To improve the quality of eye care services nationwide, the Philippine Health Insurance Corporation (PhilHealth) has issued updated clinical guidelines covering Pterygium Excision with Graft and Ocular Surface Reconstructive Surgeries (OSR), procedures used to treat the eye growth locally referred to as “pugita sa mata.”

According to research conducted at the Philippine General Hospital (PGH), roughly two percent of new eye patients were diagnosed with pterygium, with an average age of 47 and women representing a slight majority at 53 percent. 

The study found that almost half had growths in both eyes, and 42 percent were outdoor workers regularly exposed to sunlight and dust.

PhilHealth said most patients sought consultation due to visible eye growth, and doctors recommended surgical removal with conjunctival grafting to prevent recurrence and protect vision.

“Surgery is necessary when it causes vision problems, irritation, and other symptoms,” the state health insurer said.

PhilHealth said patient safety and effective treatment can only be ensured if accredited facilities, qualified surgeons, proper surgical techniques, and appropriate post-operative care are strictly followed. 

The agency added that the policy is designed to standardize treatment, prevent complications, and guarantee consistent, high-quality eye care for all its members.

PhilHealth said Circular No. 2025-0021, which took effect on November 15, establishes clear quality benchmarks and clinical guidelines for managing and treating pterygium.

“This initiative aims to ease the burden of Filipinos with this condition,” it stated.

PhilHealth President and CEO Dr. Edwin Mercado said the initiative is their step toward ensuring that every PhilHealth member receives the highest possible standard of eye care.

“Kami ay nakikipagtulungan sa mga ekspertong doktor at pinapalakas pa namin ang aming mga sistema ng pagsubaybay upang matagumpay na matupad ang mandato ng PhilHealth na makapaghatid ng benepisyong may kalidad (We are working with expert doctors and strengthening our monitoring systems to fulfill PhilHealth’s mandate of delivering quality benefits),” he said.

PhilHealth noted that the policy was formulated in collaboration with the Philippine Academy of Ophthalmology (PAO) and the Philippine Cornea Society, Inc. (PCSI), centering on patient safety and high-quality care to ensure that members’ surgeries adhere to the most current and locally applicable clinical standards.

Currently, PhilHealth covers pterygium excision with graft (RVS 65426) and offers P59,085 for ocular surface reconstruction (RVS 65780, 65781, 65782).

PhilHealth explained that the policy will enforce a maximum claim limit for eye surgeons to uphold patient safety and prevent misuse of benefits.

“This limit does not apply to procedures performed by residents-in-training in accredited government and private health facilities with a Philippine Board of Ophthalmology (PBO)-accredited residency training program, thereby promoting continuous quality training standards,” it clarified.