Dr Katherine Rachon's clinical pearl: "Check for NK more than you think you should"

Katherine Rachon, OD, FAAO, DipABO, presented a clinical poster at SECO 2026 on the management of neurotrophic keratitis using cryopreserved amniotic membrane (Cam360 AmnioGraft, BioTissue) and a dissolvable collagen shield. Titled “Treatment of Stage 1 NK Secondary to Acoustic Neuroma Removal with Cryopreserved Amniotic Membrane,” the poster highlighted the critical role of corneal sensitivity testing in differentiating refractory dry eye from neurotrophic keratitis, outlines ideal patient candidates and staging considerations, and offers practical pearls for optometrists on treatment selection, billing, and recognizing red-flag signs such as epithelial defects without pain. Rachon spoke with Optometry Times to give an overview of the poster at the conference, which is running from February 25-March 1 in Atlanta, Georgia.

What are a few key takeaways from your poster?

Katherine Rachon, OD, FAAO, DipABO: This case does a really good job of highlighting the importance of doing corneal sensitivity testing for patients that either have refractory dry eye or they may have a systemic condition, like in my case, the patient's trigeminal nerve pathway had been damaged. So with the corneal sensitivity testing, if you can find a deficit in that corneal sensitivity, then you can appropriately guide your treatment, instead of just trying dry eye treatments over and over and over again.

So in this patient, what we decided to do to start off was just to give her a little bit more immediate relief is do amniotic membrane. We used a cryopreserved amniotic membrane called Cam360 by BioTissue, and used a collagen shield that dissolved over 72 hours, and she did really well. She went from having pretty severe [superficial punctate keratitis, or] SPK, pretty significant, blurry vision, and once that collagen shield dissolved, and we removed their main tissue, pretty much, resolved all SBK on the front surface of the eye, and she was really happy. So this case, not only looking at corneal sensitivity to identify neurotrophic keratitis, but highlights the use of amniotic tissue in treating these patients.

What are some other telltale signs that there's an ideal candidate for this type of treatment?

Rachon: So Cam360 works in more early to moderate neurotrophic keratitis. So depending on which classification system you're looking at, if you're using the Mackie [system], you have the first stage of neurotrophic keratitis where there might be epithelial involvement, but there's not going to be any stromal involvement. Certainly there's not going to be any perforation. So these would be good patients to use a Cam360 specifically, and then you get into later stages, when there is stromal involvement or ulceration, where you're at risk of perforation. These are not good candidates for Cam360 and they had done a lot of studies on these patients that had decreased corneal sensitivity. And they actually found that corneal sensitivity in a lot of these patients was restored somewhat after a cryopreserved membrane. So that's awesome for patients. Maybe it's not a total fix, but at least it gives them something right off the bat, especially if they have a hard time taking drops … it's really fast.

For optometrist who may be dealing with similar cases, what are some take homes from this case study that they can apply to their practice?

Rachon: Cam360 is extremely easy to use, and it's a more comfortable treatment than a typical preserved membrane like a Prokera. So these patients, if you use a collagen shield, you can blaze it and it dissolves on their own. So maybe these patients have transportation issues and they can't get in to see you in the next couple days to remove a Prokera ring. So this really is a good tool to use in a clinic that is built on efficiency, so really easy to put in, really tolerable for the patient. If you are billing the exam properly, and you've done the corneal sensitivity testing to prove that they do have a decreased corneal sensation, then the coverage for this procedure is excellent. Out of the numerous procedures that I've done for cryopreserved membranes, I've never had a patient come back and say that their insurance did not cover it or it was an outrageous copay.

Anything else about the poster and the case study that you want to mention that we haven't touched on?

Rachon: I would just say that, just for these cases, neurotrophic keratitis is supposed to be a rare disease, and I don't think it's rare at all. If eye care providers are noticing that their dry treatments aren't working, you need to test for corneal sensitivity. If patient has a condition as common as diabetes or herpetic keratitis, you should be checking corneal sensitivity.

If you see a patient with a lot of front surface staining, or if you have a patient that has an epithelial defect and they do not feel it, that is a red flag for neurotrophic keratitis, because if you can differentiate a patient with dry eye, they're going to be in your chair all the time complaining of pain, compared to a neurotrophic keratitis patient that might have all this dryness, and you're just like, “Wow, how long has this been there for?” Because they don't feel it, and they don't complain and they don't come in. So anytime you see that kind of classic stain without pain, you need to be checking for neurotrophic keratitis. My greatest clinical pearl would be to check neurotrophic keratitis more than you think [you should.]