PhilHealth's New Cataract Guidelines

The Philippine Health Insurance Corporation (PhilHealth) has issued a new circular, No. 2025-0010, detailing the updated quality standards for the diagnosis and management of uncomplicated cataracts among adults. This circular, effective in 2025, aims to ensure that PhilHealth members receive the highest quality of care for cataract-related procedures.

The new guidelines are a part of PhilHealth's commitment to the Universal Health Care Act, which emphasizes quality in healthcare services. These standards were developed in consultation with the Philippine Academy of Ophthalmology (PAO) and the Philippine Alliance of Patient Organizations (PAPO) to ensure they are evidence-based and patient-centered.

Key Aspects of the New Guidelines

The circular covers several critical areas of cataract management to ensure comprehensive and quality care for patients.

1. Patient-Centered Approach

The guidelines emphasize the importance of patient involvement in the decision-making process. Ophthalmologists are encouraged to educate patients about their condition, the potential benefits and risks of surgical and non-surgical treatments, and how vision impairment can affect their quality of life.

2. Comprehensive Patient Assessment

Before any procedure, a thorough eye examination is required to confirm that the patient's symptoms are consistent with a cataract and to rule out other causes of visual impairment. This includes measuring visual acuity, intraocular pressure, and conducting a dilated fundoscopy.

3. Surgical and Non-Surgical Management

The circular outlines clear indications for both surgical and non-surgical management of cataracts. Non-surgical options are recommended when surgery is not necessary or advisable. For patients undergoing surgery, acceptable techniques include extracapsular cataract extraction (ECCE), manual small incision cataract surgery (MSICS), and phacoemulsification.

4. Authorized Health Facilities

Cataract surgery must be performed in a DOH-licensed and PhilHealth-accredited facility, such as a hospital or an ambulatory surgical clinic. The circular also recommends that surgeries be performed on an outpatient basis unless specific conditions require admission.

5. Intraocular Lenses (IOLs)

The guidelines provide detailed information on the types of IOLs covered by PhilHealth, including monofocal, monofocal toric, multifocal, and multifocal toric lenses. The circular also clarifies the clinical applications of each type of lens to help patients and doctors make informed decisions.

6. Postoperative Care and Documentation

The circular emphasizes the importance of postoperative care, which is the responsibility of the operating eye surgeon. Clear and accurate documentation of the entire surgical process, from preoperative assessment to postoperative follow-up, is also a key requirement to ensure patient safety and positive outcomes.

These new guidelines from PhilHealth are a significant step towards standardizing and improving the quality of cataract care in the Philippines. Patients are encouraged to discuss these new standards with their healthcare providers to ensure they receive the best possible care.

Reference: PC2025-0010