Can MDG and/or ocular surface inflammation lead to aqueous deficiency?

[Guest]

Dowork123

I am afraid even if we can synthesize a perfect substitute of our natural tears it won't be of use since the mechanical action of spreading the lipid layer over aqueous layer of the tear film needs continous and controlled delivery of lipids onto the lid margins that won't be the case with artificial instillation of tear drops even if it had ALL the components of natural tears including meibum. Such a tear drop would be drained away within minutes through the tear ducts and you would need to keep on instilling artificial tears every 10-15 minutes to be asymptomatic.

FURTHER more an artificial tear drop replicating the exact composition of natural tears would be hopelessly expensive to produce that won't be a feasible solution at all.

This is the reason why Dr. Korb says the incredible role of the meibomian glands can NEVER be substituted by any means let alone artifical tear drops.

For me the only hope is meibomian gland regeneration or tissue engineering to reproduce meibomian glands somehow and then transplant them. I would like to mention that a group of scientists had already reproduced a fully functional lacrimal gland using tissue engineering under laboratory conditions. Sounds fascinating?

Well, from my understanding they can place a salivary gland where your lacrimal gland was. Not sure how good the surgery is, but I know we’re already working on replacing the aqueous portion.

now , for the tear substitute. Everything you said is true. However, all things being equal, if I need to use an artificial tear, I’d rather it be the components of my real tears rather than a polymer. Yes it will be washed away, yes it’s not continuos flow, yes it will not replace our tears. But I’m not asking for that. I just want it to be a better option to artificial tears because artificial tears now, I react to all of them. My hope with a more natural artificial tear is to avoid a chemical reaction to the product. Hence why I only use my blood serum as an eye drop.

[Milo007]

Well, from my understanding they can place a salivary gland where your lacrimal gland was. Not sure how good the surgery is, but I know we’re already working on replacing the aqueous portion.

now , for the tear substitute. Everything you said is true. However, all things being equal, if I need to use an artificial tear, I’d rather it be the components of my real tears rather than a polymer. Yes it will be washed away, yes it’s not continuos flow, yes it will not replace our tears. But I’m not asking for that. I just want it to be a better option to artificial tears because artificial tears now, I react to all of them. My hope with a more natural artificial tear is to avoid a chemical reaction to the product. Hence why I only use my blood serum as an eye drop.

Very rightly said. I agree with your point on the reaction to artificial tears. Indeed I have noticed reaction to the ointment bases when I was on antibiotic ointments for two months. Same is the issue with artificial tear substitutes. I think in this area moisture chamber glasses and/or googles can make a huge difference since for MGD patients it significantly reduces the frequency of instillation of artificial tear drops making the patient less likely to develop an allergy. But for patients with aqueous deficiency I think the frequency of instillations would still be considerably more even while using MCG relative to MGD patients and that's where we need the most close substitute to natural tears to avoid allergy.

But even then I am more hopeful of a lacrimal gland regeneration (that has been achieved successfully recently and is under further trial) and transplant that would be the absolute best choice one can opt for.

Regarding salivary gland transplantation it is quite an efficient procedure and I have read that they use radio surgery to transplant the salivary glands. The results are very promising and patients almost get off artificial tears completely after the surgery. In India in the L. V. Prasad Eye Institute there have been quite a few salivary gland transplantations with great success. But there's one catch - since they are responsive to visual and olfactory stimulus your eyes would water like your tongue would do when you are served a delicious platter of food!

Not bad for a gain right?

Regarding use of blood serum eye drops have you considered the fact that blood serum contains pro inflammatory molecules that can actually cause or exacerbate inflammation?

[Meibum Ian]

Regarding salivary gland transplantation it is quite a efficient procedure and I have read that they use radio surgery to transplant the salivary glands. The results are very promising and patients almost get off artificial tears completely after the surgery. In India in the L. V. Prasad Eye Institute there have been quite a few salivary gland transplantations with great success. But there's one catch - since they are responsive to visual and olfactory stimulus your eyes would water like your tongue would do when you are served a delicious platter of food!

Not bad for a gain right?

So after having the procedure done, I could carry some food around in my pocket and have a sniff of it when my eyes feel dry? Sounds good!

[Meibum Ian]

Regarding use of blood serum eye drops have you considered the fact that blood serum contains pro inflammatory molecules that can actually cause or exacerbate inflammation?

I'm aware of this being an issue for whole blood (as used with fingerprick autologous blood). Wasn't aware it was an issue for spun serum though. Do you know how PRP and autologous serum compare in this aspect?

[quattroboy]

Even the NHS mentions salivary gland transplantation as an option

https://www.nhs.uk/conditions/dry-eyes/treatment/

Not sure whether it's actually been done but I'd be up for it!!!

[Milo007]

So after having the procedure done, I could carry some food around in my pocket and have a sniff of it when my eyes feel dry? Sounds good!

LOL......excellent thinking!

But in practice one can lightly press the the glands to make the glands secrete saliva. But this is usually not needed since salivary glands are active throughout your life!

[Milo007]

I'm aware of this being an issue for whole blood (as used with fingerprick autologous blood). Wasn't aware it was an issue for spun serum though. Do you know how PRP and autologous serum compare in this aspect?

Well I read that article again and there's not much to worry if you don't have systemic inflammation of any kind. When you have systemic inflammatory conditions such as sjogren's syndrome or lupus or rheumatoid arthritis your blood serum contains elevated levels of pro inflammatory cytokines, chemokines, T-cells and other inflammatory mediators. Administering serum drops to the ocular surface in such cases would mean subjecting the ocular surface to more and more inflammatory mediators via serum drop instillations. Hence the use of serum eye drops is contradictory ONLY for patients with systemic inflammatory diseases.

PRP and autologous serum drops are basically the same thing and the only difference is that the latter is mixed with a sterile saline solution to match the osmolality of the ocular surface. PRP on the other hand is just the platelet rich plasma obtained when RBCs are isolated from whole blood via centrifugal action. PRP is one of the raw ingredients of autologous serum drops.

[Guest]

Very rightly said. I agree with your point on the reaction to artificial tears. Indeed I have noticed reaction to the ointment bases when I was on antibiotic ointments for two months. Same is the issue with artificial tear substitutes. I think in this area moisture chamber glasses and/or googles can make a huge difference since for MGD patients it significantly reduces the frequency of instillation of artificial tear drops making the patient less likely to develop an allergy. But for patients with aqueous deficiency I think the frequency of instillations would still be considerably more even while using MCG relative to MGD patients and that's where we need the most close substitute to natural tears to avoid allergy.

But even then I am more hopeful of a lacrimal gland regeneration (that has been achieved successfully recently and is under further trial) and transplant that would be the absolute best choice one can opt for.

Regarding salivary gland transplantation it is quite an efficient procedure and I have read that they use radio surgery to transplant the salivary glands. The results are very promising and patients almost get off artificial tears completely after the surgery. In India in the L. V. Prasad Eye Institute there have been quite a few salivary gland transplantations with great success. But there's one catch - since they are responsive to visual and olfactory stimulus your eyes would water like your tongue would do when you are served a delicious platter of food!

Not bad for a gain right?

Regarding use of blood serum eye drops have you considered the fact that blood serum contains pro inflammatory molecules that can actually cause or exacerbate inflammation?

The molecule I believe you’re speaking about is TGF-B1. It’s found at 5x higher concentration in blood serum than in tears and it’s an inhibitory growth factor. Too large a quantity, could prevent epitheliazation.

So here’s what I’ve discovered. The original study used a low centrufugation speed 500-800rpm for 30 minutes. This resulted is high levels of TGF-B1 so it was diluted to 20% concentration with saline to counter that issue. however, this can be avoided by using a sharp centrifugation 3300-4000rpm for 15-10 mins respectively. When samples were assayed for TGF-B1, it was found that no dilution was required at those speeds.

In addition, a minimum 120 minute clot time and dilution (if preferred) with a balanced salt solution as opposed to saline, supported better cell migration and cell differentiation.

https://www.ncbi.nlm.nih.gov/m/pubmed/15756576/

UIC spins my serum at 4000rpm for 11 mins. I spin mine at home at 3300 for 16 mins. I do not dilute my serum.

[Guest]

Well I read that article again and there's not much to worry if you don't have systemic inflammation of any kind. When you have systemic inflammatory conditions such as sjogren's syndrome or lupus or rheumatoid arthritis your blood serum contains elevated levels of pro inflammatory cytokines, chemokines, T-cells and other inflammatory mediators. Administering serum drops to the ocular surface in such cases would mean subjecting the ocular surface to more and more inflammatory mediators via serum drop instillations. Hence the use of serum eye drops is contradictory ONLY for patients with systemic inflammatory diseases.

PRP and autologous serum drops are basically the same thing and the only difference is that the latter is mixed with a sterile saline solution to match the osmolality of the ocular surface. PRP on the other hand is just the platelet rich plasma obtained when RBCs are isolated from whole blood via centrifugal action. PRP is one of the raw ingredients of autologous serum drops.

Sodium citrate is sometimes used in the prp drops to prevent coagulation. Otherwise, you cannot freeze them or shake them. I have never used PRP before. I’m curious if I would have an issue with the sodium citrate.

[Milo007]

The molecule I believe you’re speaking about is TGF-B1. It’s found at 5x higher concentration in blood serum than in tears and it’s an inhibitory growth factor. Too large a quantity, could prevent epitheliazation.

So here’s what I’ve discovered. The original study used a low centrufugation speed 500-800rpm for 30 minutes. This resulted is high levels of TGF-B1 so it was diluted to 20% concentration with saline to counter that issue. however, this can be avoided by using a sharp centrifugation 3300-4000rpm for 15-10 mins respectively. When samples were assayed for TGF-B1, it was found that no dilution was required at those speeds.

In addition, a minimum 120 minute clot time and dilution (if preferred) with a balanced salt solution as opposed to saline, supported better cell migration and cell differentiation.

https://www.ncbi.nlm.nih.gov/m/pubmed/15756576/

UIC spins my serum at 4000rpm for 11 mins. I spin mine at home at 3300 for 16 mins. I do not dilute my serum.

Great information!

By the way you bought a centrifuge?

[Milo007]

Sodium citrate is sometimes used in the prp drops to prevent coagulation. Otherwise, you cannot freeze them or shake them. I have never used PRP before. I’m curious if I would have an issue with the sodium citrate.

If serum drops are working for you fine I doubt if there's a need to try PRP drops anyway!

[Guest]

Great information!

By the way you bought a centrifuge?

Yep, on amazon for 300 bucks. Bought a tachometer also to make sure it’s spinning correctly.

[Milo007]

Yep, on amazon for 300 bucks. Bought a tachometer also to make sure it’s spinning correctly.

That's pretty geeky and cool!