Treatment outcomes in the DRy Eye Amniotic Membrane (DREAM) study

McDonald, Marguerite B.; Sheha, Hosam; Tighe, Sean; Janik, Susan B; Bowden, Frank; Chokshi, Amit R.; Singer, Michael; Nanda, Seema; Qazi, Mujtaba A.; Dierker, Damon; Shupe, Adam T.; McMurren, Brittany J

doi:10.2147/opth.s162203

Cited by 47 publications

(47 citation statements)

References 30 publications

(31 reference statements)

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“…Other studies show similar findings. 160,161 One retrospective review by Macdonald et al 162 applied AMT for 5.4 (±2.8 days) on average with a sustained reduction in the DED marker (3.25±0.5 to 1.47±0.6) three months post operatively with improvement in both patient reported symptoms and clinical signs. Finally, other authors report how corneal nerve density can be significantly improved following AMT application, 163 potentially accelerating the recovery of the ocular surface health in patients with DED.…”

Section: Dry Eye Disease (Ded)mentioning

confidence: 99%

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

Walkden¹

2020

OPTH

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The aim of this paper is to provide a succinct literature review of the different clinical applications for AMT usage in an ophthalmic setting, ranging from commonly used applications to less mainstream approaches. The hope is that this review enables the reader to have a better understanding of the biological properties of amnion as well as the indications and scenarios in which AMT can be used, whilst presenting relevant evidence from within the literature which may be of interest. We also provide an update on the methods of preservation of amniotic membrane and the application methodologies. Methods: Literature search. A PubMed search was performed using the search terms "amniotic membrane transplant", "amnion AND cornea", amnion AND ophthalmology", "amnion AND ocular surface" and "Amnion AND eye". A full review of the literature using the PubMed database was conducted up until 01/05/20. The articles used were written in English, with all articles accessed in full. Both review articles and original articles were used for this review. All full publications related to ophthalmology were considered.

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Section: Dry Eye Disease (Ded)mentioning

confidence: 99%

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

Walkden¹

2020

OPTH

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“…In that study, the majority of patients experienced a reduction in dry eye workshop scores for up to 3 months. 7 However, in contrast, Suri and colleagues found a shorter treatment effect with approximately 18% of eyes with neurotrophic keratopathy (NK) experiencing a recurrence within 15 days. 4 All of our patients began to experience recurrence of both signs and symptoms of dry eye disease within 1 month of CAM removal.…”

Section: Discussionmentioning

confidence: 98%

“…There are conflicting reports regarding the duration of treatment effects for the use of CAM in treating the ocular surface. 3,4,7 The Dry Eye Amniotic Membrane (DREAM) Study recently evaluated the effect of CAM on patients with various types of dry eye disease and determined that CAM was effective for moderate-tosevere dry eye disease. In that study, the majority of patients experienced a reduction in dry eye workshop scores for up to 3 months.…”

Section: Discussionmentioning

confidence: 99%

“…1,[4][5][6] A recent study evaluated the effect of CAM in dry eye patients. 7 To our knowledge, there have not been any reports regarding its utility in managing patients with Sjögren syndrome (SS), a chronic and potentially life-threatening autoimmune disorder that causes irreversible damage to the lacrimal and salivary glands, resulting in a loss of tear and saliva production. In SS, the tear film becomes insufficient, leading to ocular surface inflammation and DED.…”

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confidence: 99%

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The use of self-retained, cryopreserved amniotic membrane for the treatment of Sjögren syndrome: a case series

et al. 2019

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Purpose-To determine whether signs and symptoms of ocular surface disease improve after placement of a self-retained, cryopreserved amniotic membrane (CAM) in patients with Sjögren syndrome (SS). Methods-The medical records of SS patients who received a self-retained CAM implant (Prokera or Prokera Slim; TissueTech Inc, Doral, FL) for the treatment of ocular surface disease between August 2012 and August 2016 at a single, large academic institution were reviewed retrospectively. Visual acuity, results of slit-lamp examination of the cornea and conjunctiva, and dry eye symptoms, were evaluated before and after CAM insertion.Results-A total of 6 eyes of 6 patients (all female; mean age, 62.5 ± 13.0 years [range, 49-86 years]) were included. All patients were on topical medications at the time of the study and had signs of ocular surface dryness. There were reductions in corneal and/or conjunctival staining in 5 eyes (83%) after the CAM dissolved. All patients who completed therapy (5/5) experienced a relapse in their signs and symptoms within 1 month of removal of the CAM, with an average time to relapse of 24.6 days. Mean follow-up time was 54.5 days. Foreign body sensation and blurred vision were the most common complaints associated with the CAM implant.

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“…corneal ulcers, neurotrophic keratopathy) with moderate to reasonably good success [8,9]. Recently treatment of DED has been evaluated using AM for treatment of more severe DED [10][11][12]. One of the more interesting findings in these studies is the effect of AM on corneal nerve regeneration (for relieving pain) along with accelerated recovery of the ocular surface in patient with DED [13].…”

Section: Open Accessmentioning

confidence: 99%

Cost utility analysis of cryopreserved amniotic membrane versus topical cyclosporine for the treatment of moderate to severe dry eye syndrome

Voigt

2020

Cost Eff Resour Alloc

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Background The purpose is to perform a cost effectiveness analysis amniotic membrane vs. topical medications in the use of treating dry eye disease. A cost effectiveness analysis comparing amniotic membrane + other topical medications to topical cyclosporine A + other topical medications was evaluated using accepted decision tree modeling software. Methods TreeAge Pro 2019 software was used to evaluate the base case costs over a one year timeframe. Sensitivity analysis was performed on those variables which had the greatest effect on choosing one therapy versus the other based on cost. Monte Carlo simulation was run 1,000 times to determine the most effective, least costly alternative. Costs were evaluated from a societal level (direct + indirect). Quality of life utility scores were evaluated using known time tradeoffs from prior studies (scale 0–1; with 1 being perfect vision). Results Over a one year timeframe, the base case demonstrated that amniotic membrane + topical medications was the less expensive alternative and provided for incremental utilities versus topical cyclosporine + other medications (Cost/utility: $18,275/0.78 vs. $20,740/0.74). If examining direct costs only, topical cyclosporine was the least expensive option over a one year timeframe: $4,112 vs. $10,300. Sensitivity analysis demonstrated that in order for topical cyclosporine to be the less expensive alternative the following variables would need to be: < 68 days productivity lost; < $161 productivity lost/day; > 79% of amniotic membrane implants would need to be re-implanted at month 4 (for whatever reason); > $2677 per amniotic membrane implant procedure (Medicare reimbursement rate); > 96% positive response to topical cyclosporine A at month 4; > 58% positive response to topical cyclosporine A at month 6 and; < 54% probability clinical improvement with amniotic membrane. Monte Carlo simulation demonstrated that amniotic membrane was the less costly, most effective alternative 91.5% of the time. Conclusion Based on improved outcomes using amniotic membrane, patient productivity was improved resulting in lower societal costs (less days lost from work). When considering the untoward effects of dry eye disease on societal costs, an improvement of the dry eye disease condition was accomplished most often with amniotic membrane.

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Treatment outcomes in the DRy Eye Amniotic Membrane (DREAM) study

Cited by 47 publications

References 30 publications

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

<p>Amniotic Membrane Transplantation in Ophthalmology: An Updated Perspective</p>

The use of self-retained, cryopreserved amniotic membrane for the treatment of Sjögren syndrome: a case series

Cost utility analysis of cryopreserved amniotic membrane versus topical cyclosporine for the treatment of moderate to severe dry eye syndrome

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