Macular Hole Treatment Cost

How Much Does Macular Hole Treatment Cost?

	With Health Insurance: Hospital Copay + 10%-50% Coinsurance
	Without Health Insurance: $1,500-$5,000+

A macular hole[1] is a break in a part of the retina, called the macula, that's responsible for central vision. It's created when the vitreous, a gel-like substance in the eye, shrinks and tugs at the retina in the process. Though the condition often comes with old age, it can also be caused by eye disorders, such as retinal detachment; eye disease, such as diabetic retinopathy; or eye injuries. Some macular holes will heal on their own and require no treatment; others may require surgery to improve vision.

Typical costs:

• Patients experiencing symptoms[2] such as a slight distortion or blurriness in vision typically start out with a visit to an eye doctor. The national average charge for a comprehensive eye exam is $114 for those without insurance. For patients with vision insurance coverage, the typical copay is $5-$35.
• If medical attention is needed, an eye doctor will typically recommend a vitrectomy[3] , a procedure in which eye fluid is removed so that the retina can be repaired. Vitrectomies typically cost about $5,000 per eye, including fees for the doctor, hospital and anesthesiologist. For instance, at VitreoRetinal Surgery[4] in Minneapolis, patients would typically pay $1,500-$3,000 for the procedure, depending on the extent of the problem and any other complications that may be present, in addition to fees for the hospital and anesthesiologist, and $50-$350 for an initial consultation.
• For insured patients, out-of-pocket costs typically consist of a specialist copay, possibly a hospital copay of $100 or more, and coinsurance of 10%-50% for the procedure, which could reach the yearly out-of-pocket maximum. According to the Kaiser Family Foundation, the average hospital copay for outpatient surgery is $132 and for inpatient surgery is $232. The average coinsurance rate is 17%-18%.

What should be included:

• In addition to taking a complete medical history, an eye doctor may perform tests[5] to see how much of the retina is affected, such as a refraction test[6] or using a lighted instrument called an ophthalmoscope to examine the eye.
• If needed, a vitrectomy typically takes two to three hours. At the end of the procedure, a silicone oil or a gas will be injected into the eye to replace the vitreous, and following surgery, patients will need to lie face-down for a few days or sometimes more, to enable the gas or oil to seal the hole.

• According to the National Institutes of Health, if a macular hole exists in one eye, there is a 10%-15% chance that a macular hole will develop in the other eye as well.
• Following a vitrectomy, patients often buy or rent health aids to help them remain in a face down position during their recovery period. Products include specially designed pillows[7] , body cushions[8] and chairs[9] and range in price from $20-$300, depending on the size and type of product. Some health insurers, like Cigna[10] will cover rental of the products.

• Patients considering vitrectomy should note the risks[11] , such as infection, an increase in the rate of cataract development, and the development of retinal detachment.
• The American Academy of Ophthalmology provides a database of ophthalmologists[12] patients can search.
• The Mayo Clinic offers a list of tips[13] to help patients prepare for a visit to the ophthalmologist.