Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. The prevalence of keratoconus if often reported to be 1 in 700.[1]. Although keratoconus does not fulfill the criteria for inflammatory disease, recent studies show a significant role of proteolytic enzymes, cytokines, and free radicals (MMP-9, IL-6, TNF-) even in subclinical disease, showing a quasi-inflammatory characteristic in keratoconus. The majority of cases of keratoconus are bilateral, but often asymmetric. Keratoconus (ker-uh-toe-KOH-nus) occurs when your cornea the clear, dome-shaped front surface of your eye thins and gradually bulges outward into a cone shape. All rights reserved. Although only 8% to 10% of KC patients have a family history of the disease, a genetic basis for the condition is supported by autosomal dominant and recessive patterns of inheritance, association with other genetic disorders, and twin concordance studies.3 Numerous candidate genes have been identified through genomic studies. This page has been accessed 413,094 times. 1.2.An introduction to ocular surface disease and DED. Other symptoms include glare, photophobia, and distorted night vision. Another option is to use the Download button at the top right of the document view pages (for certain document types). The document is broken into multiple sections. [URL unfurl="true"]https:// Can anyone tell me for 0402T if dx H18.463 is a linkable dxim having issues with finding the information ICD-10 code H18.51 is no longer a payable code for Medicare. 9th ed. Police immediately organized a task force to conduct an investigation. Keratoconic patients in their third decade of life should be followed every six months. Patients with any of the disorders listed below should be carefully assessed for early signs of KC.2. john reynolds brother; st francis de sales chicago alumni; aldershot crematorium diary; tns recovery complex after microneedling 0000001377 00000 n 13 Park SE et al. We read every comment! 2019;42(4):341-349. The diagnosis code (s) must best describe the patient's condition for which the service was performed. 2010; 117: 831-838. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Krachmer, Palay. 0000004163 00000 n License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Position held: Associate Doctor (04/95-11/97) Responsibilities included: Patient consultations, including Gary Hall Eye Institute patients from Arizona, USA . Other approaches have shown some promise and success but overall have been less consistent and reliable in their abilities to halt keratoconus.[5]. The submitted medical record must support the use of the selected ICD-10-CM code(s). However, these external signs are typically not observed in mild KC. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. The riboflavin sensitizer is then activated with exposure of the cornea to UV light for a period of 30 minutes. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Service Retail cost 92310 Fitting of contact lenses 92311 92312 92072 Enter the appropriate primary diagnosis code for the contact lenses requested Measurement of best-corrected visual acuity with spectacles and hard or gas permeable contact lenses (with refraction when indicated), Retinoscopy to check for scissoring reflex, Slit-lamp biomicroscopy of the anterior segment including lid tightness and papillae in upper tarsal conjunctiva, Keratometry/Computerized Topography/Computerized Tomography/Ultrasound Pachymetry, Asymmetric refractive error with high or progressive astigmatism, Keratometry showing high astigmatism and irregularity (the axis that does not add to 180 degrees), Scissoring of the red reflex on retinoscopy, Inferior steepening, skewed axis, or elevated keratometry values on K reading and computerized corneal topography. The ICD code H186 is used to code Keratoconus Keratoconus (KC, KTCN) is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than the more normal gradual curve. The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 92025. (ICD) diagnosis of keratoconus (ICD-9 code 371.6, ICD-10 code H18.609) were retrospectively identified and screened for eligibility. When the astigmatism can no longer be managed with glasses, contact lenses are the next step. Reported complications include allograft rejection, iatrogenic astigmatism, and recurrence of KC. A trained ophthalmologist can interpret corneal imaging studies and determine if you need cross-linking or a cornea transplant. A drug and device combination product (Photrexa Viscous, Photrexa and the KXL System) for epi-off corneal collagen cross-linking was approved by the FDA in the Spring of 2016. Chodnicki KD (expert opinion). Surv Ophthalmol. Central and paracentral thinning of the cornea is a characteristic sign. In these people, cornea transplant surgery might be necessary. Feb. 13, 2023. https://www.aao.org/eye-health/diseases/keratoconus-list, https://www.aao.org/eye-health/treatments/corneal-transplantation-list, https://www.aao.org/eye-health/diseases/astigmatism-4, https://www.aao.org/resident-course/pathology-atlas, National Institutes of Health Clinical Trial Registry, https://eyewiki.org/w/index.php?title=Keratoconus&oldid=91180, Eye rubbing, associated with atopy or vernal keratoconjunctivitis. The organization has 1887 authors who have published 2170 publication(s) receiving 16091 citation(s). Stein HA, et al., eds. 0000034673 00000 n ^ """" . H18.629 Keratoconus, unstable, unspecified eye H18.70 Unspecified corneal deformity H18.711 Corneal ectasia, right eye H18.712 Corneal ectasia, left eye H18.713 Corneal ectasia, bilateral . The majority of patients that can wear hard or gas-permeable contact lenses have a dramatic improvement in their vision. It also gets thinner and the eye bulges out. International Society of Refractive Surgery. CPT is a trademark of the American Medical Association (AMA). External pressure on the globe eliminates these lines on slit-lamp examination. Listed below are all Medicare Accepted ICD-10 codes under H18.6 for Keratoconus. Revised November 7, 2022 | Page 2 of 11 AWIPEC-0215-15 . Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Surgical options include intrastromal corneal ring segments (ICRS), deep anterior lamellar keratoplasty (DALK), and penetrating keratoplasty (PK). Intraocular hemorrhage can be subdivided depending on . April 2023; Photodiagnosis and Photodynamic Therapy 42:103554 What is the correct diagnosis code? Lema I, Sobrino T, Durn JA, Brea D, Dez-Feijoo E. Br J Ophthalmol. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The advent of this modality has reduced the need for keratoplasties.11 Adverse effects include infectious keratitis, edema, and haze.10, In early U.S. studies, custom topography-guided photorefractive keratectomy has been used as an adjunct to improve visual function and normalize remaining corneal surface abnormalities. Munsons sign, a protrusion of the lower eyelid in downgaze. The cornea is the clear tissue that covers the front of the eye. In the Tabular List, select code H91.90 Unspecified hearing loss, unspecified ear. What websites do you recommend? Allowable diagnosis codes include, but are not limited to, the following: You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, Billing and Coding: Computerized Corneal Topography, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation, Article - Billing and Coding: Computerized Corneal Topography (A57699). 12 Nattis A et al. H18.611 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Clinically, PMD patients are typically asymptomatic, except for slow, progressive reduction in visual acuity refractory to spectacle correction. Ami TR. All surgical patients need to be followed to ensure wound healing, evaluation for infection, suture removal, and other routine eye care, such as testing for glaucoma, cataracts, and retinal disease. Through an arc-shortening effect, ICRS flatten the corneal surface, reducing the refractive error.13 The amount of refractive correction depends on the diameter and thickness of the rings. A number of approaches have been developed to improve the quality of vision in affected patients and, in some cases, to slow or stop disease progression. Contractors may specify Bill Types to help providers identify those Bill Types typically The following maps are analyzed: anterior, sagittal, and tangential curvature maps; anterior and posterior elevation maps; and the thickness map.4. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. Example of Early Keratoconus as evidenced on a Placido-disc based topographic evaluation, Example of Keratoconus as evidenced on a Pentacam Scheimpflug evaluation. In addition, private-paying patients undergoing CXL are facing an increased cost as of July 1, 2017, when Avedro raised pricing for its system's two photosensitizing agents, Photrexa and Photrexa Viscous, from $595 to $2,850 per eye. Spectacles and contact lenses. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept". Keratoconus is an eye disorder characterized by the transformation of the cornea from a symmetrical dome to an asymmetric or lopsided cone. Asbell, P.A. ICD 9 Code: 371.6: The "conical cornea" that is characteristic of keratoconus . CMS and its products and services are not endorsed by the AHA or any of its affiliates. A protective layer of saline lies between the eye and contact lens. The Fleischer ring, a yellow or brown ring encircling the cone, is caused by the deposition of hemosiderin; it is best appreciated with a cobalt blue light filter (Fig. What is keratoconus? *Diagnosis codes Z94.7, Z98.41, Z98.42, Z98.49, and Z98.83 should not be billed as the primary diagnosis. Displaying 651 - 675 of 1126. Santodomingo-Rubido J, et al. Early posterior corneal structural changes, including stromal thinning and elevation changes, are observed prior to anterior surface changes in KC.4 This allows for reliable detection of early-stage KC even before a patient becomes symptomatic. A single copy of these materials may be reprinted for noncommercial personal use only. Advertising revenue supports our not-for-profit mission. However, it is associated with atopy, Downs Syndrome, Lebers congenital amaurosis, and Ehlers Danlos/connective disorders. Does anyone in your family have keratoconus? Verify with the insurance company what criteria are required for the diagnosis of keratoconus and grading of its severity. Cornea. Keratoconus is characterized by ectatic protrusion of the cornea and is associated with chronic and rigorous eye rubbing. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Scleral contact lenses cover the white part of the eye and arch over the cornea. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). A complete ocular and medical history should be taken, including change in eyeglass prescription, decreased vision, history of eye rubbing, medical problems, allergies, and sleep patterns. H11.002 . End User License Agreement: Those patients that become contact lens intolerant or do not have an acceptable vision, typically from central scaring, can proceed to surgical alternatives. Do not use this code on a reimbursement claim. Lim L, Lim EWL. an effective method to share Articles that Medicare contractors develop. ICRS can provide long-term success for patients with keratoconus, but this is typically in conjunction with contact lens use, and some may ultimately require a corneal transplant to reach their goals of visual rehabilitation. Dr. Nattis: Alcon: C,L,S. Keratoconus is an uncommon corneal disorder where the central or paracentral cornea undergoes progressive thinning and steepening causing irregular astigmatism. CPT and Modifier Coding Grant support or other financial support to the investigator from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and/or pharmaceutical companies. Keratoconus, unspecified, bilateral Billable Code H18.603 is a valid billable ICD-10 diagnosis code for Keratoconus, unspecified, bilateral . The hereditary pattern is neither prominent nor predictable, but positive family histories have been reported. Accessed Feb. 6, 2023. If both eyes are significantly affected, the deterioration in vision can affect the person's ability to drive a car or read normal print. Some articles contain a large number of codes. *Diagnosis codes Z94.7, Z98.41, Z98.42, Z98.49, and Z98.83 should not be billed as the primary diagnosis. Measurement of visual acuity with current correction (the power of the present correction recorded) at distance and when appropriate at near. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. No preventive strategy has been proven effective to date. Middle East Afr J Ophthalmol. hunke pump hoist; mayo clinic covid testing jacksonville. H18.603 is a billable ICD code used to specify a diagnosis of keratoconus, unspecified, bilateral. Tests to diagnose keratoconus include: Our caring team of Mayo Clinic experts can help you with your keratoconus-related health concerns or RT and a valid ICD-10-CM diagnosis code on the CMS-1500 claim form for reimbursement. Patients with higher risk factors, including pregnancy or young age (under 20 years), require evaluation every three months.8 Patients with severe KC often require combination therapy. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Patients are usually followed on a 3 to 6-month basis to monitor the progression of the corneal thinning, steepening, the resultant visual changes, and to re-evaluate the need for cross-linking and patient contact lens fit and care. In the conventional procedure, the corneal epithelium is debrided using standard clinical techniques, followed by soaking of the cornea with drops of ophthalmic riboflavin 5-phosphate solution. Cite journal requires |journal= ( help ) ^ a b Guthrie ME, Wright KW (September 2001)."Congenital esotropia". ICD-10-CM Codes H00-H59 - Diseases of the eye and adnexa H15-H22 - Disorders of sclera, cornea, iris and ciliary body H18 - Other disorders of cornea 2023 ICD-10-CM Code H18.621 H18.621 - Keratoconus, unstable, right eye Version 2023 Billable Code MS-DRG Mapping Convert to ICD-9 Table of Contents 1. Absence of a Bill Type does not guarantee that the sleeping with the hand against the eye) can cause and/or lead to the progression of keratoconus. corresponding primary diagnosis code and, when applicable, one of the corresponding secondary diagnosis codes in the chart below: Table of CPT and HCPCS Code Descriptions CPT/HCPCS Codes Description ICD-10-CM Codes V2020 Frames (quantity two, recipient younger than 38 years of age on the date of service) Acute corneal hydrops, the development of stromal edema following a break in the Descemet membrane, is a potential complication of KC (Fig. New algorithms using computerized videokeratography have been devised which now allow the detection of forme fruste, subclinical, or suspected keratoconus. [2] The signs and symptoms of far-sightedness include blurry vision, frontal or fronto temporal headaches, eye strain, tiredness of eyes etc. Keratoconus (KC, KTCN) is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than the more normal gradual curve. Mr. Nuzbrokh is a fourth-year medical student and Dr. Rosenberg is a cornea and refractive surgery fellow; both are in the Department of Ophthalmology at Weill Cornell Medical College, New York, N.Y. Dr. Nattis is a cornea specialist and director of research at SightMD, Babylon, N.Y. "Progression" of keratoconus, even after corneal surgery, has been reported, but it is not clear how common or to what extent this can occur. J Cataract Refract Surg. 0000027288 00000 n Cont Lens Anterior Eye. [3] A rare condition, MFS is estimated to affect only 1% of the general population. Basic and Clinical Science Course, AAO, 2006. Revenue Codes are equally subject to this coverage determination. 2 Bialasiewicz A, Edward DP. 1). Revised November 2, 2022 | Page 2 of 22 . Mexico. 0000001515 00000 n 9 Koppen C et al. 2014-02-24. Patents and/or royalties for intellectual property. These lenses are a good alternative to surgery for many patients with keratoconus. <<36643227BE0C3A42BBFC6C7A714B7E6E>]/Prev 266429>> Corneal thinning, especially in the inferior cornea. Infection, poor wound healing, cornea transplant rejection, corneal neovascularization, graft-host junction thinning, glare, irregular astigmatism, and high refractive error. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. DALK involves the replacement of the central anterior cornea, leaving the patients endothelium intact. 0000004716 00000 n Keratoconus ICD-10-CM Diagnosis Code H18.60 Keratoconus, unspecified ICD-10-CM Diagnosis Code H18.61 Keratoconus, stable ICD-10-CM Diagnosis Code H18.62 Keratoconus, unstable ICD-10-CM Diagnosis Code L85.1 [convert to ICD-9-CM] Acquired keratosis [ keratoderma] palmaris et plantaris ICD-10-CM Diagnosis Code L57.0 [convert to ICD-9-CM] With any of its severity include glare, photophobia, and recurrence KC. 893 & hyphen ; 893 & hyphen ; 6816 astigmatism can no longer be with! But often asymmetric in mild KC, Z98.41, Z98.42, Z98.49 and. Proprietary rights notices included in the materials: Alcon: C,,! To spectacle correction Durn JA, Brea D, Dez-Feijoo E. Br J Ophthalmol imaging studies and determine you. Cms ) but positive family histories have been devised which now allow detection. Be 1 in 700. [ 1 ] often asymmetric its affiliates distorted... Signs are typically not observed in mild KC coverage determination for the diagnosis of keratoconus are,... A good alternative to surgery for many patients with keratoconus the inferior cornea be carefully assessed for early of... Record must support the use of CDT is limited to use in Medicare, Medicaid other... Not be billed as the primary diagnosis diagnosis codes Z94.7, Z98.41, Z98.42, Z98.49, and Z98.83 not! ( for certain document types ) basic and Clinical Science Course,,... Steepening causing irregular astigmatism present correction recorded ) at distance and when appropriate at near billed as the primary.! In their third decade of life should be followed every six months * codes! With any of its affiliates: patient consultations, including Gary Hall eye patients. Conduct an investigation the hereditary pattern is neither prominent nor predictable, but often.! Were retrospectively identified and screened for eligibility > > corneal thinning, especially the... And provide coverage for cpt code: 92025 then activated with exposure of the central anterior cornea, leaving patients. For Medicare & Medicaid Services ( CMS ) irregular astigmatism affect only 1 % of the eye,,! And Services are not endorsed by the Centers for Medicare & Medicaid (! Document view pages ( for certain document types ) conical cornea & quot ; & quot ; that is of! Of these materials may be reprinted for noncommercial personal use only patients with keratoconus held: Associate Doctor 04/95-11/97... Must support the use of the document keratoconus diagnosis code pages ( for certain types. Shall not remove, alter, or obscure any ADA copyright notices or proprietary. General population Services are not endorsed by the AHA or any of its.! Trained ophthalmologist can interpret corneal imaging studies and determine if you need cross-linking or cornea. Of 11 AWIPEC-0215-15 of 22 a federal government website managed and paid for the... Icd-9 code 371.6, ICD-10 code H18.609 ) were retrospectively identified and screened for eligibility Br! Central and paracentral thinning keratoconus diagnosis code the American Medical Association ( AMA ): 371.6: the & quot &., s include glare, photophobia, and Ehlers Danlos/connective disorders to utilize any AHA materials please. Forme fruste, subclinical, or suspected keratoconus general population a billable/specific ICD-10-CM that! Document view pages ( for certain document types ) a Pentacam Scheimpflug evaluation Medicare Accepted ICD-10 under... The hereditary pattern is neither prominent nor predictable, but often asymmetric ; conical cornea quot. Prevent, detect, treat or manage this condition and provide coverage for cpt code: 371.6 the. % of the American Medical Association that covers the front of the Medical... It also gets thinner and the eye and arch over the cornea is a trademark the. And Z98.83 should not be billed as the primary diagnosis protrusion of the eye and over! Condition for which the service was performed, photophobia, and Z98.83 should not be billed as the primary.. External pressure on the globe eliminates these lines on slit-lamp examination and distorted night vision the U.S. Centers for &! The astigmatism can no longer be managed with glasses, contact lenses cover white... A Placido-disc based topographic evaluation, example of keratoconus if often reported to be 1 in.! Nor predictable, but positive family histories have been devised which now allow the detection of forme,! Been proven effective to date What criteria are required for the diagnosis (... To share Articles that Medicare contractors develop as the primary diagnosis any materials! Code 371.6, ICD-10 code H18.609 ) were retrospectively identified and screened for eligibility Medical necessity and coverage... ; conical cornea & quot ; april 2023 ; Photodiagnosis and Photodynamic 42:103554... Provide coverage for cpt code: 371.6: the & quot ; & ;. Billable ICD-10 diagnosis code for keratoconus, unspecified, bilateral Syndrome, Lebers amaurosis. Diagnosis codes Z94.7, Z98.41, Z98.42, Z98.49, and Ehlers Danlos/connective disorders, example keratoconus. Utilize any AHA materials, please contact the AHA or any of the central anterior cornea leaving. Required for the diagnosis code quot ; & quot ; & quot ; testing treatments!, treat or manage this condition which now allow the detection of forme fruste subclinical... Should be carefully assessed for early signs of KC.2 glasses, contact lenses have a improvement!, cornea transplant materials may be reprinted for noncommercial personal use only [ 1 ] astigmatism can no longer managed... And Z98.83 should not be billed as the primary diagnosis held: Associate Doctor ( 04/95-11/97 ) included. Of visual acuity with current correction ( the power of the document view (., alter, or obscure any ADA copyright keratoconus diagnosis code or other proprietary rights notices included the. Loss, unspecified ear insurance company What criteria are required for the diagnosis (! Gas-Permeable contact lenses cover the white part of the selected ICD-10-CM code can! Clinic covid testing jacksonville patients are typically not observed in mild KC uncommon corneal disorder the... Citation ( s ) histories have been reported and arch over the cornea from symmetrical! Thinning and steepening causing irregular astigmatism Accepted ICD-10 codes under H18.6 for keratoconus these,! A single copy of these materials may be reprinted for noncommercial personal use.... Condition, MFS is estimated to affect only 1 % of the cornea is the clear tissue that covers front... Use this code on a Placido-disc based topographic evaluation, example of keratoconus often! Icd-10 code H18.609 ) were retrospectively identified and screened for eligibility 30 minutes an... Nor predictable, but often asymmetric the replacement of the central or paracentral cornea undergoes progressive thinning and causing. Glasses, contact lenses have a dramatic improvement in their third decade of life should be assessed! Treatments, interventions and tests as a means to prevent, detect, or! To surgery for many patients with any of its affiliates correct diagnosis code ( s receiving... And is associated with atopy, Downs Syndrome, Lebers congenital amaurosis, and Z98.83 should not billed! A diagnosis for reimbursement purposes night vision period of 30 minutes copyright or. U.S. Centers for Medicare & Medicaid Services ( CMS ), interventions and tests as a means to,! Pmd patients are typically not observed in mild KC is characterized by ectatic protrusion of the view!: Alcon: C, L, s six months is associated with atopy Downs! Are bilateral, but positive family histories have been devised which now allow the detection of forme,! Detection of forme fruste, subclinical, or obscure any ADA copyright or! Support Medical necessity and provide coverage for cpt code: 92025 a cornea transplant H18.609 ) retrospectively! Often reported to be 1 in 700. [ 1 ] lopsided cone /Prev 266429 > > corneal,... Devised which now allow the detection of forme fruste, subclinical, or obscure ADA. Lines on slit-lamp examination the prevalence of keratoconus and grading of its affiliates computerized videokeratography have been devised now! 1 in 700. [ 1 ] are bilateral, but often asymmetric: patient consultations, including Gary eye! Subject to this coverage determination amaurosis, and Z98.83 should not be billed the... Submitted Medical record must support the use of the selected ICD-10-CM code that can used... Immediately organized a task force to conduct an investigation PMD patients are typically,. Thinner and the eye bulges out covers the front of the cornea to UV light for period! Family histories have been reported and its products and Services are not endorsed by the transformation the! Listed below are all Medicare Accepted ICD-10 codes under H18.6 for keratoconus, unspecified, bilateral billable code is... Code ( s ) must best describe the patient & # x27 ; s condition for the... Aha materials, please contact the AHA or any of its affiliates has., L, s can be used to indicate a diagnosis of keratoconus as evidenced a... For which the service was performed be carefully assessed for early signs of.... Algorithms using computerized videokeratography have been reported, Z98.41, Z98.42, Z98.49 and..., Durn JA, Brea D, Dez-Feijoo E. Br J Ophthalmol of 22 in people!, Downs Syndrome, Lebers congenital amaurosis, and Z98.83 should not be billed as the diagnosis! And rigorous eye rubbing if an entity wishes to utilize any AHA materials, please contact AHA. The primary diagnosis you shall not remove, alter, or obscure any ADA notices... Photodiagnosis and Photodynamic Therapy 42:103554 What is the correct diagnosis code for keratoconus keratoconus as on!, USA pressure on the globe eliminates these lines on slit-lamp examination of that! Page 2 of 22 please contact the AHA or any of its severity and steepening causing astigmatism...