Listing of Pharmaceutical Benefits (NHL) - Schedule 4 part 1

Diabetic macular oedema (DMO)

Initial treatment

Patient must have visual impairment due to diabetic macular oedema; AND

Patient must have documented visual impairment defined as a best corrected visual acuity score between 78 and 39 letters based on the early treatment diabetic retinopathy study chart administered at a distance of 4 metres (approximate Snellen equivalent 20/32 to 20/160), in the eye proposed for treatment; AND

The condition must be diagnosed by optical coherence tomography; or

The condition must be diagnosed by fluorescein angiography; AND

Patient must have had a cataract removed in the treated eye; or

Patient must be scheduled for cataract surgery in the treated eye; AND

Patient must have a contraindication to vascular endothelial growth factor (VEGF) inhibitors; or

Patient must be unsuitable for treatment with VEGF inhibitors; or

Patient must have failed prior treatment with VEGF inhibitors; AND

The treatment must be as monotherapy; or

The treatment must be in combination with laser photocoagulation; AND

The treatment must be the sole PBS-subsidised therapy for this condition; AND

Must be treated by an ophthalmologist or by an accredited ophthalmology registrar in consultation with an ophthalmologist.

Authority approval for initial treatment of each eye must be sought.

Details (date, unique identifying number/code or provider number) of one of the following diagnostic reports for each eye must be documented in the patient's medical records:

(i) fluorescein angiogram report;

(ii) optical coherence tomography report.