Eyeworld

56 | EYEWORLD | SUMMER 2024 C ORNEA Contact Perez: vperez4@med.miami.edu Pflugfelder: stevenp@bcm.edu Sabater: asabater@med.miami.edu References 1. Soifer M, et al. A multicenter report of the use of plasma rich in growth factors (PRGF) for the treatment of patients with ocular surface diseases in North Ameri- ca. Ocul Surf. 2022;25:40–48. 2. Wang M, et al. Initial experiences using plasma rich in growth factors to treat keratoneuralgia. Front Med. 2022;9:946828. Relevant disclosures Perez: None Pflugfelder: None Sabater: Ocubio developed a kit to prepare them for their use in ophthalmology. Dr. Pflugfelder: It has biologically active constituents including high levels of growth factors. Dr. Sabater: Platelet-derived products con- tain a variety of factors that play a role in tissue repair and regeneration, such as growth factors, cytokines, chemokines, or fibrinogen, among others. In addition, they have a potent antino- ciceptive effect, possibly thanks to peripheral endocannabinoid-mediated mechanisms. These combined properties make platelet-derived products unique when compared to other phar- maceutical treatments. EyeWorld: What are the special consider- ations for recommending/prescribing these products for your patients? Dr. Pflugfelder: Platelet-derived products have the potential to restore comfort, func- tion, and quality vision to patients with severe keratoconjunctivitis sicca. They can also heal sight-threatening persistent corneal epithelial defects and sterile corneal ulcers. Current obsta- cles to widespread use are availability and cost. Most of the centers that prepare these products are academic centers, although an increasing number of community practices are adopting them. Dr. Sabater: It is important to evaluate the patient's medical history and any existing conditions that may affect the safety or efficacy of platelet-derived products. We should provide detailed information to the patients about the procedure, potential risks, benefits, and expect- ed outcomes. Additionally, these products have refrigeration requirements that are critical to preserve their stability and sterility. Therefore, we should make sure that the patient will be able to follow these requirements. EyeWorld: What has been your expe- rience with prescribing platelet-derived products? Dr. Perez: I think they're becoming more popular. As ophthalmologists, we know that they work. The main issue is access. Not ev- eryone has a facility where the patient can go to get blood drawn, etc. It's a process. Then of course, it's not easy for the patient. The patient will need therapy for at least 3 months, but they work and patients like them. Dr. Sabater: I have been prescribing plate- let-derived products for more than 10 years to patients with moderate and severe dry eye disease with good results regarding signs and symptom improvement. I prescribe platelet-de- rived products every week. At Bascom Palmer Eye Institute, we treat more than 2,000 patients yearly with these products. EyeWorld: Are there any pros/cons/best practices for their use? Dr. Perez: It was originally thought that patients with autoimmune diseases don't have good plasma. We've done a study where we looked at our patients with autoimmune diseas- es, and we didn't see anything; the safety was very good. Patients with poor liver and kidney function and systemic infections are contraindi- cated for the use of autologous blood products. Dr. Pflugfelder: Pro: It is highly effective. Con: It is not covered by insurance, so it is mod- erately costly. Dr. Sabater: Platelet-derived products are very well tolerated by most patients, compared to other drugs in the market. Additionally, they have a relatively high rate of efficacy in patients with dry eye disease. However, they also have some drawbacks. For example, (1) there is variability in quality due to changes in plate- let counts and growth factor content that are influenced by the patient's age and biological conditions; (2) patients are required to get their blood drawn every few months; (3) they are not FDA approved; (4) they are not covered by insurance companies; and (5) they have strict refrigeration requirements. EyeWorld: What do you think is the future of these products? Dr. Perez: Future ideas include can we use blood products from someone else, other healthy individuals? Most of these products as of now are autologous. This is a direction I'm excited about. Then, of course, identifying other indications for plasma and platelet products and identifying who are the responders and who are the non-responders. Dr. Pflugfelder: I think they will be endur- ing but won't be used widely until they become more available to patients. Dr. Sabater: I hope that in the future we can have access to a standardized FDA-ap- proved allogeneic platelet-derived drug product with no refrigeration requirements. I think new innovations that improve the quality, stability, and accessibility will increase their adoption. continued from page 55

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