Objective:

To discuss the increasing utilization of cryopreserved amniotic membranes (CAM) in the treatment of dry eye disease (DED).

Approach:

• Historical Context: Amniotic membranes were once used only for severe ocular surface disease but are now common in DED treatment.
• Current Understanding: DED is recognized as a complex, multifactorial disease involving neurosensory abnormalities and inflammation.
• Clinical Practice: In a tertiary care center, the author evaluates patients' corneal sensitivity and treatment history to determine the appropriateness of CAM use.

Key Findings:

• Dry eye accounted for 44.2% of sutureless amniotic membrane diagnosis claims in 2020.
• Corneal nerve damage is a significant factor in DED, affecting tear production and healing.
• Studies show that CAM treatment improves DED symptoms and corneal nerve density.

Interpretation:

The increase in CAM use reflects improved identification of patients who may benefit from this treatment and a better understanding of DED as a multifactorial disease.

Limitations:

• Insurance coverage and prior authorization can complicate CAM treatment decisions.
• Factors such as glaucoma and patient comfort influence the choice of amniotic membrane.

Conclusion:

The use of amniotic membranes in dry eye is expected to continue growing as technology and understanding of DED improve.

Sources:

• Utilization patterns and costs of ocular amniotic membrane grafts in the Medicare population
• TFOS DEWS II definition and classification report