Prokera update

[LaDiva]

I am wondering about a Prokera eye drop for those of us who do not have acute chemical burns and the like. Perhaps sealing the eye with the membrane is part of the cure, though.

[eyemech]

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.

So far insurance pays pretty easily for this procedure. Probably because so few are billed and they know the cost of the product. If there is an increase in use of the product, they will probably get more selective about those that are paid for.

[spmcc]

Even with my fox news story, there was no sudden increase in calls from dry eye patients wanting a prokera placed on their eye.

BTW This is why we have to be careful when businesses join DEZ. They could be here simply to drum up business.

I'm wondering if Prokera has ever been introduced at, say, an ophthalmology or cornea conference. So far there don't seem to be many "ordinary" ophthalmologists who have heard of it. To be fair, that's also been my experience with a lot of things (e.g., IPL for dry eye, probing, LipiFlow).

Anyway, I feel that until it's been presented at a conference and the doctors take note, I doubt it will be offered. I know that I will need some kind of evidence (published peer-reviewed research) to be able to convince my doctors.

[bunnyrabbit123]

Yes, my concern exactly. "So far, insurance pays pretty easily for this procedure" and then "If you have to put 2 on, insurance might only pay for one" ??

[indrep]

Typically insurance pays for the first procedure and if a second procedure is done on the same visit it is paid at half the rate it would be paid at as a single visit.

[bunnyrabbit123]

Oh. Thanks for this. I didn't know that.

[sazy123]

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.

I Have a question about eyelid inflammation- this relates to MGD.

Did you see any improvement to inflammation of your INNER eyelids (part of the conjuntiva), or was the inflammation soley on the the surface of your eyes?

I dont have any inflammation (that i can see) on my eye suface. But my inner eyelids are very inflammed, i have MGD. So im assuming this treatment would be of no use to me- because its aimed at the surface.

And as others have said it is not clear as to if this will help MGD anyway. Unless MGD is caused by a damaged ocular suface (mine is not damaged- docs say they can see minimal probs with my surface).

What insurance do you carry? Let us know if you get it covered. I have Highmark Blue shield and they would not cover My kinerette

[wantsim]

I came back today from my appt with my cornea specialist. She doesn't think Prokera would be beneficial :-( She told me that Prokera is indicated for acute (short term) healing of cornea injuries, and would not help much for chronic dry eye.

My eyes are too big for the Prokera I was told and would need to either tape my eyelid shut for 7 days to retain it, or she would have to apply a stitch along the outer corner of my eye (tarsography) to keep the eye semi-closed. The Prokera would fall out too easily. Really? I thought I'm asian I have more oval eyes and she's worried it may fall out?

The reasoning why it wouldn't work was because although the lens would help the cornea feel better in the interim, once you remove the Prokera after 7 days, the cornea will slowly return to baseline dryness............basically back to square one.

I inquired if the nerve growth factors in the Prokera would help accelerate regrowth of the severed corneal nerves and she said she doesn't think this would make a difference.

She encouraged to try Restasis again because it works for most of her patients, yet I told her it makes my eyes burn all day long, she said keep doing it because it is all we have now. Very sad news to hear.

Suggestion was made for compounded albumin protein eye drops (from Leiters pharmacy, san jose) as an alternative, and I have not tried that yet, so told her I would be willing to give it a shot and she would call it in.
Nice doctor, willing to listen, empathetic, and I could see she felt bad that I have tried mutliple modalities and nothing has seemed to provide good relief.

The only thing we can do is keep trying and never give up !

[Pinky]

I had a consultation with an ophthalmologist in the States and she said that I'm a candidate for ProKera. She diagnosed me with stage 3 dry eye caused by ocular rosacea or possibly secondary sjogrens.

Today I got two new google alerts with info on how ProKera is being used to treat inflammation:

"the only FDA cleared therapeutic device that reduces inflammation and promotes healing."

http://www.biotissue.com/news-events...Milestone.aspx

How ProKera fights inflammation or the villain “inflammatron.” That's right - inflammatron!

http://www.prokerainfo.com/about-pro...-inflammatron/

[Jade]

I recently had Prokera in my right eye, which is my problem eye, because of a chronic cut feeling in the eye I've had for about 6 yrs. I had it in for 7 days and it felt wonderful the whole time it was in, but my eye went right back to the way it was after the Prokera was removed. I'm glad I tried it, though. I wish I could sleep in Prokera in both eyes every night for the comfort.

[Pinky]

Hi Jade,

Thanks for your reply. Is it possible that you didn't have the lens in long enough? My doctor is recommending placement for two weeks in each eye. What did your doctor say about you getting no results from treatment?

I'm glad the lens felt great while it was in. I've heard that the first day can be a killer though, as you adjust to the bulky ring that the lens is placed on.

[spmcc]

Hi Jade,

Yes, please let us know what your doctor says about why your eye went back to pre-Prokera state once the lens was removed. What does your doctor suggest you do now?

OMG, having relief during the night while sleeping makes me want them too!

All the best,
Sheila

[Jade]

Hi,
I'm not sure if I had it in long enough, but after my experience, I'm considering that my problem might be the conjunctival chalasis that comes as a result of chronic dry eye. My dr says he thinks mine is really mild, but I've read other people's experiences with mild chalasis who've had the surgery to remove it and place an amniotic graft that all their miserable symptoms are gone for years. But then I've read people's experiences with the surgery on this website who feel the same or worse after the surgery.
Maybe Prokera felt great because I wasn't blinking on my chalasis all day.
I go back to my dr in a couple days to discuss what to do next, and at this point I'm not sure what I want to try.
I was afraid of the ring around the Prokera too, but it was not uncomfortable. When the Prokera went in, they had given me some anesthetic drops, and it burned a tiny bit for maybe 10 seconds. I think the ring was over the Prokera, and then a large soft bandage lens was over that.
This sounds weird, but it wasn't too bad--he glued my outside half of my lid shut so that my eye was still open and blinked with the other one, but it was just less open.
He did it so it didn't fall out, but I think if I ever had it again, it would've stayed in fine without the glue. Also, the glue sort of gradually wore off and I was still able to wash my face with it.
I mentioned wearing it at night because usually if I get up in the middle of the night I can really feel my painful spot on my right eye. When I had Prokera in, it felt like a completely normal eye.
I think that would be reasonable to try it for 2 weeks. One nice thing too, the Ocuflox antibiotic drops I had to use 4X a day didn't hurt my eye a bit over the Prokera.