Opthalmology

MYOPIA

In recent years, myopia (otherwise known as nearsightedness) has become a growing concern, affecting up to 50% of the adult population in the United States.1 In children, the prevalence of myopia is progressing, rising from 25% to 42% between 1971 and 1999.1 Some research has shown that “kids who are exposed to less outdoor daylight in early childhood are more likely to become myopic.”2 Those with a high degree of myopia are at an increased risk of developing more serious eye-related conditions like cataracts and glaucoma.3

While the cause of myopia is not exactly known, it occurs when the eye grows too long, thus changing the focus of images on the retina to just in front of the retina (Figure 1, 2), making it difficult to focus on objects farther away.3 Myopia is measured in diopters (D), which indicate the lens strength required for correction; high myopia is considered -5.0 to -6.0 diopters or greater.3

ATROPINE

Some of the most common treatments for myopia consist of corrective glasses and contact lenses, or medical procedures like LASIK and laser surgeries. However, these options may be inconvenient, uncomfortable, or even come with unwanted side effects, especially for those who develop myopia at a young age.

Alternatively, recent studies on low-dose atropine as a treatment option have shown effectiveness in slowing the progression of myopia before severe correction is needed later in life. One study states that super-diluted atropine (0.01% concentration) reduced myopic progression by 25%.4 If myopia has already progressed to a certain point, kids treated with low-dose atropine may still need glasses; however, the rate of progression will significantly decrease.2

Studies of Atropine in the Treatment of Myopia (specifically the ATOM2 trial) have shown the effectiveness of low-dose atropine (0.01%) in Asian children; additional studies show that it can also work in other ethnic groups.5 While atropine is already being used medically to dilate the pupil or treat lazy eye, its use in slowing the progression of childhood myopia is becoming more mainstream in the US as ophthalmologists learn of low-dose atropine’s benefits and risks.

Benefits of low-dose atropine include a low occurrence of ocular and systemic side effects, particularly in children, who are the primary candidates for atropine therapy. It could also potentially circumvent the discomfort or unwanted side effects of corrective lenses and laser surgeries. Some risks of atropine in higher doses include tachycardia, altered mental status, dry mouth, urinary retention, constipation, flushing of skin; however, none of these were reported among children using low-dose atropine (0.01%). There is also the potential for the long-term development of an allergy to treatment.5

Eye growth is most rapid during childhood, so it is imperative to get “a diagnosis as early as possible and [use] atropine consistently through the eye’s growth years.”2

If you want to know more about low-dose atropine for slowing the progression of childhood myopia, get in touch with our pharmacists at 904-880-1660

References:

Pineles SL. Kraker RT. Et.al., Atropine for the Prevention of Myopia Progression in Children. American Academy of Ophthalmology. 2017; Vol. 124, Number 12.
Kate Rauch. (2017, August 31). Low-Dose Atropine for Kids with Myopia. American Academy of Ophthamology. Retrieved June 27, 2018 from https://www.aao.org/eye-health/news/low-dose-atropine-kids-with-myopia
Facts About Myopia. (2017, October). National Eye Institute. Retrieved June 27, 2018 from https://nei.nih.gov/health/errors/myopia
Diaz-Llopis M., Pinazo-Duran MD. Superdiluted atropine at 0.01% reduces progression in children and adolescents. A 5-year study of safety and effectivemess. Arch Soc Esp Oftalmol. 2018; 93:182-185.
Nicola Parry, Contributing Writer, interviewing K. David Epley, MD, R. Michael Siatkowski, MD, and Donald Tan, MD, FRCS, FRCOphth. (2016, December). How to Use Low-Dose Atropine to Slow Myopic Progression in Kids. American Academy of Ophthamology. Retrieved June 21, 2018 from https://www.aao.org/eyenet/article/how-to-use-low-dose-atropine-to-slow-myopic-progre

Introducing ASEDs: dry eye drops derived from your own blood

If you are one of those patients who have failed to find long-lasting relief, have you considered autologous serum eye drops (ASED) or AST Drops (Autologous Serum Drops).

The use of autologous serum eye drops dates back to the 1980’s when they were first used to treat chemical burns of the eye. ASEDs are made from serum -- a component of your blood that is combined with sterile saline to create a lubricating fluid rich in certain nutrients and growth factors that may be missing in very dry eyes. The term autologous means that it comes from your own body.

What are autologous serum eye drops?
ASEDs are highly effective, well-tolerated and have ingredients that artificial tears just can’t replicate, but which promote healthy growth and healing of the ocular surface (called the cornea). Some of the ingredients in ASEDs that are found in natural tears, but which aren’t available in artificial tears include antibodies, albumin, Vitamin A, and special growth factors important for healthy eyes known as epidermal growth factors.

Do autologous serum eye drops work?
In our patients with moderate to severe dry eye disease, we have found that ASEDs often help their eyes feel better, see better and, in persons with damaged or operated corneas, heal better. A number of theories have been floated as to why ASEDs help dry eye patients who’ve failed to improve significantly with other therapies, the truth is that no one is exactly sure how the drops work. We believe it may have something to do with the fact that eye drops made from your own blood contain a lot of albumins (a natural protein also found in eggs) which creates a higher quality, protective tear film for the corneal epithelial cells (surface cells).

How are eye drops made from my own blood cells?
The process for making lubricating eye drops via your own blood collection is straight forward and convenient. A very small amount of your blood is drawn at our office by a professional phlebotomist using sterile technique and strict quality controls. This takes about 15 minutes and doesn’t require fasting. The blood is then placed into a centrifuge and separated into its components. The serum is passed thru a special filter for bacterial sterilization and clarification. Aseptic technique in a ISO 5 Biological Safety Cabinet (BSC) is used to produce a finished product by diluting with a sterile, preservative-free solution, to produce a tear substitute that is specific to the patient, and contains many important growth factors and nutrients normally found in patient own healthy tears. Since the blood and tears have an almost identical salinity and pH, there is no issue of burning or stinging upon instillation. The prepared eye drops are placed in the freezer to maintain optimal freshness and retard the growth of harmful microorganisms for up to 6 months (based on scientific studies). We instruct our patients to thaw one vial at a time in their refrigerator for daily use. A vial should last for several days if the eye drops are applied four times daily. Because the eye drops are preservative-free, once opened, a thawed vial should be used quickly.

How effective are autologous serum eye drops?
ASEDs have shown to be effective in treating moderate to severe dry eye over the 20 years since its introduction and has had few known adverse events. Serum drops have been used to treat a wide range of ocular surface diseases: from severe dry eye syndrome caused by rheumatoid arthritis, Sjogren's syndrome, keratitis, or keratoconjunctivitis sicca, to moderate temporary dry eye symptoms following LASIK surgery. Because these eye drops are derived from the patient's own blood as opposed to that of blood donors, there is no risk of eye drop rejection (known as graft versus host disease).
Because serum drops are used to treat a range of ocular surface disorders, there have been few randomized, controlled studies performed using many subjects having one specific diagnosis. What's more, since these drops are custom made from patient's own tears and not manufactured, no clinical trials have been possible. As such, this treatment does not currently have FDA approval. Nonetheless, specialty ophthalmology groups such as the American Society of Cataract and Refractive Surgery, the Tear Film and Ocular Surface Society, and the International Task Force on Dry Eye all recommend ASEDs to treat moderate to severe dry eye based on their members’ success in treating dry eye symptoms with ASEDs.

At WELLHealth Rx for our local patients, we simplify the process by doing the blood draws and preparing the eye drops on-site so that our patients can get everything done at one location. Many of our dry eye patients who've had limited relief from other treatment modalities have had life-changing symptom improvement from serum drops and feel that keeping their eyes healthy is a worthwhile investment.

Disclaimer –
No compounded medication is reviewed by the FDA for safety/efficacy. WELLHealth Rx is a licensed compounding pharmacy that only engages in compounding in
response to a physician's prescription. A written prescription from a licensed physician is required for compounded medication. The information on the site is general in nature and is only intended for use as an educational tool. You should consult your physician or a WELLHealth Rx pharmacist if you have any specific questions relating to the diagnosis and treatment of any health problems. Information and statements about products and health conditions have not been evaluated by the Food and Drugs Administration (FDA), nor has the FDA approved the products to diagnose, cure or prevent disease. Office use/hospital use of compounded medications are not to be billed to Medicaid or Medicare. Such billings may be in violation of federal law.