The Dry Eye Zone

Rebecca's Blog

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Study: Aiming for a consensus on blood-based products for dry eye

This is SO timely.

For those who might be new to the topic, this is about autologous serum eye drops - that is, eye drops made by drawing your blood, spinning it down to serum, and diluting it (usually) with preservative-free saline. There are now many variations on the blood theme available, from allogeneic (someone else’s blood) to platelet-rich plasma to cord blood serum even to the “fingerprick” method.

I think back to the days when raising awareness about autologous serum eye drops was like pushing water uphill. No matter how much published medical evidence there was for its benefits, a simple reality of “how the medical world works” is that emerging treatments simply do not readily get popularized without a financially incentivized sponsor.

I would venture to say that the self-advocacy efforts of patients throughout all those years have been a major factor in the progress that’s been made. A great many patients learned about this potential treatment option only through their own research.

This picture is quite different now. While it’s still relatively unknown in general eyecare, it’s a pretty well known option in corneal practices and dry eye clinics, and so many patients are being offered serum drops as a possible treatment surprisingly soon after diagnosis.

Personally, I think it’s at the point where it’s being offered perhaps without as clear a rational or protocol as would best serve patients. So, I was very excited to see even just the title of this study. I will be writing more about this, for sure, when I get a copy of the study itself.

Blood-Based Treatments for Severe Dry Eye Disease: The Need of a Consensus. Bernabei et al, J Clin Med. 2019 Sep 17;8(9).

The use of blood-based eye drops as therapy for various diseases of the ocular surface has become increasingly popular in ophthalmic practice during recent years. The rationale for their use is based on the promotion of cellular proliferation and migration thanks to the supply of metabolically active substances, in particular growth factors. Blood-derived eye drops have been used for the treatment of several ocular surface disorders, such as dry eye disease, corneal ulcer, persistent epithelial defect, neurotrophic keratitis, ocular surface burn, recurrent corneal erosion, and limbal stem-cell deficiency. Both autologous (from patients themselves) and heterologous (from adult donors or from cord blood sampled at birth)-derived products exist, and each source has specific pros and cons. Despite an extensive literature, several issues are still under debate and the aim of this manuscript is to review the indications, preparation methods and storage, characterization of content, rationale for clinical outcomes, patient stratification, length of treatment, and rationale for repeated treatments at disease relapse. A rationale based on a "5 Ws and 2 Hs" protocol is proposed as a way of thinking, with the attempt to clarify Who, Why, When, Where, What, and How to use these treatment options.