Myths and misconceptions about autologous serum for dry eye

June 22, 2020

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Special to Ophthalmology Times®

Autologous serum eye drops (ASEDs) have become a mainstay of therapy for certain categories of patients with dry eye and those with underlying immunologic disease or poor epithelial healing.

The logistics of prescribing ASEDs have changed dramatically in the past few years, making their use far more convenient for patients and physicians alike. Many still hold on to myths and misconceptions about ASEDs that are no longer true.


»MYTH No. 1: Autologous serum is a treatment of last resort mostly used by cornea specialists

FACT:  Although ASEDs are not an entry-level treatment for dry eye, they are certainly not the most aggressive treatment option available either. In the dry eye setting, ASEDs are commonly prescribed for very symptomatic patients who do not achieve sufficient relief from artificial lubricants and for those with concerning levels of keratitis (regardless of symptoms).

We also use ASEDs very early in the treatment course. In my view, every comprehensive ophthalmologist should consider ASEDS as part of their armamentarium, for 3 reasons. First, the drops, which are derived from a patient’s own serum, are very safe for the patient, with very few adverse events reported in the literature.1,2 

For the clinician, the process of prescribing ASEDs today is no more difficult than writing any other prescription (see myth No. 2). And finally, ASEDs offer a unique mechanism of action that complements other therapies.

»MYTH No. 2: Getting ASEDs into patients’ hands is a complex process

FACT: This used to be true, but today, I can prescribe ASEDs as I would any other therapy, thanks to a turnkey operation available from Vital Tears. I simply write a prescription, which my technician enters into a web order form with the patient identification details, and Vital Tears arranges the rest.

The patient can choose to have blood drawn at a designated lab facility, in a doctor’s office, or by a mobile phlebotomist at home. The blood is centrifuged to separate the solid platelets and red and white blood cells from the liquid serum. The serum is sent to a central lab in Kansas City, where it is diluted, bottled, and packaged for delivery.


»MYTH No. 3: Patients will not be willing to absorb the cost or hassle of ASEDs

FACT: ASEDs need to be frozen or refrigerated and typically are not covered by insurance, so there are some differences between these and ordinary topical medications. 

However, patients who are prescribed ASEDs are often in considerable distress and are very willing to follow the simple storage directions for the tradeoff of easing their pain and improving their vision. They keep 1 bottle per week in the refrigerator, with the rest frozen until needed. Patients can expect to see an improvement in their symptoms within 7 to 10 days. 

When I think about my patients with dry eye on ASEDs, there are very few instances when patients have said, “You know, this really isn’t helping me and I want to stop it.” I get that report all the time from patients on the topical anti-inflammatory agents we prescribe for dry eye, due to lack of efficacy, discomfort, inconvenience, or cost. 



»MYTH No. 4: It’s not safe to use blood products

FACT: In the past, this was absolutely true, because preparing ASEDs could expose the physician, pharmacist, and/or technicians to bloodborne infectious agents. 

Today, with the Vital Tears ASEDs that we use or other local phlebotomy/eye bank sources that doctors have identified, blood products are handled only by those trained to work with blood and human fluids and are prepared under sterile conditions with strict quality controls. 

Under these conditions, ASEDs are arguably safer for patients than many other medications we prescribe because an autologous drop would not be expected to have any corneal toxicity.  


 

»MYTH No. 5: There is no evidence that ASEDs are effective

FACT: ASEDs have been shown in the literature to have very good results in many subsets of patients, including those with dry eye,2-5 autoimmune disease,6 slow or nonhealing epithelial defects,7,8 and chemical injury.9

Randomized, controlled studies would be beneficial, but clinicians can feel very comfortable that ASEDs have a long history of safe and effective use.

Moreover, treatment algorithms from the American Society of Cataract and Refractive Surgery, the Tear Film and Ocular Surface Society, and the International Task Force on Dry Eye all incorporate ASEDs as a recommended treatment for moderate to severe dry eye.10-12


About the author
Joseph Tauber, MD

e: jt@taubereye.com
Dr Tauber is fellowship trained in both cornea and uveitis. He is in private practice at the Tauber Eye Center in Kansas City, Missouri, and serves as the medical director for Saving Sight Eye Bank, where Vital Tears are produced. He has no financial interest in Vital Tears.

 

 

References:

Geerling G, MacLennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. Br J Ophthalmol. 2004;88:1467-1474. Garcia-Martin E, Pernia-Lopez S, Jimenez RMM, et al. The use of autologous serum eye drops for the treatment of ocular surface disorders. Eur J Hosp Pharm. 2019;26(6):314-317. Celebi AR, Ulusoy C, Mirza GE. The efficacy of autologous serum eye drops for severe dry eye syndrome: a randomized double-blind crossover study. Graefes Arch Clin Exp Ophthalmol. 2014;252(4):619-626. Jirsova K, Brejchova K, Krabcova I, et al. The application of autologous serum eye drops in severe dry eye patients; subjective and objective parameters before and after treatment. Curr Eye Res. 2014;39(1):21-30. Dalmon CA, Chandra NS, Jeng BH. Use of autologous serum eyedrops for the treatment of ocular surface disease: first US experience in a large population as an insurance-covered benefit. Arch Ophthalmol. 2012;130(12):1612-1613. Ali TK, Gibbons A, Cartes C, et al. Use of autologous serum tears for the treatment of ocular surface disease from patients with systemic autoimmune diseases. Am J Ophthalmol. 2018;189:65-70. Jeng BH, Dupps WJ Jr. Autologous serum 50% eyedrops in the treatment of persistent corneal epithelial defects. Cornea. 2009;28(10):1104-1108. Tsubota K, Goto E, Shimmura S, Shimazaki J. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology. 1999;106(10):1984-1989. Sharma N, Kaur M, Agarwal T, et al. Treatment of acute ocular chemical burns. Surv Ophthalmol. 2018;63(2):214-235. Behrens A, Doyle JJ, Stern L, et al; Dysfunctional tear syndrome study group. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea. 2006;25:900-907. Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15:575-628. Starr CE, Gupta PK, Farid M, et al; ASCRS Cornea Clinical Committee. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45;669-684.