Central Retinal Artery Occlusion (CRAO) And Hyperbaric Oxygen Therapy

What is CRAO? Central retinal artery occlusive disease (CRAO) is one of the most sudden and dramatic events seen in ophthalmology, though a less frequent chronic form also exists. It remains a disease of poor visual prognosis despite a multitude of studies and experimental trials. LEARN MORE ABOUT CRAO HERE.

In 2009 Anthem Blue Cross of California has added the indication of Central Retinal Artery Occlusion (CRAO) under the “Medically Necessary” list of treatable indications with HBOT. HERE IS THE MEDICAL POLICY.  If you or your center are interested in treating CRAO with HBOT I would encourage you to check into the following;
1. What are the common insurance companies in your area?
2. Search for the medical policies of these insurance companies to see if CRAO is on the covered list of indications.
3. Approach Opthamologists in your area and make them aware that patients with CRAO (when treated immediately) can be helped with HBOT.
4. Notify Emergency Rooms around you (if you are already at a hospital, have your medical director speak to the physicians at the ED/ER).
5. Some patients will offer to pay a cash rate especially if their insurance company does not cover HBOT for CRAO. So it is best to set up a cash rate for these patients by discussing with the business office of the hospital or upper management. In one hyperbaric center located at a hospital they charged the patient Medicare rates $90.00 per 1/2 hour of HBOT.

A CASE STUDY: I was fortunate enough to work with an Opthamologist that has also been trained in Hyperbaric Medicine. We recently treated an 84 y/o patient who lost total vision in his right eye and within 24 hours the patient was in the chamber. Within 5 minutes of being at depth (2.8 ATA) the patient started to gain some vision back in the affected eye. After the first HBO treatment the patient was able to read the Snellen chart at 20/200 (E), after treatment #5 the patient was able to read at 20/70 (TOZ), after 10 HBO treatments the patient was able to read at 20/30 (EDFCZP).

This is an excellent case study of HBOT and CRAO – if treated immediately can prevent the patient from permanent blindness.


Smoke Masks & Emergency Evacuation, Is your Center In Compliance?

NFPA 99 Chapter 20 ( states that a source of breathable gas allowing unrestricted mobility shall be available outside a Class A or B chamber for use by personnel in the event that the air in the vicinity of the chamber is fouled by smoke or other combustion products of fire. 

This section of the NFPA 99 speaks to a situation where if there was a fire in the room where your chambers are located (and assuming the chambers have patients in them), how will you deal with the smoke in the room while trying to decompress 2 or more patients and evacuate them without putting yourself and other staff at risk of being overcome by the smoke?  An excerpt from Ken Capek’s article in the RT Focus Journal states “This standard can be met by having a self-contained breathing apparatus (SCBA) or “smoke hood” with filtration system. The specific type of hood you purchase should be based on the time it takes to actually evacuate a patient. The evacuation duration time can only be known by performing an evacuation drill in your facility. Practice using the hood, but do not remove the airtight filter plugs for the drill or they will need to be replaced.”
For those that do not have smoke masks available in their center yet I have done a little research and found a couple of options. These products I have linked to below meet the requirements of NFPA 99 Chapter 20. The Xcaper Enterprise Smoke Mask Kit is only good for a minimum of 15 minutes.
The Dräger Smoke Hood Kit is also good for a minimum of 15 minutes as well.