Focus on glaucoma

What is glaucoma? Glaucoma refers to a collection of diseases that lead to damage of the optic nerve in the eye. This condition is frequently linked to an accumulation of pressure within the eye, known as intraocular pressure. It is important to note that glaucoma often runs in families and may not manifest symptoms until later in life. The increased intraocular pressure can inflict damage on the optic nerve, which plays a crucial role in transmitting visual information from the eye to the brain. If the pressure remains high and continues to harm the optic nerve, glaucoma can ultimately result in irreversible vision loss. If left untreated, glaucoma can lead to complete and permanent blindness within a matter of years. Nevertheless, with early detection and appropriate treatment, individuals can frequently safeguard their vision from severe deterioration.

Narrow-angle glaucoma Acute narrow-angle glaucoma is a condition that arises suddenly when the iris, the colored part of the eye, is either pushed or pulled forward. This movement can block the drainage angle of the eye, which is where the trabecular meshwork allows for the outflow of fluids. When the internal structures of the eye become obstructed in this manner, the intraocular pressure can rise sharply, potentially damaging the optic nerve responsible for transmitting images from the eye to the brain.

Primary open-angle glaucoma Chronic glaucoma, often referred to as primary open-angle glaucoma (POAG), is sometimes labeled "the silent thief of sight." This nickname stems from the fact that in the early stages of the condition, there are typically no warning signs; individuals experience no pain, vision loss, or other indicators that anything is amiss. Due to the insidious nature of this disease and the severe vision impairment it can cause as it advances, it is crucial to undergo regular eye examinations. These check-ups can help ensure that you are not developing early signs of primary open-angle glaucoma.

Possible causes of glaucoma There are several factors that can lead to glaucoma, including elevated eye pressure, or intraocular pressure (IOP), which occurs when the eye is unable to drain fluid effectively. Additionally, glaucoma can be secondary to another eye condition or disease, a situation referred to as secondary glaucoma. For instance, individuals with tumors or those undergoing prolonged steroid therapy may be at risk for developing secondary glaucoma.

Other causes of secondary glaucoma include: There are multiple factors that can contribute to the development of secondary glaucoma. These include eye injuries, which can disrupt normal eye function; inflammation of the eye, which can lead to increased pressure; and abnormal blood vessel formation due to conditions such as diabetes or retinal blood vessel blockage. The use of steroid-containing medications, whether in pill form, eyedrops, or sprays, can also lead to increased IOP. Another cause is pigment dispersion syndrome, where tiny fragments or granules from the iris can circulate in the aqueous humor—the fluid within the front part of the eye—and obstruct the trabecular meshwork, the small drainage system for the eye’s aqueous humor.

How to register on the chronic programme If you have been diagnosed with Addison’s disease, it is essential to reach out to your doctor and request that they contact our Chronic Medicine Department at 0860 11 78 59 to register you in the Chronic Medicine Management Programme. A chronic medicine consultant will collaborate with your physician regarding your treatment plan. After the diagnostic criteria have been satisfied and relevant blood test results have been submitted, your treatment will be approved. We will inform you whether your treatment falls within the Momentum Medical Scheme formulary or if a co-payment will be necessary. Once you receive authorization, you can present your prescription to your designated service provider to obtain your medication, and the claim can be processed accordingly. A designated service provider (DSP) refers to a healthcare provider, such as a doctor, pharmacist, or hospital, that is the preferred choice of a medical scheme for its members when they need diagnosis, treatment, or care for a Prescribed Minimum Benefit condition. Should you choose not to use the DSP and instead opt for a different hospital, doctor, or pharmacy, there may be a co-payment involved. Typically, the authorization is valid for 12 months. If there is no change in the medication you need to take, your doctor or pharmacist can contact us at 0860 11 78 59 to renew the authorization. The same procedure applies if there are any modifications or additions to your authorization.

For more information regarding your chronic benefits and where to obtain chronic medication and treatment, click here.

Hospitalisation If you find yourself in need of hospitalization due to complications from cardiac failure, you can log into the Momentum App, reach out to us via the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59 to request pre-authorization. A dedicated case manager will be assigned to monitor your hospital stay and follow up on your care.

Treatment plan After you have registered in the programme, you will gain access to a treatment plan that may encompass coverage for necessary tests, physician visits, and other benefits deemed medically essential by your doctor. These elements will be reviewed by our clinical team to ensure their appropriateness and necessity.

Compliance It is crucial to adhere to the following guidelines: first, ensure that you obtain your chronic medication on a monthly basis; second, take your medication according to the prescribed dosage and quantity provided by your doctor; and third, do not miss any doses. Adhering to these guidelines is not only vital for compliance but can also have significant implications for your health and overall well-being.

Please make sure your claims have the appropriate ICD-10 code It is imperative that all claims include the correct ICD-10 codes (diagnostic codes) so that we can accurately identify and process the claim from the Chronic Benefit.

We may pay claims from your Day-to-day Benefits if: There are specific circumstances under which we may need to pay claims from your Day-to-day Benefits. These include situations where claims are submitted without the relevant ICD-10 codes, if you have exceeded the allowed frequency limit for consultations or tests, or if the treatment is deemed not clinically appropriate.

Contact us For any inquiries or assistance, you can reach us through the web chat feature on momentummedicalscheme.co.za, email us at [e-mail], send us a WhatsApp message, or call us at 0860 11 78 59.

Glossary of terms Designated service providers refer to a network utilized by the Momentum Medical Scheme, which includes Associated General Practitioners and Specialists, as well as State facilities, depending on the specific circumstances. These providers are responsible for diagnosing and treating our members for Prescribed Minimum Benefits.

A formulary is a comprehensive list of medications that are covered under your specific option, from which your doctor can select the appropriate medication for your chronic condition.

ICD-10 refers to the diagnostic code used for identifying medical conditions.

Prescribed Minimum Benefits encompass a set of benefits that all medical schemes in South Africa are mandated to cover as stipulated by the Medical Schemes Act 131 of 1998 and its associated regulations. To access these benefits, certain criteria must be met: your medical condition must qualify for coverage and be included in the defined list of Prescribed Minimum Benefit conditions; the treatment required must align with the treatments specified in the defined benefits; and you must utilize the Scheme’s Designated Service Providers. For further information regarding Designated Service Providers, please refer to the definition provided on page 2.

If you decide to use non-designated service providers voluntarily, the Scheme will cover benefits up to the Momentum Medical Scheme Rate, and applicable co-payments will be enforced. However, if you utilize non-designated service providers in emergency medical situations, this is considered involuntary, and co-payments will be waived.