Prokera update

[indrep]

I think it's important to understand how Amniotic Membrane is used in relationship to ocular surface issues. It has three primary uses; to help healing from pterygium surgery and minimize scar tissue, conjunctivochalsis (folds in the conjunctiva) helps healing and minimize scar tissue, corneal erosions, wounds, etc. it helps healing and minimizes scarring.

The only true dry eye healing application is the conjunctivochalasis where the excess conjunctiva is removed so the tear film can be more evenly distributed across the ocular surface. If there are other issues related to the dry eye disease this surgery will not end the dry eye issues.

Amniotic membrane is an accelerated healing agent for tissue. It does not help with the tear film at all.

[Pinky]

I Just got the official word back from Dr. Tseng, the developer of ProKera he wrote:

Yes, ProKera can help dry eye patients in several ways. I have used it successfully for them. In short, its potent anti-inflammatory action can surpass steroid and Restasis and more importantly circumvent the potential side effect known to both of them. The membrane also contains abundant nerve growth factor that is known to promote innervations which may help correct the ocular surface deficit caused by dry eye and inflammation so that the neuronal reflex can be improved. The hydration of the membrane instantly helps maintain the preocular tear film stability. For those eyes where the eyelid blinking is incomplete, it also prevents exposure-induced dryness. Once improved, the patient will normally have a “prolonged” period of remission. Because the underlying causes of dry eye are multiple and may not be fully corrected, dry eye can return later on. Nonetheless, the treatment can be repeated.

[hankm9]

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[spmcc]

I Just got the official word back from Dr. Tseng, the developer of ProKera he wrote:

Yes, ProKera can help dry eye patients in several ways. I have used it successfully for them.

I want to speak to these patients! How come no one from DEZ who has seen Tseng got them?!

My belief is that every doctor would want to slap on an amniotic membrane bandage (aka Prokera) to every dry eye, wave goodbye, and *never see us again* -- if Prokera worked for this. Economically, it would make sense even with the cost of the 'lenses'. Dry eye patients are a huge burden for doctors... we come back again and again for decades, taking up a lot of time in their chairs. If there was something as easy as slapping on a Prokera to fix the problem, I'm sure doctors would be doing it. And Tseng would be promoting the sh$$ out of it.

Why isn't any of this happening in practice?

[littlemermaid]

Why isn't any of this happening in practice?

I haven't followed this too much but isn't it for severe cornea protection and healing, as Indrep explains, and he's saying if dry eye causes aren't fixed then it's not the panacea? I like reading Tseng - docs were so generally snooty about his demodex treatments and now they're pretending they knew about dermatophytes from the start (eg AAO Clinical Guidelines Blepharitis & Dry Eye, NHS website 'Blepharitis'). Maybe let's give him time to trial this bandage and the drops for wider use. I was reading about amniotic membrane bandage 3/4y ago for cornea melt in children so maybe it takes time to get mainstream

[spmcc]

I love reading Tseng too. He's a prolific researcher and publisher. His first article (that I could find) on amniotic membrane is from Cornea 1995 (http://www.ncbi.nlm.nih.gov/pubmed/8536460). And if I'm ever asked, "Who is the best dry eye doctor you can think of?", I always put Tseng at the top of the list. This is why I find this whole thing strange. The cost of Restasis for a year is basically the same as two of these lenses. If you're on Restasis and add on Lotemax, plugs, perhaps serum drops, and the cost of ~6 doctor's appointments per year, you're well over the cost of two Prokera. But I keep thinking that it's like a person with high blood pressure demanding a heart transplant - if you get what I mean.

[TARYN]

I had Prokera done last week with Dr Tseng and it seems to be working very well. About 3 months ago I had a transconjunctival blepharoplasty to remove some fat grafting from my right lower lid. The surgery went well, but I ended up with inflammation, tearing and excess mucous. I tried Dr Tseng's preservative free steroid drops, but they did not help. He put the Prokera lens in last Monday. I did a followup 2 days later. He took the lens out and could tell that it was working by how it looked when he took it out. I think it absorbs the inflammation and was cloudy. That lens had done all it could do...but he still wanted to see if he could further improve my ocular surface. He put another one in and told me to come back in 2 days. When I came back the the lens was almost clear which showed that my ocular surface was in good shape. It is a week since the last Prokera and I have no inflammation, tearing or excess mucous. It is very expensive and I don't know if my insurance will cover any of it. They are submitting my claim. Each Prokera lens was $2000. I only had the problems in my right eye and therefore only wore the Prokera in one eye. I could not have imagined wearing it in both eyes because it has a cloudy or blurry feel to it. It was not uncomfortable...couldn't wait to get it out. I think Dr Tseng and his staff are fantastic. About 8 years ago I had the AMT surgery and that worked very well. The conjunctivochalasis was causing burning and enlarged blood vessels. It got rid of both of those problems.

[spmcc]

I had Prokera done last week with Dr Tseng and it seems to be working very well. About 3 months ago I had a transconjunctival blepharoplasty to remove some fat grafting from my right lower lid. The surgery went well, but I ended up with inflammation, tearing and excess mucous. I tried Dr Tseng's preservative free steroid drops, but they did not help. He put the Prokera lens in last Monday. I did a followup 2 days later. He took the lens out and could tell that it was working by how it looked when he took it out. I think it absorbs the inflammation and was cloudy. That lens had done all it could do...but he still wanted to see if he could further improve my ocular surface. He put another one in and told me to come back in 2 days. When I came back the the lens was almost clear which showed that my ocular surface was in good shape. It is a week since the last Prokera and I have no inflammation, tearing or excess mucous. It is very expensive and I don't know if my insurance will cover any of it. They are submitting my claim. Each Prokera lens was $2000. I only had the problems in my right eye and therefore only wore the Prokera in one eye. I could not have imagined wearing it in both eyes because it has a cloudy or blurry feel to it. It was not uncomfortable...couldn't wait to get it out. I think Dr Tseng and his staff are fantastic. About 8 years ago I had the AMT surgery and that worked very well. The conjunctivochalasis was causing burning and enlarged blood vessels. It got rid of both of those problems.

Hi TARYN,

So do you think Prokera has "cured" your dry eye? I see you've been on DEZ since May 2006, so you've had eye problems for a while. What was your original dry eye diagnosis and what was the cause? If my math is correct, you had AMT before you joined DEZ (so many acronyms!!!)

You said each lens costs $2000, correct? Someone else was quoted $1000 per lens. Big difference for self-pay.

I'm a little confused about your description of how it felt in your eye.

I could not have imagined wearing it in both eyes because it has a cloudy or blurry feel to it. It was not uncomfortable...couldn't wait to get it out.

Do you mean "it WAS uncomfortable... couldn't wait to get it out"?

Thanks for all your info and help.

[TARYN]

I will never say something has cured dry eye. What I will say is that the AMT got rid of the burning and enlarged blood vessels and the Prokera got rid if the inflammation, tearing and excess mucous. I have MGD, but it does not seem to cause discomfort. I keep it under control by steaming the glands, using Patanol followed by a cold compress twice a day. MGD is chronic, but for me it does not cause me discomfort. Until this flareup after the lower blepharoplasty, I was doing pretty well. So far this procedure has gotten me back to a good place.

The original dry eye diagnosis was MGD and conjunctivochalasis. The chalasis was "cured or healed" by the AMT. The Prokera hopefully has "cured or healed" the ocular surface. So far my symptoms of inflammation, tearing and excess mucous are gone. I'll let you know if it is long lasting.

It was not uncomfortable, but I couldn't wait to get it out of my eye because of the blurriness.

It was $2000 per lens, so I am hoping my insurance will cover some of it. I am grateful it has worked so far.

[spmcc]

Thanks for the info, TARYN. BTW I believe we've corresponded in the past (beginning back in Aug 2010). I'm an e-friend of Jeanne's. My name is Sheila. Hi again!

Anyway, just one final question - as you are a person with a diagnosis of MGD (relatively controlled), did you get the impression that Prokera would be useful for chronic MGD?

And finally, my fingers and toes are crossed that your insurance covers the costs! Good luck with everything.

[hankm9]

Thanks for your information Taryn. Prokera sounds very promising for inflammation and healing ocular surfaces.

[TARYN]

Hi Sheila,
Yes we have corresponded. Hope you are doing ok. What is the current state of your eyes? I have been doing well until I decided to have the lower bleph. I am grateful that Dr Tseng was able to bring me back to a good place again. I think MGD is a difficult condition. I don't think that Prokera has anything to do with MGD but I will ask Dr Tseng if I go back for a follow up. As I said before, I seem to have the MGD under control. Since I came to Dr Tseng complaining about the inflammation, tearing and excess mucous from the lower bleph, that is the problem he focused on. I didn't even discuss the MGD because it wasn't bothering me.

[spmcc]

Thanks so much for the first-hand info, TARYN. I'll email you soon to catch up! Wishing you speedy healing...

[hankm9]

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[eyemech]

Cost of ProKera.
What you read was that the actual cost to the doctor was $1000. Remember if you have to put two on, the insurance might only pay for one. So, the doctor cannot possibly charge cost on the product.
I placed another one on a patient this week. As pointed out, you couldn't possibly wear two unless you had a "seeing eye dog".
A final note. They are all cloudy and do not "get" clear except when they melt and there is no membrane inside of the ring.
Two days and it "did all it could do"..I am not at all sure what that means. Exactly how does he know it "did all it could". And if it did, why place another one on the eye.
I would love to place these on every dry eye patient I had and just be done with it. That probably won't happen. Even with my fox news story, there was no sudden increase in calls from dry eye patients wanting a prokera placed on their eye.
The moderator says it isn't a cure. I am not sure any of us really knows the answer to that question. Why? Because we don't line up patients with dry eye to try it on. I am told by the company that there has been a study and that the doctor will be releasing findings in the future. The doctor is supposedly at an institution where in the words of the company, "money wasn't the issue." When isn't money the issue? The only answer is when the company supplies all the prokera for free in order to get feedback.