The Effectiveness of Lid Cleansers in Eradicating Demodex


Demodex blepharitis: White arrows denote cylindrical dandruff at the base of the lashes, while the black arrows show live Demodex mites under 100X magnificationKabat A. 1

Demodex associated blepharitis is extremely prevalent, particularly among older individuals. While virtually all of us have some Demodex mites, symptoms may start to appear when the population reaches a critical mass and there are more organisms living in the tissue. Many patients will present with non-specific ocular irritation including burning of the eyes, itchy eyelids, redness, swelling, and debris on their lashes.

A CCH Case Study: Addressing the Real Cause of Conjunctivochalasis (CCH)


An optometrist in my office referred a 69-year-old male patient, who for years had been treated for dryeye with RESTASIS, and occasionally Lotemax. At the time, he also wore scleral lenses to try to combat his dry eye. After years of struggling and trying different treatments, he still had no relief.

Part 2: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

In part one of a two part series, Arla Genstler, MD discussed Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduced the Reservoir Restoration Procedure for CCH. Here, she speaks in more depth about this procedure and its clinical results.

What are the keys to performing the Reservoir Restoration Procedure for CCH?

Dr. Genstler: The procedure is fairly straightforward however, one of the keys is to completely remove the abnormal Tenon’s capsule, deeply establish the fornix by getting the prolapse fat to retract, and then re-establish the deep cul-de-sac. Not using too much tissue glue and smoothing the cryopreserved amniotic membrane are also important – I typically wait a few minutes to make sure that it’s adhered adequately. The procedure is quick and easy and takes only about 20-30 minutes.

Part 1: Conjunctivochalasis (CCH) Dry Eye: The Reservoir Restoration Procedure for CCH

In part one of a two part series, Arla Genstler, MD, discusses Conjunctivochalasis (CCH) Dry Eye and how it’s diagnosed, and introduces us to the Reservoir Restoration Procedure for CCH.

What is Conjunctivochalasis (CCH) Dry Eye?

Dr. Genstler: Conjunctivochalasis (CCH) is a mechanical problem caused by the degeneration of the Tenon’s Capsule due to high matrix metalloproteinase (MMP) activity. The unhealthy Tenon’s causes the conjunctiva to loosen and create folds that can interfere with the tear meniscus, block the punctum preventing tear clearance, and occupy the fornix (the tear reservoir) diminishing its volume and ability to adequately hold fluid needed to replenish the tear meniscus. Over time the loose conjunctiva contracts, further shortening the fornix.

Early Intervention with Cryopreserved Amniotic Membrane: A Mindset Shift

I’m a firm believer in evidence-based medicine, which is one of the main reasons I’ve always used cryopreserved amniotic membrane (PROKERA) versus dehydrated tissue for the treatment of dry eye disease (DED). The cryopreserved amniotic tissue is processed using the proprietary CryoTek® technology (Bio-Tissue), which has been proven to preserve the biological properties of amniotic membrane and umbilical cord tissue. These biological components that have been shown to play a major role in controlling inflammation and preventing scarring, include the Heavy Chain Hyaluronic Acid/Pentraxin-3 complex (HC-HA/PTX3).

Comparatively and more importantly, dehydrated amniotic tissue products have demonstrated to have drastically altered structural and biological properties.1  As a result, cryopreserved products are able to achieve a higher quality clinical outcome. Recent work has shown that PROKERA may help the healing of the ocular surface and has demonstrated sustained reduction of DEWS score from 3.25 to 1.44 with one treatment in 3-5 days.2

A Bio-Tissue Employee’s Experience Being Treated with PROKERA

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.

Healthier Corneas: A Patient Case of Fuch’s Endothelial Dystrophy

Several months ago, a 74 year-old female presented with symptoms of blurred vision, sometimes-painful foreign body sensation, and frequent tearing while reading. Her ocular history is positive for Fuch's Endothelial Dystrophy and was treated by a combination of Muro-128 ointment hs, and Muro 128 solution b.i.d. daily. She applies non-preserved artificial tears prn, which provides temporary relief for her discomfort. As an avid reader, she was seeking relief to pursue one of her favorite activities and better quality of life. Initial examination results included:

Restoring Corneal Clarity: Cryopreserved Amniotic Membrane and Stromal HSV

A 45 year-old gentleman was referred to me for HSV keratitis. Over the course of a six to eight year period, the patient had at least 10 recurrent stromal herpetic episodes that he could recall. He had been a police officer for over 15 years, and because of his vision, he didn’t feel safe at nighttime and in dim lit conditions. Due to his condition, he was at risk of having to resort to a desk job permanently or possibly leaving his career altogether.

Study Demonstrates Cryopreserved Amniotic Membrane Graft Reduces Recurrence After Pterygium Surgery

We recently issued a press release on study findings, published in Cornea, 2017, showing that the use of cryopreserved amniotic membrane reduces recurrence rates after pterygium surgery.

In this retrospective review, 556 eyes representing 535 patients (291 males 244 females), who had pterygium excision (527 primary, 29 recurrent) were treated with adjunctive cryopreserved amniotic membrane (Amniograft®, Bio-Tissue, Inc. Miami FL). After 17.3 ± 0.8 months (range 6-74 months), corneal recurrence occurred in only 20 eyes (3.6%) and conjunctival recurrence in 12 (2.2%) eyes, for a total recurrence rate of 5.8%.

Impacting a patient’s quality of life – A PROKERA case study

I love what I do, and one of my greatest accomplishments is knowing that I truly impacted a patient’s quality of life. This was the case with one of my patients, a 45 year-old male who works using his computer all day – he also happens to only have one eye. About two years ago, he came to see me and was extremely distraught because he could no longer see his computer without his eye watering and burning. He had moderate glaucoma and was also a steroid responder, meaning we couldn’t give him a standard steroid to help with his symptoms without compromising his glaucoma.

First Study to Demonstrate Corneal Nerve Regeneration in Patients with Dry Eye Disease with the Use of PROKERA

At the recent American Academy of Ophthalmology Meeting in New Orleans, I presented on results of “Corneal Nerve Regeneration after Self-Retained Cryopreserved Amniotic Membrane in Dry Eye Disease” recently published in The Journal of Ophthalmology, 2017 (John, et al.). This study is the first study to show that cryopreserved amniotic membrane is correlated with corneal nerve regeneration in patients with dry eye disease (DED).

Ocular Surface Regeneration in Dry Eye Disease: New Article and Case Study

For patients with chronic dry eye disease causing corneal conditions such as SPK or filamentary keratitis, PROKERA® offers a viable option for immediate intervention as a powerful anti-inflammatory with the long-lasting benefit of regenerative healing.

An Account Representative’s Perspective: Five Key Things I Learned from Being Treated with PROKERA

As an account representative for Bio-Tissue, I look forward to visiting with doctors and staff and talking about the benefits of PROKERA. However, when I recently became a patient, I learned even more about the benefits of this biologic corneal bandage with cryopreserved amniotic membrane. This experience not only helped heal my ocular surface, but also provided valuable information I can pass on to doctors and staff.

Ways to Educate our Dry Eye Patients and Make Them More at Ease

Our practice has always had a strong focus on cataract surgery, and from its inception has been at the forefront of treating patients with dry eye disease (DED). Early on, we realized the importance of having a healthy ocular surface for our patients prior to surgery. As such, all of us within the practice pay particular attention when treating patients with DED. We are very fortunate to have the most up-to-date equipment and tools available to help these patients.

"Why Intervene/5 D's” Reference Guide Now Available Online

To support doctors using PROKERA and inform others who may be interested in implementing Bio-Tissue’s biologic corneal bandage device in your practice, we recently made our "Why Intervene/5 D's" reference guide available to everyone online. This handy guide provides a quick reference to various indications where PROKERA provides clinical value, and we received such positive feedback to the print version that we decided to offer it electronically.

A Protocol for Use of PROKERA after Corneal Collagen Cross-Linking

With the Federal Drug Administration (FDA) approval of corneal collagen cross-linking (CXL) (Avedro, April 2016) for the treatment of progressive keratoconus, we can expect to see a high volume of these procedures being done by corneal specialists. Although the disease is considered rare, which according to the National Eye Institute (NEI) affects approximately one in every 2,000 Americans, the disease can lead to blindness if not treated. As we know, the surgical technique for performing CXL that is FDA-approved for use in the U.S. at this time is epithelium-off (epi-off, Dresden protocol).

Part 2: Amniotic Membrane Speeds Healing

In part one of a two-part series, Josh Johnston, OD discussed the paradigm shift in treating patients with dry eye. Here, he speaks to Primary Care Optometry News (PCON) about cryopreserved amniotic membrane and how it speeds healing.

In his last blog, Josh Johnston, OD, Georgia Eye Partners, spoke about the “Paradigm Shift in Treating Patients with Dry Eye” and how the introduction of new therapies allows doctors to provide better outcomes to patients and improve clinical outcomes. One of the therapies he spoke of is PROKERA with cryopreserved amniotic membrane, and its many benefits particularly for those patients with corneal involved dry eye.

Part 1: The Paradigm Shift in Treating Dry Eye

In part one of a two–part series, Josh Johnston, OD discusses the paradigm shift in treating patients with dry eye.

Treating dry eye disease (DED) has truly evolved over the past years, and even more so recently with new diagnostics, therapies and FDA-approved drugs. We all know DED is progressive and can be hard to treat, which is actually one of the reasons I like it so much. It’s an exciting time for those of us treating DED. The paradigm shift has changed and there are new, novel products and therapies at our disposal that allow us to provide better options to patients and improve clinical outcomes.

Bio-Tissue’s Dry Eye Center of Excellence Program

Our company’s groundbreaking scientific research in the study of regenerative medicine has led to the development of innovative products that are used worldwide by eye care professionals to treat ocular surface disease (OSD), including dry eye. In order to help you leverage our products, elevate the level of care you provide to your patients, improve clinical outcomes, and grow your practice, we developed the Dry Eye Center of Excellence Program (DECE).

Part 2: The Business Impact of Offering Cliradex in Your Practice

In part two of her series, Patti Barkey, CEO, Bowden Eye & Associates, in Jacksonville, Fla., discusses how Cliradex has assisted in practice efficiency, clinical outcomes and how it has improved business and their bottom line.

Part 1: The Business Impact of Offering Cliradex in Your Practice

In part one of a two-part series, Patti Barkey, CEO, Bowden Eye & Associates, in Jacksonville, Fla., discusses why they decided to implement Cliradex in their practice, how it fits into their “Dry Eye Disease" toolbox, and how it is used.

Research to be Presented at ASCRS that Further Demonstrates Effectiveness of Cryopreserved Amniotic Membrane for Ocular Surface Healing

This week we issued a press release announcing the presentation of key research at this week’s American Society of Cataract and Refractive Surgery (ASCRS) annual meeting, May 5-9. This research further demonstrates the clinical effectiveness of PROKERA, our biologic corneal bandage with cryopreserved amniotic membrane tissue.

Cosmetics and Demodex

In part two of her series, Sarah Darbandi, MD discusses the role of cosmetics in Demodex and the importance of daily ocular hygiene.

Q:             Is there a correlation between cosmetics and Demodex?

A:              Yes. Typically what I see under the microscope is layers of dead skin, collarettes, with mascara stuck to it and eye shadow particles entrapped in the sleeves of debris on the lashes. Since some ingredients in makeup are toxic for dry eye patients who are already very sensitive, this is just one more insult to their eyelids. They typically have red, irritated eyes, and with makeup they are adding waxes and parabens that block the glands and add more inflammation.

Cosmetics and Blepharitis – A Two Part Series

In part one of a two-part series, Sarah Darbandi, MD discusses the effects of cosmetics on the eyes, particularly for patients with dry eye and blepharitis.

Q:             How are cosmetics harmful to the eyes, particularly for patients with dry eye or blepharitis?

There are many things we apply around our eyes and on our eyelids, which is the thinnest skin on our body, including cleanser, moisturizer, under eye cream, concealer, eye shadow, mascara, eyeliners and more. Many of these products contain wax (synthetic, paraffin or beeswax) as well as potentially toxic chemicals such as carcinogens and parabens. Although parabens prevent the growth of bacteria in makeup, they can be absorbed through the skin and transmitted into the bloodstream. Parabens can also make dry eye worse as they prohibit the oil glands that line the eyelid from secreting enough oil.

Five Key Facts About Bio-Tissue

As we begin the new year, we wanted to share some key facts about Bio-Tissue. As one of five companies to be profiled as “One to Watch” in the year-end issue of Advanced Ocular Care, we continue our focus to provide groundbreaking regenerative solutions to eye care practitioners and patients around the world. Here are five key facts:

A Year of New Developments

Our company implemented many key initiatives this year in our continued effort to bring innovative regenerative solutions to eye care professionals around the world. As 2016 nears the end, following are just a few of these key efforts:

Restoring Corneal Health

Earlier this spring, a 56 year-old female presented at our office for an emergency visit. Her primary symptoms were serious pain, photophobia, and a foreign body sensation in her left eye - all of which had been happening for three days. She was a new patient and stated she had a history of numerous episodes of these same symptoms however, the severity this time, specifically in the left eye, exceeded that of any previous episodes. Additionally, her medical history included heart disease and Type 1 diabetes, the latter loosely monitored of late.

Bringing Value & Affecting Change: A Representative's Role

You have all seen many industry representatives in your office and operating rooms, and I’m sure you have an opinion on what attributes define good and not-so-good salespeople. Having worked in eye care for a while now and being very passionate about what I do, I wanted to share my perspective on what I believe makes for a good representative. These attributes are what motivate me every day when I am out talking with many of you and your staff in your practices, and helping you reach your goals.

Preparing the Ocular Surface for Cataract Surgery: Q&A with Niraj Desai, MD

With the high prevalence of ocular surface disease and its affect on cataract surgery outcomes, ensuring a healthy ocular surface prior to and post cataract surgery is very important. Bio-Tissue recently spoke with Niraj Desai, MD, about his experience with preparing the ocular surface for cataract surgery.

Successfully Treating a Chemical Corneal Burn

On the date of examination, this kind 25 year old Filipino gentleman, who is a UCONN adjunct professor, presented for an emergency in reference to a chemical burn injury while helping his student with an experiment containing trifluoroacetic acid. While attempting to salvage the work, the pressure built up in the tubing and exploded into his right eye. He immediately flushed the eye under a Morgan Lens for several minutes to mitigate the acidic response. Subsequently, the infirmary contacted our office to see him on the same day to assess the status of his eye. On arrival, he wore dark sunglasses, was in tremendous pain, had light sensitivity, and his eye was sealed shut.

The Psychology of a Dry Eye Patient

In my experience taking care of patients with dry eye, there is a certain population whose success or failure with treatment, to a certain degree, hinges on how they feel about it emotionally.

As doctors, we see a problem and treat it, but then we move on with our day and our next patient. We may not always understand the albatross these patients face each day – whether it be working at their computer, driving, or performing other daily activities while their vision is blurry or their eyes are burning or tearing. From a survey perspective we appreciate the quality of life issue; but from a day-to-day misery that these patients experience, it’s hard to truly wrap our minds around this as doctors. As with anything in life, some patients handle things better than others, and unfortunately for some dry eye patients the potential for failure of treatment can be perpetuated by the emotional burden they carry.

The Dangers of Beauty Treatments

We all know using makeup, and particularly not removing it at night, can have a huge impact on eye health and lead to or worsen conditions such as blepharitis, Demodex and also dry eye. As such, it’s becoming increasingly important to discuss cosmetics and ocular hygiene with our patients. A recent case also highlights the dangers of beauty procedures, which are becoming increasingly popular, in this case eye lash tinting.

Dry Eye Awareness Month: Five Ways to Market Your Practice

As we all know, happy and satisfied patients lead to referrals, which helps to build your practice.

However, you also need to look at additional ways to grow your patient base. While traditional efforts such as advertisements, waiting room videos, and brochures are very valuable, being creative and expanding your efforts can help you prosper and be even more successful. Here are five additional ways to help you market your eye care practice:

Treating Chronic Dry Eye: Why I Use CryoTek Cryopreserved Amniotic Membrane for These Patients

Dry eye is a multifactorial and progressive1 disease for which we use many treatments, but the Prokera® corneal bandage is the first and only biologically active treatment that directly targets the cornea. Prokera has been a game-changer in my practice. I use it not only for DEWS2 Level 3 and 4 patients, but also for those with Level 1 or 2 dry eye with corneal involvement, especially Sjögren’s patients, who are chronically uncomfortable and not responding to conventional therapies, even if there is a disconnect between their signs and symptoms.

Restoring Health to the Ocular Surface

Almost a year ago, a 73 year-old woman presented for an emergency visit at our office. Her history was positive for dry eye syndrome, and keratoconjunctivitis, for which she had been prescribed RESTASIS® BID, and artificial tears PRN. She also reported that over the last several years, she had experienced repeated episodes of painful, red eyes, accompanied by blurred vision. Topical steroid treatments temporarily reduced the severity of her symptoms, however recurrences continued to present.

Five Ways to Be More Proactive About Ocular Hygiene

We have all heard the saying “If people never got sick, there would be no need for doctors.” However, this is simply not true. As doctors, we have sworn to improve those who have pathology, however one of our most important jobs is disease prevention. Although it took many years to accomplish, we need only look to our dental colleagues as models for preventive care and development of good habits. This emphasis does not eliminate the need for dentists, but it does help reduce the number of dental procedures. Eye care is slowly moving in this direction, but still has a ways to go to operate from a truly preventive standpoint.

Dentistry advocates see patients twice a year and promote routine cleaning and polishing of teeth. Contrast this with our own profession, where routine check-ups are typically done every one to two years, and the importance of lid and lash cleanliness and good ocular hygiene is oftentimes not routinely mentioned. As doctors, there are many things we can do early – really at every stage of patient care – to guide patients towards improved ocular health. As a start, we can help patients understand the importance of ocular hygiene, its implications on long-term ocular health, and the development of good hygienic habits.

By being more proactive about preventive care, including looking at chronic, progressive diseases like blepharitis and meibomian gland dysfunction differently; we can help keep our patients’ ocular surface functioning at a higher level throughout their lives. Following are five ways we can be more proactive:

Helping Patients Heal Faster While Maintaining Their Vision

A 58-year-old, wheelchair-bound female with a history of a CVA and unspecified neurologic disorder presented in my office complaining of severe blurry vision, severe pain, burning and a constant foreign body sensation of the left eye.

Her ocular history was significant for dense amblyopia in the right eye with a best corrected visual acuity of 20/400 and mild amblyopia of the left eye with a best corrected visual acuity of 20/60. She had been treated prior in the right eye with PROKERA® Slim when she presented initially months prior with similar symptoms in the right eye due to severe dry eye, secondary to an extremely low blink rate and lagophthalmos related to her neurologic disorder. Her signs and symptoms dramatically improved in the right eye. However, she did not feel comfortable placing PROKERA Slim in the left eye as she didn’t feel she would be able to safely go about her daily life with her left eye occluded and only 20/400 vision in her right eye.

New Resource to Educate Consumers About Blepharitis, Demodex and Other Lid Margin Diseases

We are pleased to announce our newly revamped website to help educate patients and build awareness about eye health and wellness, particularly related to blepharitis, Demodex, dry eye, ocular rosacea and other lid margin diseases.

The website also provides you and your staff access to clinical and product information about Cliradex, our preservative-free, all-natural lid, lash, and facial cleanser. Cliradex isolates 4-Terpineol, the most important ingredient in tea tree oil, that is clinically-proven to safely and effectively clean the skin and eradicate Demodex mites.

ASCRS Success: Presentations Demonstrate Clinical Effectiveness of Regenerative Tissue Therapies

This year, ASCRS 2016 proved to be yet another successful conference. Many exciting papers, posters, videos, and distinguished speakers discussed our regenerative tissue therapies and ocular hygiene products for ocular surface diseases.

Optimizing the Ocular Surface Prior to Surgery: Why I Added Prokera to My Refractive Cataract Pre-Surgical Regimen

Refractive cataract surgery requires a high level of attention to the ocular surface. Patients expect perfect outcomes, and any compromise of the ocular surface interferes with preoperative measurements and proper IOL selection. To ensure we don’t end up with a postoperative refractive surprise, we need to be on alert for ocular surface disease and get it under control before proceeding with surgery.

Be Proactive

Our typical cataract surgery patients have all the risk factors for ocular surface problems. They have chronic disease comorbidities, they’re using multiple medications, and so forth. Many are neurotrophic to some degree; therefore, we can’t rely on them to report symptoms. We must proactively look for dry eye as well as epithelial-based diseases, such as Salzmann’s nodular degeneration (SND) and epithelial basement membrane dystrophy (EBMD). EBMD not only leads to irregularities in preoperative measurements and outcomes but also puts patients at risk for epithelial sloughing during surgery and poor wound healing postoperatively.

Marketing Dry Eye in Your Practice

If you’re looking to positively impact patients’ lives and your practice’s bottom line, then ocular surface disease is a niche worth exploring. Dry Eye isn’t glamorous. In fact, it can be completely frustrating for all parties involved. However, the population of Dry Eye patients is exploding. Plus, there’s no end in sight to ocular surface disease woes as the Baby Boomers age and the Millennials are glued to their smart phones.

Maybe you think “I treat Dry Eye.” Your office carries nutraceuticals, warming masks, lid wipes, etc. You prescribe medications for Dry Eye disease (DED) and offer thermal pulsation. You do it all. But, the question remains, do your patients know what you do?

Identifying Conjunctivochalasis: The Importance of Restoring the Tear Reservoir for Patients with This Condition

I was an early adopter of identifying conjunctivochalasis (CCh) and addressing it as a true pathologic condition from which our patients suffer. Conjunctivochalasis dry eye, as it is often called, is truly a misnomer. While CCh contributes to dry eye symptoms, it is a separate entity from the “standard dry eye” that we see in our practices. Furthermore, a number of myths are associated with CCh.

CCh presents as dissolved and degenerated Tenon’s with excess, loose conjunctiva in the inferior fornix, and fat prolapsed into the inferior cul-desac. This results in both the obliteration of the tear reservoir within the inferior fornix and obstruction of the tear meniscus along the inferior eyelid margin. Normal tear distribution and outflow are disrupted, and the patient experiences dry eye symptoms.

Five Key Pearls to Setting up a Dry Eye Center of Excellence

Millions of people suffer from dry eye, and these patients often end up in your practice feeling frustrated after trying various treatments with limited or no relief. As you continue to see more of these patients, you may consider setting up a Dry Eye Center of Excellence that establishes a standard of care and treatment protocol just as you would for patients with other diseases such as Corneal Disorders and Glaucoma. Having this systematic approach can reap many benefits for your patients and your practice, including better clinical outcomes, improved patient satisfaction, and practice growth.

Diagnosing and Treating Demodex Blepharitis: Myths and Facts

Demodex is one of the most common causes of blepharitis, yet it still remains an often overlooked differential diagnosis. Although there is much information published on the treatment of Demodex, some dialogue still focuses on traditional treatments such as baby shampoo, lid scrubs, and ointments that are ineffective in addressing the core of the problem: the Demodex mites. Here are some myths and facts to help debunk some common beliefs surrounding Demodex Blepharitis:

The Importance of Standard of Care in Your Dry Eye Practice

When I interview talented technicians, I typically ask why they want to leave their current practice, and I’m often told it’s due to chaos and lack of structure. And undoubtedly, our former technicians say they miss the fact that our doctors all follow the same standards.

Consistency is important for both staff and patients, particularly for medium and large practices with multiple doctors. When physicians each “do things their way” it can be detrimental to efficiency, patient satisfaction, and staff morale. While it’s understandable that each doctor may have nuances, agreeing on a standard of care is a huge plus that will reap many benefits for your practice.

Reducing Pterygium Recurrence: Improve Surgical Outcomes with This Time-Saving Technique

After working my way through the painstaking troubles of some of the traditional approaches to pterygium surgery, I thought there must be a better way. Through time, I developed a new approach that I call the Tissue Tuck Technique. This technique fulfills all the criteria that, in my mind, define successful pterygium surgery. It’s efficient, reproducible, and not difficult. It has an excellent cosmetic result. And, most importantly, it has a low recurrence rate. After using this new technique in more than 700 cases, my recurrence rate is less than 1%.

How to Maintain Patient Vision During Treatment for Ocular Surface Diseases

For the millions of Americans who suffer from symptoms of chronic ocular surface disease, traditional treatments typically provide only temporary relief for patients, primarily because they don’t tackle the corneal damage that may be causing the symptoms. At Bio-Tissue, we strive to continually research and develop groundbreaking regenerative medicine treatments to help these patients and improve their quality of life.

Our innovative PROKERA® products are the only FDA-cleared therapeutic medical devices that reduce inflammation and promote healing in order to rejuvenate and heal the cornea, which is essential for patients to find true relief. PROKERA is clinically proven and has helped more than 50,000 patients worldwide.

Dry Eye Syndrome + Epithelial Erosion = A Problem, Until Now

My previous blog on Recurrent Corneal Erosion syndrome (RCE) discussed the problem with the never ending cycle of palliative treatment. Contact lenses, artificial tears, and sodium chloride drops are commonly used to alleviate the patient’s ongoing symptoms of erosions. The epithelial anomaly is usually due to trauma to the corneal surface; in the following case, the trauma was induced by corneal surgery. If the patient suffers from the condition of Dry Eye Syndrome (DES) in addition to epithelial erosion, then the equation will yield a problem that may never be restored . . . until now.

Rejuvenating the Ocular Surface

Inflammation and regeneration share a close relationship in the human body. However, the pathological inflammatory process is an impediment to the body’s ability to regenerate. What my colleagues and I have learned through our NIH-funded research is that regeneration can take place only when inflammation is effectively controlled. Our discoveries have led to the development of amniotic membrane (AM) products for healing and rejuvenating the ocular surface. These include AmnioGuard® biologic glaucoma shunt tube graft; AmnioGraft® biologic ocular transplantation graft; and PROKERA® biologic corneal bandage (Bio-Tissue), and we’re working on applying our findings to a broader area in regenerative medicine.

If It Walks, Talks, and Looks Like a Duck, Then It Must Be RCE…

As many of your patients can attest to, the dreaded “Freddy-Krueger-fingernail”, Recurrent Corneal Erosion syndrome (RCE), is unfortunately quite common in our daily practice. We always treat these patients with the classic bandage contact lens (BCL) and sodium chloride drops in hopes that this will solve their problem. However, the dilemma ensues when the abrasion persists incessantly never to heal properly again. So we ask, is it possible to prevent this type of recurrence to rid the cornea of all future erosions forever? Thankfully, with the advent of cryopreserved amniotic membrane, a reversal of this misfortune is now conceivable. Our clinic has been fortunate enough to resolve this conundrum through the use of PROKERA® as highlighted in the below case.

The Economic Benefits of PROKERA®

It’s not a simple cliché or abstraction to state, for the record, that the best, most profitable, and most enduring business plan is simply, and above all else, doing the best for the patient. Hence, when considering the economics of PROKERA® use in practice, we must ensure that we are making calculations based on the appropriate metrics. Are we considering only the myopic calculation of price and profit-margin; erroneously rationalizing that an amniotic membrane is an amniotic membrane?

Or, are we, our patients, and our long-term practice prospects, better off, by focusing on endpoints like quality of healing, speed of healing, and the other metrics of efficiency, time, and profitability that they directly and indirectly impact? In this blog, I will address the rationale (both economic and medical) behind our decision to use the PROKERA-line in my Cornea, Cataract, and Refractive practice.

Why Is Dry Eye Care Such a Buzz?

Dry Eye isn’t new to our patients and yet the ophthalmic and optometric communities are all a buzz with how to add Dry Eye care to their practices. I field at least ten calls a week from practices “ready to add Dry Eye care” to their services. I’m not sure how we all got into Dry Eye being “new” because it isn’t.

The Power of Social Media

In today’s healthcare environment, eye care practices are always looking for new ways to reach current patients, as well as attract new ones. Social media sites like Facebook, Twitter, and LinkedIn are a great way to market your practice. In fact, according to a recent report, 52% of consumers want health care related information online including tools, rankings for quality and satisfaction, reviews of doctors, etc.

Social media provides a way to engage and interact with current and potential patients and provides timely information about your practice, new treatments and services, your staff, and eye health issues.

Additionally, social media can be more cost effective than some traditional marketing tools such as print advertising or radio commercials. It’s truly a great referral tool and practice builder.

Interval Scheduling for PROKERA®

As we all know, by the time many Dry Eye Disease patients make it to us, they are frustrated and looking for symptom relief, particularly those that are chronic and haven’t responded well to conventional therapies.

In my practice, I use PROKERA® for those patients that fall into a Dry Eye Severity Level (DEWS) of 3 or 4. For these patients, with severe or in some cases disabling discomfort and visual symptoms, PROKERA has proven to be a cutting edge technology that rejuvenates the ocular surface rapidly and helps to improve patients’ quality of life.

Tips for Reimbursement and Implementation

Billing and reimbursement seems to be one of the toughest areas for Administrators and Physicians trying to implement new technologies into their practice, particularly those that have high associated costs. Whether something costs your practice $5 or $800 you should always do due diligence to make sure that you are getting paid.

The Importance of EBMD Prior to Cataract Surgery

A 73-year-old nun presented in my office complaining of severe blurred vision in the left eye that was slowly getting worse. She stated that she had seen prior eye doctors that recommended cataract surgery, however she was quite hesitant and had a lot of anxiety about surgery so wanted a second opinion.

Think Demodex First, Not Last

In the last few years, there has been increased interest in blepharitis, and several new therapeutic products have hit the marketplace. When choosing the appropriate treatment for patients, it’s important to consider etiology. The primary types of blepharitis are demodectic, staphylococcal, and seborrheic. These often occur along with MGD.

Treatment for Dry Eye: Why Don’t Other Doctors Do This?

We all know that Chronic Dry Eye can be extremely frustrating and have a significant impact on a patient’s overall quality of life. It is always gratifying when you can help a patient get relief from their symptoms, particularly when they have tried many treatment options with no success.

Such was the case with one of my recent patients, a 92-year-old female with AMD OS>OD. She winters in Texas where she receives care from a retinal specialist. Despite her discomfort, no one had treated her Dry Eye Disease in the past. The patient is an artist who paints and she does a fair amount of computer work. Here are some facts about the case:

Blepharitis: Getting to the Crux of the Problem

Traditionally we haven’t had many great options for treating stubborn conditions that affect the eyelid and ocular surface such as blepharitis and rosacea. During my training, we would recommend baby shampoo as a cleanser which would be quite irritating to the ocular surface and really didn’t get to the crux of the problem, leaving some patients with continual symptoms such as itchiness and irritation. Luckily today, we have other options for patients that are much more effective.

Quality Healing in Chronic Dry Eye Patients

The majority of patients I see in my anterior segment-focused practice who have Dry Eye are either referred for cataract surgery or are patients who have sought treatment elsewhere without success. When these patients present with dryness-related keratitis, such as superficial punctate keratopathy (SPK) that doesn’t respond to initial therapies, I turn to PROKERA®, a biologic corneal bandage composed of a cryopreserved amniotic membrane. Its natural therapeutic effects reduce inflammation, promote healing and minimize the risk of scarring, all of which are necessary to alleviate symptoms, return the ocular surface to a normal state and optimize cataract surgery (and LASIK) outcomes.

A Safe, Effective Procedure for Conjunctivochalasis

For many patients suffering from constant eye irritation, redness, and swelling, their symptoms can affect their daily activities and work. By the time I see some patients with these types of symptoms, many have already been to numerous doctors and tried all types of medications and artificial tears with no relief. Although these symptoms may seem like Dry Eye, for some patients they are actually a common condition called Conjunctivochalasis (CCh), that is often confused as Dry Eye due to similar symptoms. They may complain about having dry eyes, but are actually tearing.

Naturally Fresh, Healthy Eyes: Patients Talk About Cliradex

Ever wondered what patients have to say about Cliradex®?

A Cautionary Formula: When EBMD with Concomitant Dry Eye Disease Is Mixed with Glaucoma Medications

Dry Eye Disease (DED) is on the rise with dramatic statistics illustrating a 10% increase over the next decade along with epithelial basement membrane dystrophy (EBMD) ranging from 10-40% of the population to make matters more complex.

I recently had a case of a 66 year-old female with a longstanding history of both EBMD and DED, which was compounded by two glaucoma medications. This presented as an emergency for what the referring Optometrist diagnosed as a large abrasion.

Blepharitis – Signs and Symptoms, Treatments and Practice Management

In part two of his two part series, Dr. Schachter discusses the signs and symptoms of blepharitis, treatments, and practice management. View part one, Blepharitis - Overview and Prevalence.

Blepharitis, like many ocular surface diseases, is a condition where signs and symptoms don't always match. Therefore, it is often overlooked. The reason for this may be that blepharitis is a chronic, progressive condition. In our practice, we screen for the disease and treat it early. If you let it progress it will be harder to treat.

A History of Innovation

Recently I had the pleasure of accepting the prestigious Tibbetts Award on behalf of TissueTech™ (parent company of Bio-Tissue and Amniox Medical) for the Company’s significant achievements in regenerative medicine. Maria Contreras-Sweet, Administrator, U.S. Small Business Administration (SBA), presented the award at a White House ceremony, and I was honored to be among the other 22 companies recognized out of thousands of applicants.

TissueTech received its first Small Business Innovation Research (SBIR) grant in 2003, and since then the Company has received 11 SBIR grants that have helped to support its growth and led us to being at the forefront of innovation in regenerative medicine. Our history of federal funding through SBIR and the National Institutes of Health (NIH) has been instrumental in the development of many innovative products that are used worldwide by doctors in ophthalmology and optometry as well as orthopedics and chronic wound care.

Lid Wipes or Lid Scrubs?

When treating ocular surface diseases such as dry eye, blepharitis, meibomian gland dysfunction, and Demodex, there are various approaches and treatment options based on the patient’s condition. Many of these approaches such as lid scrubs and lid wipes not only treat the condition, but also help to prevent it from worsening by adhering to good lid hygiene. However, it is important to understand the differences between the two and when/for what condition each should be used.

Blepharitis – Overview and Prevalence

In part one of a two part series, Dr. Schachter discusses the prevalence of blepharitis and the opportunity this presents for eyecare providers.

Blepharitis, or eyelid inflammation, is a very common, chronic condition that presents in our practices every day. In the US, blepharitis affects approximately 80 million patients each year. In a study done in my practice, we found around 25 of 100 consecutive patients had blepharitis.

Turning Dry Eyes into Happy Eyes

Dry Eye affects an estimated 20.7 million people in the United States and is one of the most common reasons people visit their eye doctor. It can be very uncomfortable for patients with symptoms ranging from redness, itchy and watery eyes, to blurred vision; and it can also be challenging for their doctors as they seek to provide treatment and relief for their patients.

Preparing the Ocular Surface for Cataract Surgery

The condition of a patient’s ocular surface prior to cataract surgery, particularly refractive cataract surgery, can greatly impact the outcome. This is especially true for patients with dry eye and/or mild or severe epithelial basement membrane dystrophy (EBMD). Both of these conditions are so prevalent, they can be easy to overlook. I was taught in residency, 10% of the population, but if you look at the studies, it's widely variable. Some studies are upwards of 30 to 40% of the population.

Pterygium Surgery – The Thorn in Our Side

As we all know, pterygium surgery can be challenging and is often time-consuming and painful, produces poor cosmetic results, and has high rates of re-occurrence. This can be very frustrating for us as doctors and also for our patients.

Five Ways to Market Your Practice

As we all know, happy and satisfied patients lead to referrals, which helps to build your practice.

However, you also need to look at additional ways to grow your patient base. While traditional efforts such as advertisements, waiting room videos, and brochures are very valuable, being creative and expanding your efforts can help you prosper and be even more successful. Here are five additional ways to help you market your eye care practice:

PROKERA® Dry Eye Case Studies

In this retrospective PROKERA dry eye study, 11 patients with dry eye and who experienced persistent ocular discomfort, visual fluctuation, and exposure keratitis, despite maximal medical treatment, were treated with PROKERA®. The device was placed for 2 to 11 days.

Continue reading to learn more about five patients from the study conducted by Scheffer C. G. Tseng, M.D., Ph.D.; Anny Cheng, M.D., Hosam Sheha, M.D., Ph.D. at Ocular Surface Center, Miami, FL.

Cryopreserved Tissue’s Superiority over Dehydrated Biologics

We have long known the benefit of the use of amniotic membrane in ocular wound healing, but a study I co-authored published in the Journal of Wound Care last October brought to light the considerable differences in the structural and biological properties of cryopreserved and dehydrated amniotic tissues. 

Amniotic Membrane Technology and Quality Healing

We all know treating ocular surface inflammation is crucial to promoting healing of the ocular surface. If left uncontrolled, inflammation can lead to chronic pain and discomfort, delayed healing, and in some cases, more tissue damage and possibly vision threatening complications such as scarring. Although the use of amniotic membrane to treat ocular surface diseases and inflammation has increased, I am often baffled as to why this dramatic technology isn’t more widely used. Its benefits are so clear and there are hundreds of scientific papers to support its use.

A Combination Approach to Treating Recurrent Corneal Erosion Syndrome

Management of recurrent corneal erosion (RCE) syndrome can be frustrating for both the patient and doctor. Patients are often upset by the recurrent episodes of pain and decreased vision, and we as doctors may become discouraged when presented with the inability to cure our patient’s disease.

Dry Eye CCH: It's a Tenon's Problem

An estimated 3.2 million women and 1.68 million men age 50 and over are affected by Dry Eye Disease, and the demographics are growing rapidly among Baby Boomers who work on computers all day. Dry Eye can be quite uncomfortable for patients and tends to get worse if left untreated, leading to pain, scarring, and in many cases fluctuating vision, which may cause intermittent loss of vision.

All of these symptoms can be frustrating, especially for the patient, as well as the doctor. Making the diagnosis is the key to effective treatment. Communicating effectively with the symptomatic individual is also critical.