Article

CLINICAL: CONTACT LENSES

CONSIDER MEMBRANES

BIOLOGICAL CORNEAL MEMBRANES CAN BE A QUICK, EFFECTIVE TREATMENT METHOD

A 46-YEAR OLD male, new patient presented with a red, inflamed right eye, increasing photophobia and pain, which he said started three days prior. He said he owns a landscape company and is outdoors a large percentage of the day. The patient said he initially went to an urgent care facility, where physicians told him his right eye was scratched and gave him an antibiotic eye drop to use q.i.d. The patient said he was using the drops as prescribed, but sought my help because his eye felt worse.

Slit lamp exam revealed a 1.5mm vertical by 0.5mm horizontal corneal ulcer OD at 9:00 mid peripherally. (See image.) No foreign bodies were detected OD, and his OS was clear and quiet. His presentation — diagnosis of a corneal ulcer — suggested he could benefit from a biological corneal membrane.

CONSIDER BIOLOGICAL CORNEAL MEMBRANES

A biological corneal membrane is a FDA Class II medical device made up of a thermoplastic ring, which holds the membrane in place, and amniotic fluid. Adhered to the ocular surface for a time period dictated by the condition (about three to four days), the membrane promotes healing by regenerating epithelial cells.

This is a valuable treatment option because of its speed and effectiveness at providing patients with relief. Consider it when a patient presents with a high severity anterior segment issue, such as a corneal ulcer, and for a variety of keratitis cases.

Slit lamp exam revealed a corneal ulcer OD.
Courtesy of Jason R. Miller, O.D., M.B.A.

For example, a 63-year-old female patient, who presented with an advanced case of keratitis and recent failures from past medical treatments, was treated with an amniotic membrane that cleared a majority of the keratitis after four days of wear.

DISCUSS IT

When addressing this treatment option with the patient, consider referring to it not as contact lenses, but “biological corneal bandages” to be precise. In addition, address the patient’s possible discomfort with wearing it.

For example, “Mr. Smith, our best course of action for reducing your pain and addressing your corneal ulcer is a biological corneal bandage. This bandage will reduce inflammation and promote the healing process quickly; you’ll only wear it four days, and it will provide you with relief to go about your daily outdoor activities.”

CODE

The proper CPT code for this procedure is 65778, which is defined as “placement of amniotic membrane on the ocular surface; without sutures.” It includes reimbursement for materials used.

THIS PATIENT

After discussing the 46-year-old patient’s options, we proceeded with a biological corneal membrane because of his need to function outside and work, which was being impeded by his pain.

I inserted a biological corneal membrane in office; the patient returned four days later for removal. The ulcer healed nicely, with only a trace amount of superficial punctate keratitis around it. The patient reported no pain or photophobia persisting. OM