COAG Program Details

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The Columbia Ophthalmic Applied Genetics (COAG) Program consists of 5 phases.  Please click each phase below to learn more:

  • Phase 1: Physician Referral or Physician Evaluation for a Referral
  • Phase 2: Patient Review Group
  • Phase 3: Pre-testing Genetic Counseling and Sample Collection for Genetic Testing
  • Phase 4: Follow-up Genetic Counseling
  • Phase 5: Appointment with Ophthalmologist

 

Phase 1: Physician Referral or Physician Evaluation for a Referral

  • A physician referral is necessary for a patient to be considered for enrollment into Columbia Ophthalmic Applied Genetics (COAG) by the patient review group.  Physicians can click the link below to complete the online referral form to refer a patient to COAG.  It is critical that the physician completes this form with as much detail as possible, so that the case can be accurately discussed by the patient review group.  A physician referral does not guarantee that the patient will be accepted into COAG. 
  • If you are a patient who does not have a referral, please call 212-305-9535 to schedule an appointment for a COAG referral evaluation.  At this appointment, you will be examined by a CUIMC ophthalmologist who will determine whether your case is appropriate to refer to COAG.  If so, they will complete the physician referral form and your case will be reviewed by the patient review group.

 

Phase 2: Patient Review Group

  • Patient review group meets monthly to review all physician referrals to COAG.  The group first decides if they think the case has a genetic cause.  If not, the patient is not accepted into COAG.  If the patient is not accepted into COAG, the patient review group will make a recommendation about which CUIMC ophthalmologist is most appropriate for the patient to follow-up with.  If the group decides the case does have a genetic cause, the patient is accepted into the program.  The group then decides:
    • Which ophthalmologist should this patient be examined by?
    • Which type of genetic testing is appropriate?
    • Which family members also need to be examined and/or genetically tested? 
  • If you have been accepted into COAG, you will be contacted with instructions on how to initiate the next phase of the program.

 

Phase 3: Pre-testing Genetic Counseling and Sample Collection for Genetic Testing

  • Before you have an initial appointment with your COAG-recommended ophthalmologist, you are required to have an appointment with our genetic counselor in order to receive pre-testing genetic counseling.  At this appointment, you will also provide a sample for genetic testing.  We charge a one-time non-covered services fee for genetic counseling and this fee must be paid at the pre-testing genetic counseling session.
  • As a pre-requisite to your pre-testing genetic counseling session, you are required to complete a family history questionnaire.  This is an online form, which will ask you questions about your own medical history and also questions about your family members.  We require that this questionnaire be completed and submitted prior to the genetic counseling session because you will likely need to contact family members in order to receive the information necessary to complete the form.  The genetic counselor will review your responses and it will enable her to accurately explain to you the role that genetics play in your particular family.  Please note that your pre-testing genetic counseling appointment will not be scheduled until we receive your completed family history questionnaire.
  • At your pre-testing genetic counseling session, you will meet with our genetic counselor for one hour.  She will explain the type of genetic testing recommended by the patient review group and will also explain the types of results you could receive.  The genetic counselor will be able to answer your questions about how your condition could have been inherited and how it could potentially be passed on to your children.  At this appointment, you will also provide a sample for CLIA genetic testing.  Detailed information about CLIA testing is listed below:
    • CLIA (Clinical Laboratory Improvement Amendments) is a laboratory certification that means the results of testing from that lab can be used diagnostically.  CLIA testing results are necessary in order to be enrolled in many clinical trials and to receive any FDA-approved treatment.  If you are asked to provide a sample for research testing, it is a supplement to CLIA testing and the results of research testing cannot be used on their own for diagnostic purposes.
      • There is sometimes a charge for CLIA testing and depending on the type of test being performed, it can possibly be billed to your health insurance first.  If this is the case, we submit your sample to the lab and the lab submits a pre-authorization to your insurance provider.  Your insurance provider lets us know an estimated out-of-pocket cost for your testing.  We contact you to discuss the estimated out-of-pocket cost and to ask if you would like to proceed with testing.  Therefore, in the event that we can bill insurance for your testing, the lab does not begin testing your sample until we have spoken with you about the insurance outcome and received your consent to proceed with testing.
        • If the testing cannot be billed to your insurance, you will need to provide a credit card that the cost of testing can be charged to or a check for the cost of testing at the time of sample collection.  You may attempt to get reimbursed for the cost of testing from your insurance provider.  Your responses to the family history questionnaire and the details of your pre-testing genetic counseling session will be shared with your ophthalmologist, so that they may be taken into consideration for your ophthalmic examination.
  • For more information about genetic counseling, please see the Diagnostic Services page: https://www.columbiaeye.org/our-services/COAG/diagnostic-services

 

Phase 4: Follow-up Genetic Counseling

  • Once the results of your CLIA genetic testing have been received, the patient review group meets to discuss what they mean for your care.  The patient review group determines if these results indicate a certain diagnosis.  They also decide if any further testing needs to be performed and if any additional family members need to be tested.
  • Once the plan for your care has been finalized by the patient review group, you will be contacted to schedule your follow-up genetic counseling session.  At this appointment, you will meet with our genetic counselor to receive an explanation of your genetic testing results.  Specifically, she will discuss what the results mean for you and your family and you will be able to ask questions.  The genetic counselor will give you instructions for how to schedule your appointment with your COAG-recommended ophthalmologist.  These instructions will include a recommendation of family members who should accompany you to your appointment for an examination and/or genetic testing.  

 

Phase 5: Appointment with Ophthalmologist

  • At your appointment with the ophthalmologist, you will receive an examination and also an explanation of what your genetic testing results mean for your ophthalmic condition.  Any necessary additional testing will be performed or scheduled and the ophthalmologist will let you know your follow-up schedule.
  • At this appointment, you and any family members present may be given the opportunity to participate in CUIMC research.  Please note that not all research studies and clinical trials involve a treatment.  The goal of many research studies and clinical trials is to collect clinical and genetic data from patients in order to further our understanding of disease and aide in the development of treatments in the future.
  • If the genetic mutation causing your disease has been identified as a result of CLIA genetic testing, your ophthalmologist will let you know if there are any treatments, clinical trials, or research studies that you qualify for.  These could be at CUIMC or at other institutions across the country or the world.  We are happy to facilitate your enrollment in any treatment, trial, or study that you meet the eligibility criteria for.  If you do not qualify for any treatment, trial, or study, we will store your case in our database.  We search our database frequently for genetic mutations that are the targets of new treatments, trials, and studies and we will contact you if there is anything new that you may qualify for.