OCULAR PHOTODYNAMIC THERAPY WITH VERTEPORFIN (VISUDYNE™)

Does the Ontario Health Insurance Plan (OHIP) cover ocular photodynamic therapy?

Starting June 15, 2002, OHIP will cover ocular photodynamic therapy with verteporfin (Visudyneä). This includes visits to the doctor, the drug (verteporfin) and the laser treatment.

How do I know if I am eligible to receive this insured service?

You are eligible to receive this insured service if you have all of the following clinical conditions:

• You have classic subfoveal choroidal neovascularization (CNV) caused by age-related macular degeneration or pathologic myopia.

• The area of your classic subfoveal CNV is at least 50% of your total CNV lesion. Your doctor needs to determine this by performing fluorescein angiography.

• Your vision is equal to, or worse than, 20/40.

• Your treatment starts no later than 30 months following initial diagnosis of classic subfoveal CNV caused by age macular degeneration or pathologic myopia.

To find out if you are eligible, please talk to your eye doctor.

If you do not meet the above criteria, then all associated services including the drug, laser treatment, tests and visits to the doctor are not insured as medically necessary services. If you still wish to have the treatment, please talk to your eye doctor about the cost and payment. The ministry does not set or regulate fees for uninsured services.

If I began treatment before June 15, 2002, am I still eligible for a refund?

If you had treatment between April 1, 2002 and June 14, 2002, then you may be eligible for full refund of the actual amounts that you paid for the drug, doctors’ fees and tests if you meet the clinical criteria described above. Talk to your eye doctor about how to receive a refund.

Treatment received before April 1, 2002 is not insured and is not eligible for a refund.

Disponible en français

For more information visit www.health.gov.on.ca