Contact Lens Practice Pearls
Managing Logistics with Autologous Serum Eye Drops
BY GREGORY J. NIXON, OD, FAAO
Autologous serum eye drops have garnered increased attention regarding their potential benefits for dry eye patients. Studies have shown that their use can provide both objective and subjective improvements for patients suffering from severe dry eye (Jirsova et al, 2013; Celebi et al, 2014). The rationale is that eye drops created from a patient’s own serum would contain similar growth factors, fibronectin, and vitamins to support and maintain the corneal and conjunctival epithelium (Geerling et al, 2004).
Since these drops are made from living components of the blood, they must be obtained, formulated, transported, handled, and managed properly to avoid contamination. These are additional challenges that you should be prepared for when considering autologous serum eye drops for dry eye patients.
Obtaining the Serum Samples
Autologous serum eye drops are typically formulated only by a compounding pharmacy, so you will likely have to research the availability of such a facility in your area.
But first, you need to write a laboratory order for the blood draw itself. Typically, the instructions are to draw 40ml of blood, which should be set aside for 30 minutes and then centrifuged at 5,600 rpm for 15 minutes to separate out the serum. Afterward, the serum should be tested for hemolysis with a desired H-index value of <1. Once this is confirmed, the serum tubes must then be stored on ice for immediate transport to the compounding pharmacy.
Formulating Serum Eye Drops
To avoid contamination, compounding pharmacies will either formulate the drops immediately on their arrival, or they will freeze them for formulation within one to three business days. Compounding pharmacies are typically instructed to provide either 20% or 50% solution by dilution with preservative-free saline.
The serum eye drops are dispensed in 3ml dropper bottles that must be kept frozen until ready for use. My local pharmacy provides 50 frozen 3ml dropper bottles (typically filled with only 2ml of drops) with each blood draw. They recommend using all of the frozen product within 90 days. This is done by thawing and refrigerating individual bottles to be used for drop instillation every two to four hours daily. Once thawed, each dropper bottle should be used within 48 hours or discarded.
Currently, there is no insurance coverage for autologous serum eye drops. Patients should expect to pay an approximate $20 lab fee per blood draw and from $135 to $250 in pharmacy costs for a 90-day supply of drops. Patients who respond well to the therapy and continue to use serum eye drops year round can pay upward of $1,000 annually.
Weighing the Options
Because of the inconvenience and costs, autologous serum drops are often reserved for patients who have Sjögren’s syndrome or similar cases of severe dry eye. However, you could also consider them for patients who are unable to obtain symptomatic relief from other forms of dry eye treatment.
Autologous serum eye drops should not be instilled while wearing contact lenses. However, their use might provide enough relief for severe dry eye patients to return to part-time intermittent contact lens wear for the times when they need their lenses the most. CLS
For references, please visit www.clspectrum.com/references and click on document #224.
Dr. Nixon is a professor of clinical optometry and director of extern programs at The Ohio State University College of Optometry. He is also in a group private practice in Westerville, Ohio. He is on the Allergan Academic Advisory Board, the B+L Advisory Board, the Alcon Glaucoma Advisory Board, and the Alcon Speakers Bureau. You can reach him at firstname.lastname@example.org.