EyeWorld India March 2019 Issue

70 EWAP PHARMACEUTICALS March 2019 platelet-rich plasma. While with proper equipment clinicians can potentially spin the blood down themselves in the office, this may open a sterilization and safety Pandora’s box, she said. Eyeing the evidence Evidence at this point on the efficacy of biologic products for dry eye tends to be anecdotal, Dr. Jeng pointed out. While there aren’t currently any randomized controlled trials, there are case series available. A Cochrane review 1 showed that there was no definitive evidence to suggest that these agents are better than traditional treatments for dry eye. “But they’re used differently,” Dr. Jeng said. “Generally, this is used for people who have failed many other things, so if you talk to cornea specialists, they will say that it does work in the right patients.” Dr. Gupta took part in a retrospective chart review 2 involving 21 patients who took amniotic cytokine drops twice daily for 30 days to attempt to quell their dry eye disease. Investigators found that patients’ dryness scores after 4 weeks dropped down to 41.4 from 68, and mean corneal staining was down to 3.2 from 7.2, Dr. Gupta reported. Overall, with success such as this and compounding becoming more available, Dr. Gupta expects to see other biologics come out of this category. “I think that anything that we could do to help patients garner insurance coverage or better access to these medications would be a step in the right direction,” she said. EWAP References 1. Pan Q, et al. Autologous serum eye drops for dry eye. Cochrane Database Syst Rev. 2017;2:CD009327. 2. Gupta PK. Clinical outcomes of amniotic cytokine extract in the treatment of dry eye disease. Presented at the 2017 American Academy of Ophthalmology Annual Meeting. Editors’ note: Dr. Gupta has financial interests with Ocular Science. Dr. Jeng has financial interests with TissueTech (Miami, Florida). Contact information Gupta: preeya.gupta@duke.edu Jeng: BJeng@som.umaryland.edu 24-house IOP monitoring – from page 68 when sleeping, and changing the medical or surgical approach to care could lead to stabilizing these spikes over time. These are a couple of scenarios where I can see continuous monitoring leading to an enhancement of outcomes in a subgroup of patients.” Dr. Mosaed agreed. “I think 24-hour IOP monitoring makes sense if a patient’s glaucoma seems to be getting worse despite what is considered controlled intraocular pressure in the office setting. This makes you wonder if he or she is having IOP spikes outside of office hours. Are patients having nocturnal IOP elevation? Do they have decreased perfusion pressure during the nocturnal period or some other explanation for why they would be getting worse? These are patients in whom it would make sense to do a sleep study,” she said. She added that perfusion pressure is an important concept in these patients as well. “A lot of the information that we’re getting from 24-hour IOP studies relates not just to IOP but also to what happens to systemic blood pressure during the nocturnal period as it relates to IOP. Are some of these patients progressing because they have decreased perfusion pressure during the nocturnal or even diurnal periods? So, 24-hour IOP by itself as an isolated measure may not be as relevant as 24-hour perfusion pressure,” Dr. Mosaed said. With regard to the future, Dr. Kahook thinks we are in the middle of a revolution in the surgical management of glaucoma utilizing microinvasive techniques with a favorable risk- benefit profile. “This has pushed surgical intervention into an earlier treatment modality for glaucoma patients, and obtaining more reliable data on adherence problems or lack of therapeutic efficacy from medications might help drive decision-making to earlier surgery with enhanced outcomes,” Dr. Kahook said. EWAP Editors’ note: The physicians have no financial interests related to their comments. Contact information Kahook: malik.kahook@gmail.com Mosaed: smosaed@uci.edu Biologics in the dry – from page 69