-19 pandemic. Federally-qualified public health centers (some of which offer optometry/ophthalmology services to their patients) were also included in this temporary waiver enabling telehealth services to be provided to patients in their homes. In addition, the CMS has temporarily eased its HIPAA requirements pertaining to telehealth consequent to the Covid-19 pandemic in order to enable increased telehealth utilization.

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Remote Patient Monitoring and Consultations

Common co-disorders in senior-aged people with keratoconus include diabetes (Type 2), cardiovascular disease (i.e., plaque build-up in the arteries), cancer, and asthma. The Covid-19 pandemic has increased the fatality rate of senior-aged people with these co-disorders, so telehealth visits can be life-saving for them.

Keratoconus-afflicted people over age 60 who have any of these aforementioned co-disorders especially can benefit from remote consultations to quickly identify if vision is worsening (albeit most likely not due to keratoconus). Likewise, remote patient monitoring via telehealth can enable reinforcing instructions (such as daily use of eye drops) to keratoconus-afflicted people who have undergone eye surgeries in the past.

According to a research article in April 2020 in BMJ Open Ophthalmology, Covid-19 can cause cornea surface disease in the form of conjunctivitis – and an early study revealed Covid-19 eye infection in 0.8 percent of the studied Covid-19 patients. Indeed, keratoconus-afflicted people age 60 and older who develop Covid-19 may experience increased symptoms of keratoconus (such as cornea pain) as well as the usual Covid-19 symptoms of fever, cough, and difficulty breathing. Furthermore, this article described utilizing a patient’s cell phone camera to capture an image of the patient’s eye for use by a cornea clinic in a telehealth consultation about the patient’s worsened eye-related symptoms.

Telehealth Videoconferencing Tools and Covid-19

Many HIPAA-compliant telehealth videoconferencing tools now exist to enable patients to continue to receive care by clinicians while remaining at home – whether due to self-quarantine as a result of Covid-19 exposure or to decrease the likelihood of contracting a Covid-19 infection. Overall, healthcare centers of all types have been limiting the scheduling of “in-person” appointments to those considered urgent in order to decrease the potential for community spread of Covid-19, and eye care centers have been no exception.

The trained professionals of the Precision Keratoconus Center are available to help you to understand your diagnosis of keratoconus and the various treatment options for this cornea disorder.

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