New Prokera Website for Dry Eye

[sazy123]

I agree, and if it aids healing then it would help dry eye that resulted. Could it not help lasik dry eye though- since that is damage to the ocular surface.

I like the idea of the drops better- since that could reach the MGDs and the eyelids.. I dont think the contact would help MGD, and the majority of DE envolves MGD. If your problem is purely ocular suface damage and resulting dry eye (and or mucin deficiency) then this could help...

[spmcc]

Could it not help lasik dry eye though- since that is damage to the ocular surface.

That's why I mentioned Prokera to someone who posted here as a "LASIK disaster"
(http://www.dryeyezone.com/talk/showt...light=disaster). The research shows that AMT is used for acute, severe trauma. So IMO the obvious next step would be to try it on post-Lasik/PRK dry eye.

[Pinky]

http://www.aaopt.org/Media/Default/N...erOct20122.pdf

American Academy of Optometry symposium Oct. 2012

Presented a Case study of a 59 year old Caucasian woman with secondary sjogrens who was helped with Prokera.

“Patient reported increased comfort, less pain and no sensitivity to light. It (ProKera) is becoming a viable treatment option for patients with recalcitrant dry eye disease."

[sazy123]

Pinky when are you trying prokera?

Is this covered by insurance?

[Pinky]

I live in BC and ProKera hasn't been approved by Health Canada yet. I would have to travel out of country for treatment. I envy people in the US where ProKera is readily available.

Re: Insurance. This has been discussed on the other ProKera thread. Or, you can contact Bio-Tissue, the manufacturers of ProKera for more info. Being from Canada, I have no idea if it would be covered by American medical insurance.

[bunnyrabbit123]

Hi Pinky,
Don't be getting envious just yet, I'm gonna agree with what Rebecca said earlier- Prokera may be available here, but would only be used for someone with severe cornea damage and no other options. I don't think this will be considered as a treatment for dry eye anytime soon, even if your symptoms are significant. It's still steroids, plugs, cautery,restasis and "stop bothering me, it's just dry eye" at most practices.

[Pinky]

"Prokera may be available here, but would only be used for someone with severe cornea damage and no other options. I don't think this will be considered as a treatment for dry eye anytime soon, even if your symptoms are significant.”

This is absolutely not true.

Although the basis for treatment is only anecdotal at this point, there are numerous ophthalmologists and optometrists in the US using Prokera to treat severe dry eye without corneal damage.

I plan to be treated by an ophthalmologist based in Seattle who is a corneal specialist with an interest in the inflammatory and immunologic mechanisms of dry eye disease, and is currently using ProKera to treat dry eye.

My treatment would require three out of country appointments – two for lens placement, and one for follow-up. I need to arrange a driver, travel medical insurance for each separate appointment and appropriate travel documents including medical info. So yes, I’m envious of those living in the US where this treatment is currently readily available.

[hankm9]

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[DCRdryeye]

Speaking of pain relief. I've been on Minims (a non-preserved prednisolone drop that comes in vials) and doxycycline 100mg for a bit over a week now and have already noticed improvements. I can last longer without my moisture chamber glasses, eg: went into the supermarket without them for the first time in years, and I could cope very well. It was like my eyes were anaesthetized to the pain. Of course, any longer and I'd be in pain again. Isn't it ashame that the predisolone drops are only available for use temporarily? I was instructed by my eye doc to get a glaucoma test within 6 weeks of started the steroid drops.

[soaps]

DCRdryeye : i have been on this before with very high pressure as a result. please check pressure regularly. However my pain was so severe this really saved further damage i believe .may i ask what glaucoma test ? E.g. just photo of optic nerve or dilation test? Interest to know what was recommended.

[DCRdryeye]

Thanks for the warning soaps. The doctor who prescribed the Minims Prednisolone drops is Dr. Colin Chan in Syndey. I had to travel from Victoria to see him. He suggested a 'glaucoma' test in 6 weeks but didn't explain what type of glaucoma test, I didn't know there were different types. I'd have to get a ophthalmologist in Victoria to do the glaucoma test (whatever type of glaucoma test that maybe). I'm not sure when I'll see Dr. Chan again, I assume early next year.

How long were you on the Prednisolone drops before you got high pressure?

[sazy123]

I emailed Dr Tseng:

''There has been some discussion regarding Prokera on the www.dryeyezone.com.

Many of us have been wondering whether Prokera would have application in people whose dry eye is primarily caused by MGD. That is, those of us who have minimal surface damage or surface issues, staining etc. But do have MGD, inflammed inner eyelids and a painfull ocular surface due to a lack of Medium.

Have you had any success treating people who have MGD with Prokera. Or is its application only for people with ocular surface damage and resulting inflammation and dry eye.

Does insurance cover this procedure.

I appreciate your help.''

This was his response:

''ProKera can be used for managing dry eye that has been difficult to treat this far. At this moment, I have used it for treating different types of dry eye including aqueous tear deficiency, inflammatory, and exposure, of which some did have meibomian gland dysfunction. Yes, it is covered by most insurances including Medicare.''

[sazy123]

Annoying, just when id dediced to go back to the UK, there another viable treatment option to try. Thats covered by insurance. My issue is my eyelids so i still dont think something aimed at the eye surface (only) will help me. The drops on the other hand appeal to be more because they may be able to penetrate the eyelids.

However- If others who have MGD with minimal surface problems try it and get success, i would like to try it. But right now theres no antedotal evidence of people with MGD/ocular rosasea having been helped. Other than what the docs say. I prefer to listen to patient experiences. If i was staying in the US i would try it- if it is covered by insurance- what do you have to loose?

Anyone have any idea what the AMX drops cost in italy?

Pinky, where did you get the information that docs are using this to treat dry eye without any surface damage?

[bunnyrabbit123]

Pinky,
I guess I typed without thinking (not the first time). I'm apparently wrong on this and wish you every success. I know you'll let us know how this goes. I would like to know how you found the doctor who is going to treat you?

[littlemermaid]

He suggested a 'glaucoma' test in 6 weeks but didn't explain what type of glaucoma test, I didn't know there were different types. I'd have to get a ophthalmologist in Victoria to do the glaucoma test (whatever type of glaucoma test that maybe). I'm not sure when I'll see Dr. Chan again, I assume early next year.

DCRdryeye, If you have started the steroid eyedrop Prednisolone, I think you need an eye pressure check at around 2wk (please check), and thereafter according to risk (we do 2m). Any optician can do this - ask for intraocular pressure (IOP) to be tested. There are various methods I know about (see Dr Google, search 'tonometer'). There are even non-contact tonometers now (eg iCare) so if your eye surface doesn't like anaesthetic drops, find an optometrist with one of those.

Hopefully Soaps will tell us how long it took for raised eye pressure, but meanwhile have a look at Unicorn's experience - she started dexamethosone 0.1% and found herself with glaucoma (raised eye pressure) within 2wk. The ophth did not arrange IOP checks or even advise her to get them. Yes it's rare but it happens. The patient must stop the steroid eyedrop.

I don't understand why some eye doctors don't make this clear and specify an IOP test should be done and when. A red eye on steroids needs urgent attention too. We have been using steroid eyedrops 4y under close supervision, pulse and taper according to flareups, and long-term 1/wk. I'm happy with IOP test every 2m. We really don't want to be using steroids long term. To be avoided. They are to get inflammation under control and prevent further damage, as Soaps says, and hopefully enable the eyes to restore some functions, I think.

It is negligent, I feel, that some ophth prescribe and do not ensure patients on steroids are monitored. It would be so useful to give patients a leaflet explaining this. After a quick Google on Prednisolone and side effects, I would email asking Dr Chan exactly what he meant about 'glaucoma checks' (important to get our money's worth).

http://eyewiki.aao.org/Steroid_induced_Glaucoma
Medscape - drug-induced glaucoma - register for Medscape, it's really good