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<p>There has been a significant change in clinical practice in ophthalmology since
the last tariff prices were set and reference costs used to calculate prices were
collected, with a shift to performing Minimally Invasive Glaucoma Surgery (MIGS) instead
of open glaucoma procedures which are frequently combined with cataract extraction.</p><p>
</p><p>MIGS are significantly cheaper, and both procedures cannot be differentiated
using operating procedure code supplement codes. Open/tube glaucoma procedures are
nearly always done with a graft of sclera or tutoplast, which triggers multiple procedures
so will receive significantly more under the 2019/20 prices than MIGS procedures,
which is appropriate.</p><p> </p><p>NHS Improvement has carried out an impact assessment
which shows that the national tariff changes should not affect patient access to glaucoma
treatment.</p>
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