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[00:00:33] Speaker A: WTC Minneapolis St. Paul FM 107.5K 298CO Minneapolis Intelligent Radio with SRN News. I'm Bob Agnew in Washington. A large earthquake rock Southeast Asian update from correspondent Jennifer king. A powerful 7.7 magnitude earthquake centered in.
[00:00:55] Speaker B: Myanmar rocked Southeast Asia midday Friday causing extensive damage.
[00:00:59] Speaker A: Public infrastructure has been damaged.
[00:01:02] Speaker B: The this includes roads, bridges and public buildings.
[00:01:05] Speaker A: We currently have concern for a large scale dam. Marie Manrique is a Red Cross program coordinator. The major bridge that connects Mandalay to Saguyn has also collapsed.
Head of the military government Senior General Ming Anhuang warned that many people are.
[00:01:21] Speaker B: Missing and the initial death toll is likely to rise.
[00:01:24] Speaker A: I'm Jennifer King.
President Trump continues to talk about the US Taking control of Greenland as Vice President vance and a U.S. delegation paid a visit to an American military base in Greenland on Friday. This is SRN News.
Eric Metaxas believes there's a reason it's been sealed. By now the JFK files, 80,000 pages have been released. If they didn't want this to come out for 60 something years. Why? There's a reason. And it seems that if it comes out today, we're going to find out the reason and it's not going to be pretty folks. The Eric Metaxas show overnights at 3 on AM 1280. The Patriot Intelligent Radio.
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[00:03:11] Speaker A: Many people are searching for the right 401k decisions within these crazy markets. Are you looking for a local community of investors with the right skills that could help build confidence, make better financial decisions right here in the Twin Cities because you are the best steward of your own money. Call OTA today to learn more in our free introductory investing class, either in center or virtually at 9528-1444-1095-2814-4440 or go to learnwithota.com does an education where your.
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[00:05:25] Speaker C: Prefer apps like TuneIn, iHeartRadio or Audacy.com.
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[00:05:50] Speaker D: Good morning, I'm Dr. Kerry Gehl and welcome to Wellness 1280 radio. Open your eyes Radio. Please listen as I discuss the newest information in the world of health, nutrition and sports. Every Saturday morning 6am Central Time on AM 1280 the Patriot. Also, please share your thoughts by emailing me at drkerrygalbgmail.com that's D R K E R O Y-G-E-L-BMail.com and visit my new website, wellness1280.com where we have all guest links, wellness 1280 info and previous shows. Wellness is taking over the Patriot Airways for the next hour. Sit back and enjoy my interview with Dr. Mike Johnson. Your eyes are under constant attack. Dryness, inflammation, infections, even surgical trauma. But what if nature provided a powerful way to heal and protect them? Enter corneal amniotic membranes. A revolutionary treatment harnessing the regenerative power of human birth tissue to restore and safeguard vision from severe dry eye and corneal ulcers to post surgical recovery. This cutting edge therapy is transforming eye care. But how does it work and who benefits the most? Joining us today is Dr. Mike Johnson, an Alabama based optometric physician, consultant and lecturer at Ophthalmologics Biological Tissue, Owner and Managing Director of Excel Eye Care with Excel Health Group and Managing Partner and National Provider Trainer at nuvisa ocular devices. Dr. Johnson will break down the science, the impact and the future of amniotic membranes in eye care. Could this be the key to unlocking a new era of of vision restoration? Stay tuned. This is Open YOUR Eyes Radio and podcast with Dr. Kerry Gilb. Mike, welcome to the program.
[00:07:55] Speaker A: Thank you, thank you sir. Feel honored Honored to be a guest.
[00:07:59] Speaker D: I'm so happy to have you. I want to ask you, so what is amniotic membranes?
[00:08:05] Speaker A: Sure. So amnion tissue or amniotic membranes in, in the, in the sense of where it is coming from and what is it from? A basic principle is the, the fetus is protected by the placenta and the outer layer that's towards the outer portion, toward the mother is the chorion. The innermost lining that is closer to the amniotic fluid is the amnion. And we know from scientific studies that the amnion possesses the antibacterial, the antibiotic, anti angiogenic, the anti inflammatory, all of the properties that you want to promote a healthy tissue, healthy promotion of wound repair, if you will.
And the beauty from an eye care ocular perspective is that it's five layers thick, which is bioidentical, biosimilar if you will, to the five layers of the cornea. So the beauty is that the basement membrane structure all the way to the epithelium of this chorion can absorb and readily and almost immediately take on the properties of the compromised or damaged, infected scarred corneal tissue. But you can also use it for, you know, lid margin issues. You can use it for the conjunctival issues. There are some procedures where you have repair to the conjunctival that we'll probably talk about in a little bit. This is some other new technology. But yes, what is amnion or amniotic membranes? The process where a lot of companies are lowering the tissue in either a lower temperature state to dehydrate it. And in our case with the ones that I use, we lower it with an air dried process. So there's no chemicals, there's no preservatives, it is just its preserved state and it's dehydrated. So it can stay in its packaged form for five years. You don't have to use it, you don't have to store it. Some of the original products that were on the market 15 years ago, they had to be stored in a very special freezer at a certain temperature. But so that is what amniotic membranes are. It's a dehydrated tissue that has all the properties to immediately give a response and a healing time.
[00:10:21] Speaker D: So the amniotic membrane, let's just go back for a minute with the.
It protects the baby, gives the baby nutrition. But early in the 20th century they found that the amniotic tissue would be very good for wound healing and reconstructive purposes. And what are some of the factors within the membrane now before we even get into the eye part that, that the amnion has, is it growth factors, hyaluronic acid, cytokines, stem cells? How do these help the body with burn victims, foot ulcers? It's very big in podiatry now with foot huge. So talk about some of the non eye indications of where somebody would use this type of regenerative tissue.
[00:11:08] Speaker A: Right. You hit the nail on the head in the nursing home section or in the wound repair section. That's a big market for it. Where you know your podiatry, your ulcers, your bed bound sores.
There are a lot of dental procedures where you have gum, gum procedures or gum disease where you can apply the amnion.
Facial issues. As far as depending on how you want the amnion delivered, it can be in a dehydrated tissue substance or it could be in a serum where you can apply it to eczema, rosacea issues. You can use it with scarring. As far as post procedural for the aesthetics world where you can apply it, you know, with your red light therapies, you want to increase the healing time.
As far as you know your, your plasma fibroblast procedures or these individuals that are using facial aesthetics and they want to see a rejuvenated look. You can also see it in a serum formation with hair restoration and helping with the fight with the loss of hair follicles and help stimulate that.
[00:12:16] Speaker D: Wait a minute. Hair restoration. I want to hear more about that.
[00:12:21] Speaker A: I'm not really sure if you're, if you're in the scenario. I think you might have passed that window for that one, sir. But no. So what you're looking at individuals that might be looking at spending thousands of dollars on hair transplant and you want to be able to use the transplant and then have the follicle in place to. And help promote or think of it like in its simplistic terms. You're. If you're planting a crop and you want to have a nice bed if you will to put that follicle in place. Well, the soil needs to be enriched with fertilizer type substances. And so the amnion is literally like a membrane cellophane tissue that you can apply all of the fertilizer growth factors, the anti angiogenic neovascular properties. There are some other properties that are on the horizon where you might see in the eye care world that there are studies being done for use using insulin on directly on the eye to help reduce scars, infections that's if you're in the LinkedIn world. We already know that because the, the insulin like growth factor is already present in the amniotic membrane. As far as our testing we already have that as far as one of our pamphlets. As far as the properties the you know, the receptors that help block any type of scar formation promoting the reduction of the fibrosis or the anti fibrotic so that you can reduce scar formation that comes into play for individuals that have had scars, the wound repairs and then from an eye standpoint circling back to that you may have patients or people that are in the audience that have had these shingles with eye related infections and the second and third recurring where you can reduce the infection and then apply the membrane to help reduce the scar formation which is where the permanent reduction in vision is. So yes, there's a world of properties for this tissue.
[00:14:20] Speaker D: Comments about it's being used in burn units has been used in burn units for a long time. How does it help people with burn with that have burns, right.
[00:14:28] Speaker A: So depending on your layer of your burn and when you're talking about amnion for the eye it's a very small, we're talking, you know, 12 millimeters or less. But in the, in the wound area where you're trying to not necessarily have to get a transplant tissue, you from a piece of the body or another portion you can add that. What is it going to do? It's going to allow that basement membrane scaffold, especially if the burns are going to a deeper layer. But it's going to allow you to help prevent any kind of infection from, from setting in and immediately allow that tissue to start healing back to its normal properties and reduce that scar formation or that pulling slash, you know, traction of that collagen tissue.
[00:15:08] Speaker D: And it's interesting because they lack immunologic markers. So there's lack of allergy from this. So correct a big allergy because you're using an amniotic membrane from somebody else. But there's lack of allergy. So that's very interesting. When we get back from the break, I'm speaking with Dr. Mike Johnson, managing partner and national provider trainer for Nuvisa Ocular Devices. He's an optometrist in Alabama. This is Dr. Kerry Gelb for Open youn Eyes Radio wellness1280.com We'll be right back.
[00:15:42] Speaker B: I went to the eye doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this problem affects more than 40% of Americans. My eye doctor thinks this disease is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot Being nearsighted myself but the good news is that the doctor told me about a new FDA approved product called My Sight. This specific one day contact lens is already worn by thousands of children in the us. It is proven to slow down the progression of nearsightedness and best of all, Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom and when she plays sports. I Recommend you visit openyourizedradio.com to find an eye doctor that specializes in this treatment program. Learn
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[00:16:45] Speaker A: Night of worship and prayer on Friday, April 25, believers from across the Twin Cities are coming together for the Merge Worship and Prayer Night, a night of praise, unity and revival. Gather with hundreds of believers as we seek God's presence and pray for transformation in our city. Don't miss it. Friday, April 25 Learn more at mergeusa.org that's mergeusa.org.
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[00:17:43] Speaker B: Eye doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this problem affects more than 40% of Americans. My eye doctor thinks this disease is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot being nearsighted myself. But the good news is that the doctor told me about a new FDA approved product called My Sight. This specific one day contact lens is already worn by thousands of children in the us. It is proven to slow down the progression of nearsightedness and best of All Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom and when she plays sports. I Recommend you visit openyourizedradio.com to find an eye doctor that specializes in this treatment program. Learn
[email protected].
[00:18:48] Speaker D: This is Dr. Kerry Gelbin. We're back with Dr. Mike Johnson and we're talking about an interesting topic. We're talking about amniotic membranes. These are things that are used for non healing problems with the eye and other parts of the body. And before the break we were talking about is it a problem because we're using a tissue from somebody else that they're going to get allergies. So Mike, can you elaborate on that a little bit?
[00:19:13] Speaker A: Sure. So the tissue itself when, when it's processed, first of all the, the tissue that we are getting is 100% from voluntary donated mothers where we have done their testing making sure there's all it passes all the FDA requirements, the ISO requirements and as well as the FDA tissue donation requirements.
And it's also from voluntary scheduled cesarean. So the tissue that we, that ophthalmologics uses for their production of the ophthalmic amnion, we know where it's coming from. There's no cross contamination. The sterility factor is there.
[00:19:53] Speaker D: When we, how do we know about communicable diseases like hiv, syphilis? Do we have to worry about that?
[00:20:01] Speaker A: No, you don't. 100%. So inside each packet they actually have by requirements the testing so that we know every, every tissue has been tested when the mother signed up to be a voluntary donor. And we have specific groups and hospitals that we have assigned as our donation and harvesting hospitals. But once the cesarean has been performed and the tissue has been donated, it goes through a second round of testing to confirm that the original testing. So you go through two rounds of testing for communicable disease or any type of outlying factors whether that individual had some type of bloodborne pathogen or something in their system present. So the risk of having a cross contamination or an exposure if you will, to to that is zero because the tissue would not be viable in that case.
[00:20:48] Speaker D: When we're, let's go back to allergies because yeah has a lack of immunologic markers which are these little markers that bring in the, that bring in the immunity to fight a problem or cause an allergy. So it's very interesting how it has a lack of that. Can you.
[00:21:07] Speaker A: That is correct. I would say that in the same sense if your, your, your audience isn't familiar with stem cells or you know, tissue transplant cells to where like you said, there's no biomarkers present to where it will be having that T cell immunologic response. So this tissue is, it's got an avascular layer and it will take on the properties of the tissue that it's absorbed into without having that immunologic slash inflammatory response. That way you don't have to worry about a graft host rejection or anything of that nature. The other thing from an allergy standpoint is there are some companies that use a preservative, some of them an alcohol based and some of them have a little small sulfur base to where they're dropping the temperature quickly and freeze drying it and then they use chemical. So some of it, some of the brands out there that are available and there's several brands out there will use a little mini preservative base. So if you have individuals that have a sulfur allergy, they might want to just double check and ask about the product being used in the clinic that they're attending. In the case of optologics we lower the temperature and it's an air dried production system. There is no preservatives and there is no risk of any contamination or exposure to sulfur or any alcohol based. I will say that also that the ophthalogics tissue amnion, there's two different facilities. One is for the wound tetra division that has to do with the podiatry slash gum disease and then the other one is strictly ophthalmic. So we know once we get a package for depending on which product is being ordered by the provider, we know exactly where it is harvested from, where it was donated, from what hospital system and then also which process it went through from start to finish.
[00:22:53] Speaker D: This is, it's interesting because people want to know that this is safe and a lot of people don't know anything about this and that this is really, you know, we use this in my clinic. I have placed, you know, hundreds of these membranes and have helped many, many people. And we're going to get into the eye, how it helped the eye in a little bit. But I want to talk a little bit about some of the properties of amniotic membranes and why they're helpful. First I want to start that they're anti inflammatory. Explain why that's important.
[00:23:24] Speaker A: Sure. So I would say one of the underlying issues with dry eyes, there's different types of dry eye. From an inflammatory dry eye, where the surface has to the, to the general audience, we have these little particles in our tears that cause the tears to either be too acidic in ph or not enough. And if there's a presence of these particles called MMP9 proteins, then the surface itself will lead to the individual having burning sensation or the breakup in the actual tears holding themselves together because they won't withstand in the oils that are on that surface will not be of a good quality. And so the anti inflammatory properties of the membrane help stabilize and cause the MMP9 levels present. And the osmolarity, which is just fancy word for the ph acidity of your tears, to be calmer and allow for the every time you blink, for the tears to displace across your eye in a uniform layer, not to evaporate as readily and stabilize that inflamed, irritated surface. To where instead of having to use eye drops every two, three, four hours, the idea is to, to absorb that membrane, that amnion into the surface and allow the healing to be there for comfort and to have a longer sequence of time to where you may not have to use the drops every 2, 3, 4 hours, but allow you to get breaks and, and a reprieve from the burning in the sensation. So anti inflammatory is a huge component of, of the amnion.
[00:25:10] Speaker D: Yeah, because we want to be careful of chronic inflammation. Because if we get chronic inflammation, that's when we get scarring and we get A's where people can't see through the cornea, the front of the eye, it'll delay healing. So that's very important. Let's talk about a second property, delayed scarring or anti fibrotic, why is that important?
[00:25:31] Speaker A: That's huge. So when you're talking about a corneal cornea being the front of the eye, an individual that has chronic dry eye to where the tears are not in that area and it's exposing the nerve tissue and not telling the brain to produce tears, or that this area is exposed and being painful, then the area will dry out and scar. Or if an individual has chronic infections like herpes simplex keratitis or what we have a lot of dystrophies like Nausman Measman's nodular dystrophy, where you have an exposure to the surface and the elements of life, the wind, the air, cause that area to kind of get a smoky white thing. So the cornea is normally crystal clear. And when you have a scar in the eye, the way it responds, whether you had an injury or whether you had some type of infection or chronic inflammatory issue leading to a scar, then you'll get a fibrotic, almost like a white hazy scar formation and it can go deeper. So the amnion itself, if you can stabilize the infection from the dendritic ulcer or stabilize the tear inflammatory surface, the amnion itself can help absorb in and resurface that damaged scarred area with those anti fibrotic slash healing properties.
[00:26:54] Speaker D: So a next property of amniotic membranes and why they work so well is they prevent new blood vessels from coming into the eye. Why is, why is that important?
[00:27:04] Speaker A: New blood vessels coming into the eye imply that there's a proliferation of new vessels that are what we call neovascular vessels that are unstable in the cornea when they're growing inward. Then you have a pathway for the other opportunistic infection. So the blood vessels can be a pathway for the bacteria that can be traveling through that system. It can be a pathway for the new growth of tissue to cause the corneal tissue, or what we call pannis, to set in to where you have a more opaque surface or scar formation with the proliferation of the new blood vessels. New blood vessels are not a good thing for a pristine clear cornea. It would be the same effect of you having a crystal clear kitchen window pane and you see little mini cracks coming in from the side. Well, there's breaks in that, that perfect surface that are allowing other particles, other fluids or other things to leak inwards. So you, you don't want new vessels because that, this leads to other future problems.
[00:28:12] Speaker D: And it also has antimicrobial properties, which means, that's doctor speak, which means there's a less risk of infection or decreased infection. Can you talk about that for a minute?
[00:28:22] Speaker A: Sure.
You know, when you're talking about eye related infections, the number one thing from, from a clinical perspective is I'm not going to treat an active infectious ulcer directly with an amniotic membrane. That's, that's, that's a little bit off the scale of what our mode of practice is. We want to see an improvement through the standard of care. So we're going to put you on the topical antibiotics to reduce that. But the second we start to see that infection start to recede or start to stop and heal itself, that's when you can go in and add that amnion so that no secondary opportunistic infections come into play. Or let's take back to the whole wound repair. We have an individual that has an Open wound on other parts of the body. The risk, especially in hospital settings. And then I do a, a lot of work in multiple states with my nursing home care. There's always the risk of those nosocomial, you know, secondary infections of the bacteria that lives all around us. So if you can apply a membrane to an eye that has an open sore, or what we call an epithelial defect, you're going to allow that tissue to heal and cause that surface to resurface healthier. You're going to prevent the blood vessels from coming in, but then you are preventing any further secondary infection by where there's already a break in tissue.
[00:29:41] Speaker D: And you know, there's over 700 publications on the benefits of amniotic membranes for people that haven't heard about this. And it really helps with wound healing real quick, much quicker than you would do if you just put a bandage, contact lens in the eye. So we would have, in the old days, we would just someone have a wound, we put a bandage, contact lens. Now we could use this tissue to help heal wounds. And they do really, really well with that.
[00:30:09] Speaker A: Usually it's an immediate response. I would say we want the wound, the, the amnion to be in place. You know, three days is optimal for the, the complete absorption of the amnion. But usually within 24, 48 hours you're going to see that whatever that defect or that wound on the eye or the other tissue, you're going to see the, the beneficial results of it.
[00:30:31] Speaker D: And when we get back from the break, we're going to talk about dry membranes and wet membranes and what the difference is. This is. Dr. Kilingetto, open your eyes.
[00:30:42] Speaker B: I went to the eye doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this problem affects more than 40% of Americans. My eye doctor thinks this disease is, is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot being nearsighted myself. But the good news is that the doctor told me about a new FDA approved product called MySite. This specific one day contact lens is already worn by thousands of children in the US it is proven to slow down the progression of nearsightedness. And best of all, Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom. And when she plays sports. I Recommend you visit openyoureysradio.com to find an eye doctor that specializes in this treatment program. Learn more at openyourizeradio.com Tune in to.
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Visit oneplace.com today. I went to the Eye Doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this problem affects more than 40% of Americans. My eye doctor thinks this disease is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot being nearsighted myself. But the good news is that the doctor told me about a new FDA approved product called MySite. This specific one day contact lens is already worn by thousands of children in the US it is proven to slow down the progression of nearsightedness. And best of all, Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom and when she plays sports. I Recommend you visit openyoureyesradio.com to find an eye doctor that specializes in this treatment program. Learn more at open your eyes radio.com.
[00:33:43] Speaker D: We'Re back with Dr. Mike Johnson, consultant and lecturer for Opthalogics Biological Tissue Inc. He works a lot with amniotic membranes and he's teaching us about that today. And there's two main kinds. There's a dry kind and the wet kind. If you could start off with the dry the pros and the cons of having a dry membrane what the pros and cons are for the patient what's the pros and cons for the physician.
[00:34:12] Speaker A: You know, I'm a little partially biased. I'm gonna say there's not that many cons on the dehydrated other than, you know, I would say that it the dehydrated tissue came out of play where the store the pros. It's got a five year shelf life. Our product Ophthalogic has a five year shelf life. There are some brands that have a three year shelf life depending on all their how they were producing it. But it lasts longer. You can store it at room temperature. It's a very small, it's the size of literally an envelope that holds it in place.
You can get it in different sizes. So usually from a cost standpoint it's a pro because investment wise for the provider it's a lot less, it's fractional compared to the wet slash. There's only one real wet product out there that's made by a company and you have to keep it in a freezer and then you have to lower the temperature down. But from a con standpoint of the dehydrated, I would say that all of your normal eye related conditions, it's you, it's clinically indicated. I would say that the only con would be that if you're wanting, if you have a neurotra, a severe neurotrophic effect where you're wanting a severe thinking about doing Oxybate and the listeners out there, if you have neurotrophic keratitis, it's a very bad scenario where it's a very sick eye that's losing its nerve sensation and so that that surface is pretty much dying. So I would say the con would be that you would not want to use a dehydrated and a very severe grade 4 neurotripic case. More than likely you're going to have a corneal specialist involved and then your next step would be looking at a you know, twelve, fourteen hundred dollar eye drop called Oxybate. It's just pretty rare. So I would say that if in my clinical decision making I normally almost always do the dehydrated. The pro is that it comes in a smaller size. You can go to a 5 millimeter. In a nursing home setting you might have your patients that are in a physical position, whether in a wheelchair or they may have a kyphosis where their neck just doesn't allow them to sit back a little bit. You can go to their bedside and apply it. And you know, if the pediatric population or an older patient there's, they might be fighting you a Little bit. You might have to kind of move them around. So a smaller membrane size tends to be a pro when it comes to that. The, the other thing is Opthalogix is the only company that has an open port membrane where it actually has a hole in the middle. So if you have these individuals that are on the go, parents, and they have to work, or they're professionals like a fellow eye doctor, and they, they know they've got a recurring recurrent corneal erosion where they feel the sharp pain, but they still have to work for the rest of the day and they don't want to have a slight reduction in vision. You can use the aurora, place the membrane and go to work about your day. It's a beautiful membrane that you can use in the sports setting. I had just had a case the other day care for a Division 1 college team. And so the individual had an abrasion, but they also were about to get into round one for the nitrogen. So we were able to apply a membrane. They were still able to practice, still go travel. A team never missed any kind of practice or anything like that. That's the.
[00:37:23] Speaker D: Let me interrupt you here for the Aurora, where they have that aperture, there's like a 5 millimeter aperture so you could see through it. And you also make an eclipse which doesn't have the aperture.
[00:37:34] Speaker A: That's correct.
[00:37:35] Speaker D: Why would anyone ever use the eclipse? Why would you use the eclipse and not just always use the aurora? Because you could see better with that. Is there any advantage of using the one without the aperture, the eclipse without the aperture that you could see better with? Is there any advantage to the eclipse? Why I would.
[00:37:53] Speaker A: I will say there was definitely an advantage if you have a corneal finding that is in a specific area. Right. So if you've got an 11 millimeter cornea and you see a specific abrasion slash defect, or let's just say you had a dendritic ulcer that was down at 4 o'clock and it was in a very specific quadrant. I would want to apply a membrane, a 5 millimeter or an 8 millimeter directly on top of that so that it can get secured adhesion and absorption maximal into that spot. But now if it's a, if it's a case where this individual's got dry eye and it's diffuse, it's just all over the eye. And I want them to have a good absorption and a good spread because the amnion is going to get a lateral spread. So you're, you know, the little open port 5 millimeter port. Some people worry about, well, will I get the effects of the amnion in that open port as well? The answer is yes, we see a lateral spread. The visual I always do when I'm teaching other interns and other doctors is imagine pouring syrup on a, on a stack of pancakes, right? You're going to see that syrup spread across the entire tissue or pancake, if you will. So I would say the pro, or in my case, I tend to order when I'm doing my purchasing, I order several of the fives and several of the eights so that I can get the smaller size for that very specific defect that I just want to put in place before I put a bandage lens on top of it. But if it's a large diffuse area that I'm just treating the whole eye, I'm going to use the Aurora so that they can have a viewport and they can go about their day without any kind of reduction. Because I do, I do want to keep that bandage lens holding it in place for around two to three days.
[00:39:36] Speaker D: So Aurora we're going to use, it's a more diffuse type of injury or that we're trying to treat, or if it's of it, if it's a more concentrated part, then we're more likely to use the Eclipse, the one without the aperture.
[00:39:51] Speaker A: That's true. And, and again, that's, that's my clinical preference. I, I have some doctor colleagues that just use the Aurora on everything. That way that the, there's no risk of the patient having a reduced vision. We, we did a study.
[00:40:04] Speaker D: You do have doctors that will use the Aurora, the one with the aperture on everybody. And this is the one without the aperture.
[00:40:12] Speaker A: Right. I think it comes down to preference. I think some of your doctors, they just like to have a smaller ones. They can put it in place and there's no fold formation. It's just, you just put it in place, tap, tap with the forceps and it's secured in place and it's easier. Right, but then you have some doctors that want to have that full coverage360 and get a maximum amount. We did a study on the, the 10. The Aurora comes in two sizes. It's a 10 millimeter with a 5 millimeter port. And then you have a 12 millimeter.
[00:40:43] Speaker D: 12 millimeter.
[00:40:44] Speaker A: Right, right. And so the 12 millimeter has the same amount of amnion as a full 10 millimeter eclipse.
[00:40:51] Speaker D: So, and what the studies show, studies.
[00:40:53] Speaker A: Show that the, the amnion is going to laterally spread. So if you Were are comfortable with it and you're, you're not worried about like a central ulcer slash central defect. The aurora is perfectly fine to use for all cases.
[00:41:05] Speaker D: So the 10 and the 12 were equal pretty much.
[00:41:08] Speaker A: Right.
[00:41:08] Speaker B: So.
[00:41:08] Speaker A: So the 10 millimeter aurora is the equal to the 8 millimeter eclipse in amnion surface tissue. And the 12 millimeter aurora is equivalent to the 10 millimeter eclipse from a standpoint of surface amnion. Yes.
[00:41:23] Speaker D: So, all right, let's move to the cryopreserved or the wet amniotic membrane.
This is a little more complicated to ins to put on a patient. It's also more painful. It's not as comfortable. I don't want to use the word pain painful, but it's not as comfortable.
Tell me about the pros and the cons of the wet type. And you mentioned before when you would use a wet type of. It was a really, really bad neurotrophic case where that means that the neurology going to the eye is pretty much not there and the patient can't really feel the eye. And this eye starts to dry out and kind of starts to die off. And that's what we don't want to happen. The front of the eye, the cornea. But if you could talk a little bit about that.
[00:42:10] Speaker A: Sure. So you are correct. The wet frozen amniotic membrane, it's packaged in a way to where when you apply it, it has a ring involved, what we call a polycarb ring. And you have to put it in place. You have to put the ring in place. And you know the patient is going, you're going to have to educate the patient that there's going to be some discomfort, but it's the risk reward. So you're educating your patient that you are in a very compromised situation. And we are trying to save this eye from severe scar formation from severe infection. And you're putting all hands on deck with that one. So the pro is that it's your go to if you've got a pretty nasty situation where you've had your failed attempts with treatment as far as your medications and you're right before referring them for some type of surgical intervention or second opinion from a cornea specialist.
So the ring is going to stay in place. You're looking at again, several days with that ring in place. And then the, the patient, as far as putting it on, I'm not going to say it's. It's traumatic, but it's definitely one where you have to educate them as far as the Removal slash, you know, and the insertion of the ring with the amnion, it is going to be a wet amnion that you're applying in place after you've, you know, brought it back to room temperature and got it out of the freezer. So the, the maximum absorption there is is optimal for those pretty bad cases. Cost wise is, is definitely a con. It's, it is more expensive from your investment standpoint. But a pro would be that it, it's definitely your go to if you have a pretty bad situation and you know you have to have to kind of keep it a temperature, you have to keep it inspected.
So pro wise would be it's your go to for your pretty bad cases. So if you've got a patient listening and they go to a clinic, that's a subspecialty clinic. There's, there's a high likelihood that they have both types in clinic.
And also these, all of these are usually readily shipped within 24 hours because it is human tissue. So it has to be, you know, shipped air and certified and signed for the next day.
[00:44:15] Speaker D: Now does this have more growth factors or hyaluronic acid than the dry or the more cytokines or stem cells than the, than the dry?
[00:44:26] Speaker A: Studies show that the, the numbers as far as when that actual tissue comes out of the freezer and it kind of reaches it, you are going to see a little bit more of the presence of the cytokines and the growth factors. Yes. But from a statistic percentage of what you're using it for, they're, they're fairly equal. Yes.
[00:44:46] Speaker D: And how long do these last? So the doctor gets them, they put it in the refrigerator or the freezer, I assume the freezer, it's going to last about a year refrigerated, maybe three or four months. But, but correct me on that if I'm wrong.
[00:44:58] Speaker A: You are correct. Freezer wise for that particular one, you're looking at a year. And then of course you have to get it out and be ready. So it's not one of these things that you're, you, it's going to be a planned application case. Right. So that's a con where if you come into my office and you have an emergent situation, we're going to have to lower it, get the temperature back, get the, get it out of the freezer and go and get it ready for you to be applied. Whereas with a dehydrated one, I walk back to my storage cabinet, I get the, the reverse round tweezers, I can apply it immediately and put a bandage lens in place. So there is a prep time for a second.
[00:45:32] Speaker D: This is Dr. Kerry. Go for open your eyes radio. We're up against the break. We'll be right back.
[00:45:36] Speaker C: Back.
[00:45:42] Speaker B: I went to the eye doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this problem affects more than 40% of Americans. My eye doctor thinks this disease is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot being nearsighted myself. But the good news is that the doctor told me about a new FDA approved product called My sight. This specific one day contact lens is already worn by thousands of children in the US it is proven to slow down the progression of nearsightedness. And best of all, Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom and when she plays sports. I Recommend you visit openyourizeradio.com to find an eye doctor that specializes in this treatment program. Learn
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[00:47:41] Speaker B: I went to the eye doctor the other day with my daughter Maggie. I was shocked when the doctor told me that my daughter was already becoming nearsighted. It turns out that this Problem affects more than 40% of Americans. My eye doctor thinks this disease is getting worse. Perhaps it's getting worse because of kids prolonged time spent playing with smartphones or maybe because kids now spend less time outside. My genetics probably aren't helping her a whole lot being nearsighted myself. But the good news is that the doctor told me about a new FDA approved product called MySite. This specific one day contact lens lens is already worn by thousands of children in the US it is proven to slow down the progression of nearsightedness. And best of all, Maggie loves these contact lenses. The doctor taught her how to use them. Now it is so exciting to see her have even more success in the classroom and when she plays sports. I Recommend you visit openyoureyesradio.com to find an eye doctor that specializes in this treatment program. Learn more at at open your eyes radio.com we're back with Dr. Mike Johnson.
[00:48:46] Speaker D: Expert on amniotic membranes. He's with, he's a consultant lecturer with Ophthalmics Biological Tissue Ink. And we're talking about wet amniotic membranes. But to take out those membranes you have to use anesthetic because it could be uncomfortable, is that correct?
[00:49:06] Speaker A: Well, so with the dehydrated membranes, the whole point is that it wants to absorb into the cornea. So the only thing you're going to remove, be removing at day three or day four would be the bandage contact lens where normally we would use a topical anesthetic just for the ease of mind. And we're going to already be staining and evaluating the patient. So if they were to come back and us remove the bandage lens, we could do that without any anesthesia from a dehydrated membrane standpoint. But yes, as far as a wet membrane that has the polycarb ring in place, you have to use an anesthetic. That way you can get the ring out and, and get in a safe manner to, to be able to evaluate the patient.
[00:49:44] Speaker D: So with the dry membranes going back to dry, you know we were talking about wet, but let's go back to dry. You have to put a contact lens on it. Explain why it needs to have a contact lens and best method to do it for the doctors listening, do you put it in the contact lens and then apply it or is it better to put it on the eye and then put the contact lens over it? What are the pros and cons to both?
[00:50:07] Speaker A: So I'm actually going to say that we highly recommend to not put the membrane in the contact lens and Then apply it. We have several cases, and that's one of my roles with the company is we'll have doctors call with some troubleshooting issues here. Of late, we've had several call and say that the patients experience a little bit of a, an irritation where they feel a presence of, on the edge. And what has happened is they had applied the, the amnion into the bandage contact lens and the amnion was starting to secure to the bandage contact lens. And then they apply on the eye. And different parts of the amnion would be absorbing into the eye. Every time you blink, a contact lens is going to rotate. So you're literally causing it to rotate. And almost like a, like you're opening a jar or whatnot. You don't want any kind of grinding or movement at all to an already sensitive and compromised cornea. I would say that our preferred optimal way that we would apply would be directly onto the cornea. And you actually want to have a few seconds, I would say 10, 15 seconds, where you use the forceps. We like the reverse geometry forceps where you have to squeeze to open the forceps and then back it away. And they have a round, almost like a loop on the end to where you just literally just tapped it in place. The membrane itself is going to have a little bit of an opaque gray appearance to it, wide opaque appearance. Once it absorbs into the cornea, you're going to see it turn more translucent and take on the properties of the eye. You as a clinician want to see that. You want to see that absorption for just 15, 10, 15, 20 seconds. Then, then grab the bandage contact lens and put it in place. That way you know that the amnion is already securing to the cornea. And then if you put a bandage lens in place, it won't necessarily shift it or move it. That's very much the case when you're dealing with the Aurora because you want to secure it and keep it in place all the way around, allow it to kind of get in that pupillary zone, especially in their, their photopic condition, which would be what their pupils doing during the daytime. I will say that in the nursing home setting, we don't really recommend the bandage contact lens because you're going to have to rely on the administrative nursing staff of the nursing homes to take care of this patient post operatively, if you will. So what I normally do is, when we're teaching and training these other groups that do nursing home eye care, is we do a bandage situation where most of the time Your membrane cases are going to be a follow up, do them right off the bat when you go into your nursing home setting. That way you can apply the membrane, the amnion, and then we use an eye patch and a second patch where it's folded that we call that a pressure patch. And then we have tape and gauze and ophthalogix was really good. That was a recommendation that myself and a few others had. Is, can we have a kit? Well, we don't want to walk around with all these supplies. But if we order a membrane for nursing home care, they will ship you a bag that has a drape, has tape, gauze, iPads, and a little packet of preservative free tears. And so that way, if you can keep that in place, keep that eye closed, keep it pressure patched for that five to six hours optimally, by the time you finish with your clinic, on your way out, you yourself can go check on that individual, take the patch off and then the majority of what you've wanted to accomplish is already in place. So those are the two modalities that we recommend is the contact lens bandage after it's applied and then the nursing home eye patch, pressure patch situation.
[00:53:40] Speaker D: And what drops would you recommend that the patient use? So they have the, they have the membrane on. They may have a contact lens on top of it or they may have had a patch. The patch comes off. Now the patient has to have some drops. Antibiotic, antibiotic steroids. I know for myself I'm always using antibiotic steroids. I'm using Tobradex typically to prevent an immune response. Even though we talked about how it's unusual to get an immune response. I've seen some bad immune response, especially with the first patient I did a membrane on, had a terrible infiltrate. So now I always use Tobradex, which is a combination antibiotic steroid. I've never had a since then. But you're the expert, what do you think?
[00:54:24] Speaker A: Right. So what we want to do is in the eye care setting, you're already going to have them on some type of topical. Usually it's a steroid of some nature. I prefer Isuvis as a failed treatment from two to three weeks ahead of time. And then you're going to see, you know, Mr. Smith come in in two weeks and it's part of your documentation. So you follow the dry eye workshop and you're at stage three.
I tend to already have them on that drop. And so afterward they'll continue their treatment drops the next day while the amnion is on, especially for that first six, four to six hours. We would only recommend like a preservative free teardrop if there's any kind of discomfort with that, bandage content, lens, whatnot. But as far as your antibiotics slash combo drops, you're right. Tobradex in my neck of the woods is a little bit expensive, so. So you do have a generic version that's called Maxitrol or what we call Neopolidex. The only thing I would recommend is just making sure the patient does not have any sulfur allergies to that. It's usually a pretty cheap drop that you can prescribe them. Another important thing is that your patients will already potentially be on other eye drops. Right. There are other problems like glaucoma, where this patient might be taking glaucoma drops at bedtime. What we always say is you're already on your drops, your eye pressure is going to be fine for one day. We need you to give us as pristine of a surface as possible to maximize that. So if they're already on glaucoma medications, let's not do those the rest of the day. Today just use the preservative free tears, pick up your glaucoma drops the next day and just pick up where you left off. That way we allow that amnion to not get kind of flooded with any kind of preservatives from the latanoprost or the timolols or anything of that nature.
[00:56:08] Speaker D: Some of the original membranes, you had to know whether they were inside, they were, which side you had to apply. There was, there was the upside, there was the correct side and the incorrect side.
[00:56:19] Speaker A: So, so as far as the, the dehydrated membranes, the oncologics membrane is what we call omnidirectional. You literally can apply it either side. And that comes into play really importantly from a clinical perspective, because when you go to apply a membrane, the heat from the patient's body temperature is going to cause that membrane to kind of curl upward a little bit. I always give the visual of like a stingray where you'll see a stingray effect. And some doctors get a little panicky and they're like, well, what do I do? I don't want to have a fold. The beauty of this, you can just literally flip over your, your forceps and just use the other side and that curled up side will just literally fold and just curl right back down onto the cornea and you, you get a perfect application. The ones that have the, the Polycarb ring that are the frozen and the wet. Usually they have a front side and a backside so you know which way to apply properly. There is a proper way for that. But most all of your dehydrated membranes are bi directional to where you can apply them on either side.
[00:57:18] Speaker D: Do you think the herbia find where they use this as a delivery mechanism? Well, they may put antibiotics in it or some kind of for allergies, some kind of medication for allergies or even who knows what, even glaucoma. Do you see that in the future?
[00:57:37] Speaker A: I do.
They're already working on that in Europe. Actually the what they're finding is that, you know, in the World of Genomic 3D Printers and Bio Bio 3D Printers, Matter of fact, here in Alabama, at the Alabama I Bank that that's a non profit group, they have one of two tissue printers where they actually can reproduce the same tissue product to get it from a donation standpoint, they're using that more in research for corneal transplants, endothelial transplants. And so in Europe what they're doing is they're infusing the, the synthetic amnion that they're trying to produce and they are, they're doing studies where they're infusing it with olapatadine and dexamethasone. So it's in, it's in the pipeline. But if you know anything about the United States of America, we have this wonderful thing called the fda.
So it's going to be many years and many millions of dollars. But yes, to answer your question, there's there, there are those and there's already a company that we worked with, Opthalogics, did a study with, they use, they have a contact lens that has been infused with one lens that's infused with amoxy fluxism, which is a fourth generation fluoroquinolone antibiotic.
[00:58:54] Speaker D: Well, hold that thought because okay, for next week we're gonna have you come back and we're sure about this. But if people want to find out more about you. How could they do that, Mike?
[00:59:04] Speaker A: Sure. So they can go to opthalogics.com and take a look at that. And then of course myself, I'm on LinkedIn and then I, I'm at my practice is Dr. Michael Johnson and Associates.com as well.
[00:59:18] Speaker D: I want to thank Dr. Mike Johnson for joining me, but he's going to join me again next week. This is Dr. Carrie Gel for Open your Eyes radio on wellness1280.com.
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