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Eye scan for macular disease – is it enough?

Macular Disease Foundation Australia welcomes the news that from 1 November 2016, Medicare will provide a rebate for the use of an ocular coherence tomography (OCT) scan for the initial diagnosis of 'wet' age-related macular degeneration, diabetic macular oedema (DME) and other similar conditions, when the procedure is performed by an ophthalmologist. A maximum of one OCT scan per year will be reimbursed.

While this new listing is good news, the Foundation is greatly concerned that a rebate will not be paid for OCTs used to monitor the outcome of ongoing treatment using eye injections.

Macular Disease Foundation Australia, Chief Executive Officer, Julie Heraghty said, "OCT scans are an essential part of the ongoing management of eye injections. They allow people to be treated as often as needed, but as little as possible - in other words best practice medicine. It is simply unacceptable that patients with already high treatment costs are expected to pay the full cost of this essential test."

OCT scans are now globally accepted to be standard of care and are routinely used to monitor the response to treatment and enable the ophthalmologist to determine the need for, and timing, of ongoing eye injections. Without OCT scans to determine the response to treatment, patients would require monthly eye injections. OCT scans enable individualized treatment so that the majority of patients can receive significantly fewer eye injections, resulting in substantial savings in drug costs to the PBS, as well as reduced treatment burden and risk for patients.

The Foundation has been advocating for funding of OCT scans for many years, and will continue to make representations to Medicare and policymakers for a more appropriate rebate. The Foundation believes that up to six OCT scans per year should be funded, for the purpose of monitoring response to eye injections.

1 November 2016

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