Last month, I outlined the biologics that are becoming more prevalent to treat ocular surface disease when traditional therapeutics fail. These therapies are derived from microorganisms, human or animal sources, and I utilize them when a patient hasn’t responded appropriately to conventional treatment. This month, I would like to share how I approach conversations with patients to discuss biologic treatment options.

Autologous Serum Eye Drops

When discussing autologous serum eye drops (ASED), I inform patients they will have their blood drawn to extract serum containing their body’s growth factors to help promote the healing of their corneas. The serum from their blood will be mixed with a predetermined amount of balanced saline solution. The drops will be kept frozen, and each bottle will be thawed out and used for one week. I instruct patients to use the drops at least four to five times a day and to increase the dosage to use all of the drops in the thawed vial if they have additional drops at the end of the week.

Platelet Rich Plasma

This explanation is similar to the one I give with ASED. I tell patients that both ASED and platelet rich plasma (PRP) are products from their blood, and both contain growth factors. However, while ASED does not contain platelets, PRP has two and a half times the number found in whole blood. Those platelets have an abundance of healing factors. I also explain that PRP is not diluted with a balanced saline solution.

Cenegermin

When prescribing cenegermin, I explain the cornea is one of the richest innervated tissues in the body, but the patient's condition has caused a down-regulation of corneal nerves, resulting in neurotropic keratitis. The reduction of nerve impulses results in misinformation traveling from the cornea to the brain, which affects the cornea’s ability to heal itself. Cenegermin is bioidentical to human nerve growth factor, an intense treatment six times a day for eight weeks that will cause regeneration and production of more nerves. After treatment, the cornea will be able to transmit accurate information to the brain and repair itself.

Amniotic Membranes

I start this conversation by telling patients that we are at a stage in their treatment in which we must use a biologic and that I recommend an amniotic membrane to activate the regenerative healing process of their cornea. I will explain that an amniotic membrane is placental tissue harvested from healthy moms undergoing planned C-sections. These women are tested and provide consent in advance. The tissue is harvested and taken to a laboratory where it is tested again for pathogens and, finally, prepared to be used in medicine. I explain this kind of tissue has been used for years, not only in ophthalmic surgery, but also in burn clinics, wound clinics and orthopedic surgeries. This tissue is available to be utilized in our eye clinic right in the exam room without having to undergo surgery.

Repository Corticotropin Gel Injections

Here, I describe the process of using adrenocotrophic hormone to stimulate patients' adrenal glands to release cortisol. The gel is self-injected twice a week to inhibit the inflammatory process that continues to drive their cornea’s non-healing cascade, and the treatment will be a minimum of three months.

These simple conversations give patients a more complete understanding of their treatment plan and help us find the best treatment for them.

Douglas K. Devries, OD has a degree in financial management from the University of Nevada and graduated from Pacific University College of Optometry. He is co-founder and managing partner of Eye Care Associates of Nevada. He is an adjunct clinical professor of optometry at Pacific University and residency program director. He dedicates the majority of his clinical practice to ocular surface disease.