OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT OCULARISTS ASSOCIATION OF SOUTHERN AFRICA. OASA Policy 007

Transcription

1 OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT OCULARISTS ASSOCIATION OF SOUTHERN AFRICA OASA Policy 007 This policy adopted by members of OASA On the 16 day of November 2010 President: Pedro Carvalho Amended on the 03 Day of July 2015

2 OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT OCULARISTS ASSOCIATION OF SOUTHERN AFRICA Table of Contents: 1. Disclaimer / Usage of this Policy / Principles of this Policy Page 3 2. Interpretation / Glossary Page 4 3. Introduction Page 7 4. Peer Review Page 8 5. Methodology Page 9 6. Procedure Details Page SAOA Procedure codes Series 5000/Ocular Prosthetics Page 25 Procedure codes maintained by Optical Assistant (Neutral Third Party) 2

3 OCULARISTRY PROVIDER QUALITY ASSURANCE POLICY DOCUMENT OCULARISTS ASSOCIATION OF SOUTHERN AFRICA 1. DISCLAIMER a. The Ocularists Association of Southern Africa has made every effort to ensure that: i. the standards contained herein are as comprehensive and error free as possible. ii. users of these standards shall bear the responsibility of any action that may arise from the omission or lack of accuracy of these standards. iii. the information and recommendations contained in this document have been provided in good faith. iv. the consequences of any action taken by any person as a result of information contained in or omitted from this document is not the responsibility of the Ocularists Association of Southern Africa nor any person/s or organization/s linked with this document, nor sources of reference. 2. USAGE OF THIS POLICY a. This document is intended for: i. the use of the profession of Ocularistry without limitation to any independent practice, group practice, network, public or private sector. ii. recommending standards to introduce a policy of quality assurance including continual improvement of the service provided by all Registered Ocularists. 3. PRINCIPLES OF THIS POLICY a. The Ocularists Association of Southern Africa promotes, without reservation: i. access to health care ii. embraces all principles contained in the Health Charter in the Bill of Rights as incorporated in the Constitution of the Republic of South Africa, iii. the expectation that these policy standards will be upheld. 3

4 1. Interpretation/Glossary 1.1 Ocularistry shall mean the profession populated by Ocularists. 1.2 Ocularist shall mean a trained professional who fits and manufactures custom designed Ocular Prostheses and Scleral Shells. 1.3 Phthysical Eye shall mean an eye where injury or disease has resulted in loss of function and shrinkage in size of the globe. 1.4 Enucleation shall mean the removal of the eye with the remaining orbital contents intact. Where possible, the four extra-ocular eye muscles are attached to an orbital implant. 1.5 Evisceration shall mean the removal of the eye's contents, leaving the scleral shell and extra-ocular muscles intact. 1.6 Exenteration shall mean complete surgical removal of the contents of the orbit, including the eyeball, fat, muscles and other adjacent structures. 1.7 Socket shall mean the bony cavity of the skull which normally contains the eyeball and its associated muscles, vessels and nerves. The socket also refers to the bony cavity after evisceration, enucleation or exenteration. 1.8 Ocular Prosthesis shall mean an artificial eye which is a type of craniofacial prosthesis used to restore crucial orbital function and structure. 1.9 Haptic Shell or Scleral Shell shall mean a Haptic Lens which is an Ocular Prosthesis fitting over the scleral surface of the phthysical eye Sclera shall mean the dense, white, fibrous outer membrane encapsulating all of the eyeball except the cornea Cornea shall mean the transparent, anterior window of the external membrane of the eye which is continuous with the sclera Microphthalmia shall mean an eye abnormality that arises before birth where one or both eyeballs are abnormally small Enophthalmos shall mean the recession of the eyeball into the orbit Motility Coupling Device shall mean the implant to Prosthesis coupling device Fornices shall mean Conjunctival fornix: The fornix of the conjunctivae refers to loose arching folds connecting the conjunctival membrane lining the inside of the eyelid with the conjunctival membrane covering the eyeball. In anatomy, a vault like or arched structure Implant shall mean an Orbital Implant which is placed within the socket after removal of the eye to restore volume to the eye socket and enhance movement or motility of an Ocular Prosthesis and eyelids Implant Migration shall mean the migration of a surgical implant in the eye socket. 4

5 1.18 MOI shall mean OASA s Memorandum of Incorporation Member shall mean a member of OASA referred to in Article 8 of the OASA MOI HPCSA or Council shall mean the Health Professions Council of South Africa OASA shall mean the Ocularists Association of Southern Africa Association shall mean the Ocularists Association of Southern Africa (OASA) 1.23 OASA Membership number shall mean the designated number given to each OASA member upon registration to OASA in accordance with the MOI SAOA shall mean the South African Optometric Association Scope of Practice shall mean the examination and assessment of the globe, socket and related structures to facilitate the manufacture and fitting of the appropriate, comfortable and safe prosthesis or prostheses and/or appliance or appliances to restore the dignity, appearance and functionality of the patient. This includes the eye socket, blinded eye, phthysical eye and the surroundings. The Profession of Ocularistry assists patients to become more functional and to restore the appearance, and where necessary, collaborates with Ophthalmologists, Plastic Reconstructive Surgeons, Psychologists, Psychiatrists and Maxillofacial Surgeons. Ocularists promote orbital and ocular health by rehabilitating the socket / orbit through manufacturing, fitting and maintaining of ocular prostheses and scleral / haptic shells for those who have had an eye or eyes enucleated, eviscerated, exenterated and those with total or partial vision loss and with an unsightly, damaged and/or disfigured eye known as a phthysical blinded eye Custom Ocular Prosthesis shall mean a Prosthesis that is fitted over an orbital implant or fills the entire eye socket. These Prostheses are close fitting and the fabrication requires accurate impressions. These Prostheses are manufactured from medical grade acrylic resin Pre - Fabricated Ocular Prosthesis shall mean a Prosthesis fitted from stock, either manufactured by a trade supplier or by the Ocularist, and may be modified by the Ocularist. These Prostheses are manufactured from medical grade acrylic resin Acrylic Prosthesis shall mean a medical grade acrylic resin Ocular Prosthesis Glass Eye shall mean a pre-fabricated Ocular Prosthesis manufactured from cryolite glass Ombudsman shall mean the Ombudsman appointed by OASA POPI Act shall mean the Protection of Personal Information Act, No 4 of 2013 (Act) of South Africa CPD shall mean Continuing Professional Development 1.33 Labour Act shall mean the Basic Conditions of Employment Act, 2002 and as amended Explanation of Code Grading: 5

6 RSV Point Time Skill Risk Equipment Relativity Service Value points use consultation as 100 points as a base line. Each practice will use its own monetary value for points. In minutes, approximate. Score out of 5, (1 = min; 5 = max) Skill and experience needed for any given task. Score out of 5, (1 = min; 5 = max) Risk of repeating any given task. Score out of 5, (1 = min; 5 = max) Expense of and/or number of pieces of equipment required to achieve any given task. 6

7 2. Introduction 2.1 Ocularistry The Profession of Ocularistry promotes orbital and ocular health by rehabilitating the socket and orbit or ocular contours through fitting, manufacturing and maintaining of Ocular Prostheses and scleral / haptic shells for those who have had an eye or eyes enucleated, eviscerated or exenterated; and those with total or partial visual loss as well as with unsightly, damaged and/or disfigured eyes known as phthysical blinded eyes The Ocularist's domain is manufacturing and fitting of Ocular Prosthetics in accordance with OASA s Scope of Practice Scope of Practice: The examination and assessment of the globe, socket and related structures to facilitate the manufacture and fitting of the appropriate, comfortable and safe prosthesis or prostheses and/or appliance or appliances to restore the dignity, appearance and functionality of the patient. This includes the eye socket, blinded eye, phthysical eye and the surroundings (?). The Profession of Ocularistry assists patients to become more functional and to restore the appearance, and where necessary, collaborates with Ophthalmologists, Plastic Reconstructive Surgeons, Psychologists, Psychiatrists and Maxillofacial Surgeons. Ocularists promote orbital and ocular health by rehabilitating the socket / orbit through manufacturing, fitting and maintaining of ocular prostheses and scleral / haptic shells for those who have had an eye or eyes enucleated, eviscerated, exenterated and those with total or partial vision loss and with an unsightly, damaged and/or disfigured eye known as a phthysical blinded eye The Profession of Ocularistry intervenes to assist the patient in becoming more functional, restores and maintains the orbital structural integrity and to restore their appearance An Ocularist is a trained Professional who consults, advises, fits and manufactures Ocular Prostheses An Ocularist is qualified to fit Scleral or Haptic Shells This document encapsulates the system, tools and methods used to accredit Ocularists in a fair and an unbiased manner. 7

8 3. Peer Review System 3.1 A peer review system is utilised by OASA to establish whether the standards contained in this Quality Assurance Policy are being upheld. Domain Quality Standard Designation Criteria Existing Ocularists: Matriculation Certificate; 5 Year Apprenticeship; at least 15 Years Private Practice to obtain Ocularists Registration through Recognition of Prior Learning. Future Ocularists: National Senior Certificate; 360 Credit Diploma to be registered. HPCSA Registration OASA will be seeking registration with HPCSA. HPCSA principles are voluntarily upheld by OASA. CPD Portfolio Active CPD compliance. Informed Consent Consent procedures and Consent Forms. Consultations Respecting patients including all aspects of privacy in consultation, compliant with the Health Charter. Patient Records To include clinical history and observations, diagnosis, methodology and ongoing management. POPIA All documentation stored in accordance with the POPI Act. Patient Education Comprehensive written information regarding their condition. Treatment Options and Costs Written treatment and cost options. Storage of Ocularistry Meets manufacturer and regulatory standards. Manufacturing Materials Storage of contact lens and Meets manufacturer and regulatory standards. related products Administration of all Record detail of material or substance administered and response. materials and related substances Practice Service Knowledge All practice staff to be conversant with the services offered. Recruitment and dismissal As per individual practice policies in compliance with the Labour Act of South procedures Africa. Protection from abuse and All matters to be deferred to the OASA Ombudsman. discrimination Autonomy of patient Ocularists are autonomous in their patient management. management Disposal of Hazardous Meets with manufacturers and regulatory standards. Use and disposal of Materials materials is according to relevant legislation. Insurance Professional indemnity, practice contents, practice liability, product insurance. Health & safety Adequate space, lighting, ventilation, cleanliness and comfort. Wash basin available for hand washing. First Aid Appropriate first aid kit available in accordance with the relevant regulations. Fire & disaster planning Serviced fire extinguisher and emergency evacuation plan in place. Equipment Practice equipment supports practice aims. Claims Management System Approved system to manage all third party claims. General Ocularistry care Consultation time by the registered Ocularist is adequate to explain diagnosis, management, care (including after care) and cost. Related disciplines Co-management, where necessary, through related professionals. 8

9 4. Methodology 4.1 Custom, Haptic Shells and Pre-fabricated Ocular Prostheses: Ocularists utilize one or several combined fitting and manufacturing techniques. The manufacturing process begins with the initial fitting procedure and continues until the Ocular Prosthesis is finalised and fitted in the patient s eye socket or over their phthysical eye The patient care team may be expanded to include other disciplines, for instance Ophthalmologists, Plastic Reconstructive Surgeons, Psychologists, Psychiatrists, Optometrists and Maxillofacial Surgeons. 4.2 Ocularists have appropriate equipment and materials, although there will be some variances in practice methods. 4.3 Worldwide there are two main mediums for manufacturing ocular prosthetics, namely medical grade acrylic resin and cryolite glass. 4.4 Internationally, the lifespan of an acrylic ocular prosthesis is five years, thereafter the acrylic deteriorates to a point that it may be detrimental to the wellbeing of the socket. The lifespan of a glass ocular prosthesis is 2 years In cases where there has been surgical intervention during the ocular prosthesis life cycle, it is customary to manufacture a new ocular prosthesis due to the surgically induced changes in the socket The lifespan of an Ocular Prosthesis can be detrimentally affected when contraindicated drugs are administrated, or any other non-compatible cleaning material is applied to a Prosthesis. This will necessitate the replacement of the Ocular Prosthesis to prevent any damage to the socket An Ocular Prosthesis needs to be replaced before the indicated lifespan if the socket or ocular surface or orbital shape changes. This could be due to implant migration, weight fluctuation or a variety of other reasons. 4.5 In the case of young children, it is important to note that the Ocular Prosthesis needs frequent, regular monitoring and alterations, even multiple replacements in a single year to accommodate the growing child s changing socket Where the Prosthesis is not regularly altered to accommodate the growth of the child, consequences can include deformities of the facial structure which in some cases can require facial reconstructive surgical intervention to rectify Children s sockets stabilise by approximately the age of 18 years, and the adult replacement lifespan cycle normalises. 4.6 Annual consultation and surface evaluation is necessary for all patients. Small children will need more regular assessments Annual polishing is very important to maintain the surface of the Prosthesis, and ensure patient comfort as well as maximising the lifespan of the Prosthesis. 9

10 4.6.2 The fit of the Ocular Prosthesis will be assessed which may result in potential build ups, resurfacing, cutting down or re-veining. 4.7 The fitting and manufacturing process shall include one or more of the following finished products: An Ocular Prosthesis for an eviscerated, enucleated or exenterated eye socket, with or without an implant (Implant would be surgically placed by an Ophthalmologist) A scleral shell Ocular Prosthesis for a phthysical, microphthalmic or blind, disfigured globe Custom-made conformers for: post-surgical eye sockets globe shield for eyelid surgery contracted eye socket expansion congenital microphthalmos socket and/or eyelid expansion congenital anophthalmos socket and/or eyelid expansion template for prosthesis-to-implant motility-coupling device placement procedure Enlargement (augmentation) of an Ocular Prosthesis Reduction of an Ocular Prosthesis Modification of Prosthesis for motility-coupling device(s). 5. Procedure Details Explanation of RSV Point Allocation: RSV Point Relativity Service Value Points use consultation as base line. Each practice will use its own monetary value for points. Time In minutes, approximate. Skill Score out of 5, (1 = min; 5 = max) Skill and experience needed for any given task. Risk Score out of 5, (1 = min; 5 = max) Risk of repeating any given task. Equipment Score out of 5, (1 = min; 5 = max) Expense of and/or number of pieces of equipment required to achieve any given task. 10

11 Prosthetic Consultation Purpose of Code A patient new to the practice, or a patient who has not been seen by the Ocularist for at least a period of three months Procedure: A Prosthetic consultation shall include documenting one or several of the following: patient personal & contact details; clinical history and observations, diagnosis, methodology and on-going management; informed consent to continue with proposed treatment plan from patient or guardian Discussion of patient expectations include: overall cosmesis achievable with fitting and manufacturing overall cosmesis with current Ocular Prosthesis in situ Ocular Prosthesis and socket care psychological care or counselling previous Ocular Prosthesis fitting where applicable possible cosmetic surgery where applicable cosmetic devices where applicable discussion of future consultations through the process of Ocular Prosthesis fitting and manufacturing adaptation to Ocular Prosthesis and monocular vision or blindness discussion of realistic costs involved, where possible discussion of realistic life-span of the materials used in the manufacturing of an Ocular Prosthesis Examination of eye socket; condition of the orbital or ocular tissue condition of the socket structure, lids and fornices presence of discharge, inflammation or irritation implant mobility if applicable 11

12 possible surgical intervention evaluation of achievable movement Where necessary, discussion on Implant and other surgical options available to the particular patient, where applicable showing implants, mobility peg and coupling systems Where necessary, refer to Ophthalmologist; Plastic & Reconstructive Surgeon; Optometrist; Psychologist; Psychiatrist; Maxillofacial Surgeon; parent or guardian Ocular Prosthetic Consultations can include photography of any one or several of the above examinations Discussion on realistic results achievable and all options available. RSV Points 100 Time 60 minutes Risk 2 Equipment Impression for all Ocular Prosthetics Purpose of Code to determine the shape and size of the socket to create a positive replication of the missing volume for accurate, three dimensional manufacture of the Ocular Prosthesis to determine position and angle of the motility/coupling peg to determine if the shape of the socket has altered since the last prosthesis was fitted The socket shape can change for many reasons, some of which include; Soft tissue changes Scarring Developmental growth Fatty tissue absorption Healing after surgery and/or trauma 12

13 Change in patients body weight Implant migration Procedure The eye socket is inspected for globe or implant position and irregularities in conjunctival tissue and lids. Abnormalities which must be addressed are identified Various methods are used in taking of impression An appropriate impression shell or conforma is chosen or manufactured and placed into the socket Impression material is placed in the shell and then placed into the socket or over existing globe. OR The shell is placed into the eye socket and impression material is introduced into the eye socket behind the shell using a syringe or dental Silicon gun. OR Impression of socket over existing prosthesis for building up of prosthesis or positioning of motility peg or the like When the impression material is set, the impression is removed from the socket The impression is then invested in an investment medium in preparation for replication Re-inspection of the socket is usual, and is needed to check that no impression material is left behind. RSV Points 403 Time 90 minutes Risk 5 Equipment Iris Colour Purpose of Code Patient s iris is measured for correct iris & pupil and an appropriate button size, shape and thickness is chosen. 13

14 5.3.2 Procedure RSV Points 166 Time 90 minutes Risk 4 Equipment An iris button for an acrylic Ocular Prosthesis is either hand painted or drawn on a suitable material compatible with the MMA scleral colour discussed under procedure code Manufacture of Ocular Prosthesis An iris button can be used ex stock, painted or drawn from the patient directly When painting with MMA, ventilation in the room must be adequate Model Fitting Purpose of Code A Prosthetic model is manufactured as a pre-cursor to the final fitting of the Ocular Prosthesis A model is the initial version of the final Prosthesis. The model is therefore more easily adapted and adjusted than a final Ocular Prosthesis A model may be required to be worn for a period of time for various reasons including time to allow swelling of the socket to subside or for patient adaptation Procedure RSV Points 922 Time 180 minutes Risk 5 Equipment Model manufacture: Replication of impression is done in the appropriate material for models Model fitting includes: Modification or shaping of model for comfort, socket shape compatibility, best movement achievable, size, symmetry of face and features, eye socket fornices and eye socket irregularities as well as motility peg positioning where necessary. 14

15 Prosthesis Manufacture & Moulding Purpose of Code The Ocular Prosthesis will be the final product Procedure The model indicating the pupil and iris positioning is then invested in a dental investment medium for replication in a suitable flask depending on the method of curing to be used When both sections of the mould are finalised, the flask is opened and the prototype model is removed The iris button is placed in the predetermined location in the anterior section of the mould Either half of the mould may be enlarged slightly by grinding or scraping; or a shim-material may be placed between the mould halves if necessary The mould is cleaned, inspected and a dental separating medium is applied to each side of the mould Scleral toned manufacturing polymer and monomer are mixed together in a suitable container as per instructions of relevant manufacturer, and shading appropriate to the patient s sclera Once the scleral-toned mixture is ready, the iris button is placed in position and the mould is packed with the scleral-toned material and closed with pressure Manufacturer s instructions are to be adhered to, including multi-level curing The moulding flask is then placed in one of the following; The moulding flask is submerged in a water bath and processed in accordance with Specification 12 of the American Dental Association. If using materials requiring different processing times, manufacturer s directions and curing times are to be adhered to. Specification 12 reads in water at 73 C (+/- 1 C) for one and a half hours and then brought to boiling point for a further half hour. When the heating schedule has been completed, the flask shall be cooled in air at 23 C (+/-10 C) for thirty minutes and then immersed in water at 23 C (+/-10 C) for a further fifteen minutes Microwave Ovens (times and power levels may vary depending on the power rating and wattage and the ballast mass placed in the microwave oven). The specific power of the microwave oven, its 15

16 model number, brand name as well as levels, curing times and ballast mass shall be indicated on the Patient Records Alternate source of Polymerization Propagation. The chosen methods, time and temperature shall be adhered to and all pertinent information shall be indicated on the Patient Records All sources of Polymerization propagation are considered Curing-units All batch numbers and curing methods and times shall be indicated on the Patient Records The mould is then released from pressure, mould sections separated and Prosthesis removed from the mould, excess flashing ground away, iris exposed to proper diameter and scleral area is readied for painting and veining After procedure code veining, the mould is again inspected, repaired, cleaned and a separating medium is applied to both sections The prosthesis is placed into the posterior section of the mould. Clear material polymer and monomer are mixed at the same ratio of 3:1 and cured as before with Lot and Code numbers recorded on the Patient Records. The mixture is then placed on the anterior surface, the mould sections interfaced and closed. The pressurized moulding flask is processed in the curing-unit as before. Once cured, the prosthesis is released from the mould. Flashing and surface irregularities are ground away. It is first polished with a coarse to gradually finer gradients of polishing materials. See procedure code Polishing. RSV Points 1065 Skill 4 Time 360 minutes Risk 3 Equipment Follow-up ( within 6 months ) Purpose of Code A consultation appointment or check-up within the first six months after RSV Points 55 Time 240 minutes Risk 4 Equipment 4 16

17 Consultation away from Practice Purpose of Code Patient may be unable to attend consultation at the practice, or in need of the Ocularist to accompany the patient to a fellow Professional s consulting room Procedure RSV Points 188 Time 240 minutes Risk 1 Equipment If a consultation has to take place away from a registered practice or regular satellite practice address. This may be in conjunction with an Ophthalmologist or other specialist, at their practice rooms. (The satellite practice address is accepted as a normal address) Consultation as per procedure code Consultation, but including traveling time Travel costs may include AA rates from practice to consultation and back again Glass Eye, complete with Consultation and Fitting Purpose of code This form of Ocular Prosthesis is performed predominantly by Ocularists trained abroad and in accordance with their standards This code includes the completed Ocular Prosthesis including consultations, manufacture and fittings. RSV Points 1150 Time 120 minutes Risk 5 Equipment Drill Ball and Socket (pegging to coral) Purpose of Code 17

18 Coupling of the Prosthesis to the peg can only be done on acrylic Ocular Prostheses and will result in maximum movement being transferred from the implant to the Prosthesis The coupling may also be used to hold the Prosthesis in place, and prevent the Prosthesis from causing lower lid sagging or soft tissue changes Procedure Drilling of Ocular Prosthesis for peg coupling to Ocular Prosthesis. Various methods are used for coupling position determination including; RSV Points 162 Time 120 minutes Risk 5 Equipment Impression of eye socket either on back of Prosthesis or with standard shells Pilot hole drilling used with temporary small headed peg Manual judgement by Ocularist Trimming and Re-shaping Purpose of Code Instead of making a new Prosthesis, costs can be saved by adjusting an existing Ocular Prosthesis Procedure Adjustments are made to an existing Prosthesis whereby cutting of the Ocular Prosthesis will allow for better fit or cosmesis, provided that the material is viable. RSV Points 81 Time 120 minutes Risk 5 Equipment 3 18

19 Build-up Purpose of Code As with procedure code Trimming & Reshaping, costs are saved by working on an existing Ocular Prosthesis Procedure To perform an alteration to an existing Ocular Prosthesis usually using dental wax to build-up the shape and then adding to the Ocular Prosthesis in the compatible material, provided that the material of the existing Ocular Prosthesis is still viable All factory specifications of the materials used, as described above, must be strictly adhered to. RSV Points 239 Time 360 minutes Risk 5 Equipment Veining Purpose of Code To replicate the veins in the sighted eye Procedure Replication of veins and scleral shading is matched to the patient s sighted eye or sample, where necessary Iris tones are enhanced, or applied to anterior surface along with the scleral tones and veins Artwork is then cured onto the Prosthesis as per the appropriate curing methods. RSV Points 113 Time 240 minutes Risk 4 Equipment 3 19

20 Polishing Purpose of Code To produce a perfect surface on the Prosthesis for maximum comfort To minimize irritation to eyelids As a final procedure after procedure code Manufacture of an Ocular Prosthesis Procedure Final polish of an Ocular Prosthesis or polishing on a yearly basis, is performed in order to maintain the surface of the Prosthesis A final wet and/or dry high gloss is applied after inspection of all surfaces is complete. There should be no visible defects when examined with a 3x loupe or magnifier. The Prosthesis is now ready for disinfection and dispensed to the patient Minor surface reduction may be made during the fitting process, with subsequent re-polishing of all surfaces, before the final fitting of the Prosthesis. Before final fitting, re-inspection under a 3x loupe or magnifier is required. RSV Points 50 Skill 4 Time 60 minutes Risk 2 Equipment Materials for Custom Eye Purpose of Code Factory specifications and instructions will be strictly adhered to Materials will vary from practice to practice, but only socket approved dental and ophthalmic supplies may be used Records of batch numbers of materials used are to be recorded on patient s record file. RSV Points 314 Skill 2 Time 15 minutes Risk 5 Equipment 2 20

21 Stock Eye Purpose of Code Reducing costs to patients Procedure RSV Points 224 Skill 4 Time 120 minutes Risk 2 Equipment Limited colour and shape choices are available and the properties of these Ocular Prostheses shall be clearly addressed with the patient where a stock Prosthesis is fitted Prosthetic Haptic Lens Purpose of Code This surcharge may be charged when working on a patient with a phthysical eye Increased risks include; RSV Points 490 Time 180 minutes Risk 5 Equipment Additional time taken for appointments Additional time taken for fitting and manufacture Increased risk of remaking due fitting challenges and therefore to discomfort and fit Increased risk of breakage due to the fragility of the Prosthesis during any stage of the manufacturing process. 21

22 Motility / Coupling Peg Purpose of Code The purpose of a motility/coupling peg is to transfer movement from the implant to the Prosthesis Procedure Supply of a Titanium or other peg for use with the implant specific coupling system administered by the Surgeon. RSV Points Relevant to input cost Skill 2 Time 30 minutes Risk 1 Equipment Conforma Supply and Fit Purpose of Code RSV Points 130 Skill 3 Time 60 minutes Risk 1 Equipment An ex-stock model for use in or after surgery as a temporary socket retention tool whilst socket is healing or while patient is not yet ready for fitting of a final Prosthesis Conforma Supply Only Purpose of Code RSV Points 81 Skill 3 Time 15 minutes Risk 1 Equipment Conforma supplied to Doctor for use in or after surgery as procedure code Surcharge, Children 5 years and under. 22

23 Surcharge - Children under 5 years of age Purpose of Code This surcharge may be necessary when working on a young patient as the fitting is more time-consuming on the patient who is not yet able to cooperate or fully understand the importance of the work done to achieve a satisfactory end result Increased risks include: RSV Points 495 Time 240 minutes Risk 5 Equipment Additional time taken for appointments Additional time taken for manufacture Increased risks of re-making due to lack of co-operation Assist in Theatre per 30 minutes Purpose of Code May include: Discussion with Ophthalmologist, Reconstructive Surgeon, Anaesthetist and/or theatre staff, patient and the like Assistance requested by Doctor, usually in the fitting and shaping of models for reconstructive purposes and/or Taking of impression for manufacture of model in patients who are not easily able to have this done in practice and/or Patients who require model fitting for reconstructive purposes Post procedure consultation in ward with patient and/or parent or legal guardian Travel costs at AA rates may be charged for travel from practice to theatre and return. 23

24 RSV Points 102 Time 180 minutes Risk 1 Equipment Complete Eye Purpose of Code Is to provide one global price of all manufacturing and fitting costs including six months aftercare Procedure The Complete Eye code is a combination of the following codes: Prosthetic Consultation Impression for all Ocular Prosthetics Iris Colour Model Fitting Prosthesis Manufacture and Moulding Follow-Up (within 6 months) Veining Polishing RSV Points 3136 Time 1335 minutes Risk 5 Equipment Materials for Custom Eye Where appropriate procedure code Prosthetic Haptic Lens and/or procedure code Surcharge - Children under 5 Years of Age will be charged in addition to the Complete Eye Code. 24

25 6. SAOA Procedure codes Series 5000/Ocular Prosthetics South African Optometric Association Coding Structure As per Optical Assistants Publication updated annually Fees inclusive of 14% V.A.T Series 5000 Ocular Prosthetics 25