As a post-LASIK patient with severe Dry Eye Disease (DED), I’ve tried many treatments that either didn’t work or that I didn’t like due to the side effects like taste and burning. I’m also not the most compliant patient even though I work in eye care – kind of like cobblers who don’t shoe their kids – so using drops and medication can be challenging. I was starting to develop a lot of problems including a gritty sensation, fluctuating vision, nighttime irritation, and most notably stabbing pains in my left eye at night.
After consulting with my doctor, I realized I had to do something due to the amount of dryness on my ocular surface. From my work in the field, I knew of the many benefits and positive clinical outcomes with Prokera®. I also knew from experience that due to my very large eyes, fairly protruding globes, shallow lower lids, and tight upper lids, that having Prokera inserted could be a bit of a challenge. However, in my work with patients and doctors I have rarely seen issues regarding the sensation of Prokera, so decided to try it again.
To further solidify this decision, recent clinical studies have shown the benefits of cryopreserved amniotic membrane (Prokera) for the treatment of DED, including the Treatment Outcomes in the Dry Eye Amniotic Membrane (DREAM) study (Clinical Ophthalmology 2018, Marguerite McDonald, MD, and Hosam El Sheha, MD), demonstrating notable improvement of DED symptoms, improved ocular surface, and notable reduction of DED severity lasting for at least three months.
My doctor had used the Kontur 55 18 mm lens as a technique for that rare patient like myself, so he suggested that we give it a try. It covered the internal surface of the tissue itself, still exposing the Prokera ring, but provided enough of a buffer between my eyelid and the ring that the Prokera stayed centered.
For my right eye, I was conducting an in-service training with a new physician and allowed her to use my eye to practice. I had her tape my eye with a transparent dressing (3M Tegaderm) to keep my eye as closed as possible. However, it still rode up when I moved my eye, and I was constantly adjusting it down and into place. I used the “tricks” I discuss with doctors including pointing my nose directly at what I was looking at, using a non-preservative eye drop, taking ibuprofen if needed, and getting a lot of rest.
Based on my experience, as well as what I see in the field every day, here are a few recommendations I would give to doctors. These will save you and your patients time, and potentially a trip back to your office:
- Have your patient wait in the waiting room – After inserting Prokera have patients wait for 15-20 minutes to allow the proparacaine or tetracaine to wear off, then quickly bring them back into the lane to see how they’re doing. This way, you’ll get a true assessment of how the patient feels before they go home.
- Address any issues if needed – If after waiting, your patient has any issues, try using a Tegaderm patch or a different taping technique. Taping for the first 24 hours is always recommended to allow the patient time to adjust to the foreign sensation.
- Set patient expectations – Let them know that they will feel a foreign body sensation in their eye, but this is totally normal. It’s also important to inform the patient that discharge is normal as their eye adjusts to the foreign body.
- Emphasize that resting is important – Tell your patients that like other medical procedures, they will need to rest and not do strenuous activity during treatment. They may also need to miss work for a couple of days and stay home to allow their eye to heal.
- And, for those very challenging patients like myself, consider using a Kontur lens.
As with any medical procedure, patients need to understand that although they may need to make some adjustments during treatment, it’s necessary to allow their eyes to heal. And that’s what we are doing here, healing eyes with regenerative medicine, and improving vision and lives!
Leah Jones is a Practice Marketing and Implementation Consultant for BioTissue. She travels extensively throughout the United States working with doctors and their staff to successfully implement Prokera in their practices.