How can amniotic membranes treat ocular surface disease?
Hardeep Kataria, OD, FAAO, is an optometrist at Avant Eyes Optometry & Advanced Dry Eye Center. She has been using Prokera® corneal bandages for over five years because of their powerful ability to treat ocular surface disease (OSD) and deliver rapid results in difficult cases.
“Being able to provide fast resolution for a troubling issue builds patient trust,” she said. “Not only has the amniotic membrane helped me take care of patients, but it's also a great practice builder.”
How leading optometrists use Prokera corneal bandages
Dr. Kataria leverages Prokera corneal bandages for a broad spectrum of applications.
“Initially, I thought I should reserve them as a last-resort treatment option,” she said. “Now, I've started using them a lot earlier in my treatment protocol, which really expands my options and helps patients with symptom resolution, too.”
Advantages of cryopreserved vs dehydrated amniotic membranes
Dr. Kataria said she initially used dehydrated amniotic membranes, but eventually found better success with Prokera cryopreserved amniotic membranes.
“Once I became more comfortable and confident with the application and taping the eyelid, I realized the cryopreserved membrane was a lot more powerful in comparison,” she added.
Additionally, Prokera is the only FDA-cleared cryopreserved amniotic membrane, which supports the corneal healing process without harmful side effects.1,2,3
What clinical indications do you use Prokera® for?
Dr. Kataria uses Prokera corneal bandages to treat:
- Recalcitrant superficial punctate keratitis (SPK), possibly with moderate- to severe-dry eye disease (DED), and potentially with an overlap of neurotrophic keratitis (NK)
- Patients who have exhausted other SPK treatment options without results — such as cyclosporines, punctal plugs, artificial tears, ointments, and soft bandage contact lenses
“Stage one neurotrophic keratitis is an excellent clinical application,” she explained. “That’s a patient with few symptoms, maybe they're coming in with blurry vision, have a very stubborn SPK, and corneal sensitivity testing reveals results you don’t expect.”
Additional indications include:
- Stage-2 NK, for which Prokera is an excellent first-line therapy option
- Infectious keratitis, regardless of etiology
- Presence of a corneal-related bacterial ulcer
- Need for preoperative optimization of the ocular surface
“It’s so important to optimize the ocular surface before any type of cataract or refractive surgery,” Dr. Kataria explained. “The key in this case is that amniotic membranes provide rapid resolution. Patients preparing for cataract surgery are not going to wait six months for their dry eye to heal.”
How do you introduce the concept of Prokera to patients?
Dr. Kataria keeps explanations succinct and relatable. Key points she covers in her initial discussion include:
- The amniotic membrane is similar to a contact lens.
- It is derived from donated placental tissue.
- After placement, a piece of tape will be placed over the eye.
- The amniotic membrane will remain in the eye for 2-5 number of days.
“I keep it super short and let the patient ask questions,” she explained. “If I try to present all the information at once, I may lose the patient. But if we take it in bite-sized pieces and allow the patient to ask the questions, we can address them one by one. And it's very important to address any perceived obstacles so I can let them know they’re really not obstacles — just issues we can overcome together.”
What is the typical Prokera application workflow in your practice?
Noting that it takes less than ten seconds to apply the Prokera amniotic membrane, Dr. Kataria said since she and her staff thoroughly educate the patients, they know what to expect and require little monitoring after the application is complete.
“If we set expectations from the get-go about what they may experience, then the patient isn’t surprised by anything,” she explained. “They often come back and say things were better than anticipated.”
How long do you leave a Prokera on the eye?
When Dr. Kataria first started using cryopreserved amniotic membranes, she left them on for five days, per the DREAM study.4 However, over time, she has reduced that to one to three days, depending upon the patient’s needs.
“For an infectious keratitis patient, I'm going to see that patient back daily anyway,” she explained. “So if I place a membrane, I will have them back in 24 hours, remove the membrane, assess the cornea, and then decide if we need to place another membrane. For NK or dry eye patients, I find two to three days works really well.”
“When you're first starting out, it's almost counterintuitive,” she added. “It may seem you should leave it on longer if the clinical presentation is worse. But the hotter the eye and the greater the inflammation, the shorter my treatment is.”
What is your process for patients who require at least one Prokera in each eye?
If treatment to both eyes is indicated, Dr. Kataria tells the patient each will be done separately. Once the desired endpoint is reached in the treated eye, she fits the other eye with a membrane on the same day, which is more convenient for the patient.
If the clinical endpoint isn’t reached, she recommends repeating the membrane application in the same eye, which she refers to as “serial placement.”
Which model of Prokera do you prefer?
There are four Prokera models:
- Prokera Classic: Maintains orbital space with a symblephoron ring for cases where prevention of closure or adhesion is a concern
- Prokera Slim: Uses ComfortRing™ technology for a lower profile device that contours to the ocular surface to maintain comfort in treatment
- Prokera Plus: Maximizes the therapeutic benefit with a double layer of cryopreserved amniotic membrane tissue, for patients who need intensive treatment
- Prokera Clear: Provides patient with visual acuity during treatment with a 6mm ClearView™ aperture, which is crucial in monocular needs
“I prefer Prokera Slim, hands down,” Dr. Kataria said.
Is Prokera covered by insurance?
Prokera is covered by insurance, and Dr. Kataria’s practice has a dedicated staff member who helps the patient understand any financial obligations they may have.
How can eyecare providers learn more about Prokera and amniotic membranes?
“Eyecare providers who would like to learn more about Prokera should contact their BioTissue representative,” Dr. Kataria said. “Everyone is so helpful, and we can get you set up with the local rep in your area.”
