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I was looking up some info on autologous serum and found a response from an opthamologist who apparently thinks that serum drops are junk science. This is old (2009) but seriously, I hope this is not the norm still.
Thread question:
"Curious as to opinions of opthamologists about the efficacy and safety of autologous serum eyes drops to treat chronic dry eye.
Along the same lines, any opinions on the surgical stenosising of the lacrimal puncta in an effort to avoid constantly having to replace plugs that fall out."
Response:
"Autologous serum drops are a hideously expensive and a complicated way to wet the eye. The cases where I have seen these used were with patients whose doctors had exhausted every available commercial drop and were at the end of their rope, due to patient dislike or intolerance for anything else. In these cases, the patients did not need autologous serum drops either, what they needed was a psychiatric consultation.
The drops have to be compounded at a hospital pharmacy, have only a very limited shelf life and require scrupulous preservation by refrigeration. They are expensive.
I have yet to see anyone in more than a decade who really needed this. Maybe severe autoimmune conjunctivopathies with extreme dry eye or post-burn or Stevens-Johnson Syndrome patients merit their use, but those are not common. Unpreserved eye drops with or without methylcellulose thickeners in single-use dropettes are sufficient for most people who have sensitivities to preserved eye drops.
Punctal stenosis is a way to retard evacuation of tears from the eyelids. It also retards evacuation of bacteria and mucus and debris. ("It's awfully dry in this room, I think I'll go down the hall and plug up the toilet.") It works to keep applied drops available to the eye surface a little longer. Of course, if the primary problem is tear-film deficiency, it does nothing to address that problem.
I rarely need to do this procedure. I also almost never put plugs in anymore either. Most people with tear-film deficiency benefit more from treating their root cause of the deficiency, whether it be age-related decrease in basal secretion, blepharitis, rosacea, Demodex, chronic inflammation or whatever else ails them, and augmenting low aqueous secretion with wetting drops.
My $0.02. I know I could make more money doing differently, though."
http://forums.studentdoctor.net/arch.../t-607345.html
Seems like he got chewed out later down in the post but I mean, wow....people with dry eye need "psychiatric evaluation?" Oh, and serum is "hideously expensive?" I think not, when you consider Restasis at $90 a brick and whatever excessive amounts of over-the-counter product plus steroid drops that most of us would be using if we weren't on serum. Does this doc just put his patients on steroid drops for life or something? He doesn't even like plugs.
Not to rile anyone up but I am so glad this doc is not mine and can only hope that there aren't others out there like this gem.
Thread question:
"Curious as to opinions of opthamologists about the efficacy and safety of autologous serum eyes drops to treat chronic dry eye.
Along the same lines, any opinions on the surgical stenosising of the lacrimal puncta in an effort to avoid constantly having to replace plugs that fall out."
Response:
"Autologous serum drops are a hideously expensive and a complicated way to wet the eye. The cases where I have seen these used were with patients whose doctors had exhausted every available commercial drop and were at the end of their rope, due to patient dislike or intolerance for anything else. In these cases, the patients did not need autologous serum drops either, what they needed was a psychiatric consultation.
The drops have to be compounded at a hospital pharmacy, have only a very limited shelf life and require scrupulous preservation by refrigeration. They are expensive.
I have yet to see anyone in more than a decade who really needed this. Maybe severe autoimmune conjunctivopathies with extreme dry eye or post-burn or Stevens-Johnson Syndrome patients merit their use, but those are not common. Unpreserved eye drops with or without methylcellulose thickeners in single-use dropettes are sufficient for most people who have sensitivities to preserved eye drops.
Punctal stenosis is a way to retard evacuation of tears from the eyelids. It also retards evacuation of bacteria and mucus and debris. ("It's awfully dry in this room, I think I'll go down the hall and plug up the toilet.") It works to keep applied drops available to the eye surface a little longer. Of course, if the primary problem is tear-film deficiency, it does nothing to address that problem.
I rarely need to do this procedure. I also almost never put plugs in anymore either. Most people with tear-film deficiency benefit more from treating their root cause of the deficiency, whether it be age-related decrease in basal secretion, blepharitis, rosacea, Demodex, chronic inflammation or whatever else ails them, and augmenting low aqueous secretion with wetting drops.
My $0.02. I know I could make more money doing differently, though."
http://forums.studentdoctor.net/arch.../t-607345.html
Seems like he got chewed out later down in the post but I mean, wow....people with dry eye need "psychiatric evaluation?" Oh, and serum is "hideously expensive?" I think not, when you consider Restasis at $90 a brick and whatever excessive amounts of over-the-counter product plus steroid drops that most of us would be using if we weren't on serum. Does this doc just put his patients on steroid drops for life or something? He doesn't even like plugs.
Not to rile anyone up but I am so glad this doc is not mine and can only hope that there aren't others out there like this gem.
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