By Scott Huffer, OD, FAAO
March 15, 2017
There is a new medical eyecare treatment that relies on the use of amniotic membranes to repair damaged eyes. It is putting my practice on the forefront of eyecare, helping us to build our medical eyecare specialty, helping both our patients heal faster, and our practice to grow and gain profitability.
Amniotic membranes are small pieces of the lining of the amniotic sac. It is human tissue donated from healthy mothers delivering by C-Section. The tissue is comprised of stem cells, and as such, have remarkable healing properties. Their benefit was discovered as surgeons began doing surgical procedures in utero. They realized the babies with surgeries performed in utero were delivered without a scar. The tissue has been used to heal persistent diabetic foot ulcers, severe burns and many other slow healing wounds. The results have been impressive.
This is a procedure an OD does him or herself, and it is a wonderful opportunity for optometrists to handle cases like recurrent corneal erosions without the need of an ophthalmologist. I have found this can avoid a procedure like stromal micropuncture or PTK.
In the case of ulcers, all-prescription eyedrops are used as usual over the membrane. The patients still need antibiotics to heal, but the membrane will significantly accelerate the process.
We use two amniotic membrane brands. One is called Prokera. It is stored frozen, and retains fluids associated with the membrane believed to facilitate healing. It is a 22mm round, hard plastic ring with the membrane tented over it. It is pretty easy to insert and remove, and doesn’t require any additional equipment. With our first order they provided a small freezer for storage. The cost is around $950 per membrane.
The second amniotic membrane we use is from BioDOptix, and this membrane is stored dry. It, therefore, has a longer shelf life, and can be stored in a cabinet instead of a freezer. The insertion is a little more complicated as the cornea has to be dried out first. To dry out the cornea we use a speculum to hold the eye open and surgical sponges to dry the surface of the eye. Then the membrane is placed onto the cornea. The edges are smoothed with the surgical sponge and a bandage contact lens is placed on top. Then the speculum is removed. These membranes typically cost around $570.
Acquire Necessary Equipment
For such a cutting-edge treatment, use of amniotic membranes doesn’t require sophisticated technology. The key pieces of equipment are: forcepts, speculum and surgical sponges. Most offices have two-out-of-three of these. A speculum can be ordered for less than $100.
Beneficial to Patients and Generates Additional Revenues
We have been incorporating amniotic membranes into our practice for about a year and a half. I have done probably eight procedures that have made use of the membranes. We make an average per-patient profit of $800, after factoring in the expense of the membrane. Most of these have been erosion patients. One of the first patients I tried this on had recurrent erosions 3-4 times a year over the previous two years. She is now 15 months without an erosion since the membrane placement. The use of amniotic membranes kept her from seeing a corneal specialist for phototherapeutic keratectomy, and she now thinks the world of me and our office.
We bill insurance $2,500. In general, we are reimbursed somewhere between $1,250 and $2,100 for the procedure depending on the insurance. Between the insurance reimbursement, and the membrane used, the net profit will vary, but we average around $800 per patient.
As I tell patients, insurance covers it as much as it covers anything, meaning it will vary from insurance plan to insurance plan with some requiring a greater co-pay than others. The CPT code we use is 65778-79.
Which Patients Can Use this Treatment?
Any patient with eyes that need extra help healing can benefit from use of amniotic membranes. I have used it most for recurrent corneal erosion patients. In these patients, for whom we are considering surgical treatment options, the membranes are less invasive, cost less, and in some cases, provide better outcomes.
Most of these patients have had one, or two other, failed treatment attempts, so they are ready to hear an alternative. I explain that the tissue is comprised of stem cells, and that it is believed the tissue will differentiate into new, fresh cornea cells for the patient.
Any office seeing emergencies should have amniotic membranes. One patient I saw managed to chemically debride her entire cornea. I placed a membrane, and her cornea was healed fully a week later. I remember this because I had a patient who had PRK the day before her injury, was 30 years younger, and her cornea was not fully healed during that same time frame.
Educate Yourself About Amniotic Membranes in Eyecare
I learned about amniotic membranes at a continuing education meeting. At many of the big meetings now there are talks about membranes. The two major membrane supplier companies and their representatives are a wonderful source of information, and offer a great start for doctors seeking an education on this new procedure: www.biotissue.com and www.BioDlogics.com.