For years, there were two things Karen Errico would not leave her house without: her house key and a tube of eye drops.

“Because of dry eye disease and vision difficulties, I was using over-the-counter eye drops twenty times a day. I wouldn’t leave the house without that tube because I knew, in twenty minutes, I was going to need eye drops.”

After having LASIK surgery on both eyes and cataract surgery on her left eye in 2001, Karen developed dry eye syndrome, a problem that affected both her comfort level and her vision. “My eyes were just horribly dry and scratchy. They felt irritated,” she says. “To read or use my eyes was a strain, very uncomfortable. It affected my reading and I had constant headaches.”

Following a series of referrals among various ophthalmologists, Karen finally found herself in the hands of a doctor who could help. “I believe my original referral sent me to Dr. Desai as a corneal specialist, thinking that I needed a cornea transplant,” she recalls. “But he made it clear that would be absolutely his last form of treatment and that, fortunately, there were many other things we could try first.”

Cataracts and dry eye disease

Neel R. Desai, MD, a fellowship-trained ophthalmologist and a cornea, cataract, and refractive specialist with The Eye Institute of West Florida, has a very clear protocol for the treatment of dry eye disease. “My philosophy is that it is a medical condition, an inflammatory condition, and that it should not be treated surgically. We have to treat the inflammation and there isn’t a surgical procedure that can do that.”

For Karen, the progression began with her earlier eye surgeries, though the cycle can also be caused, according to Dr. Desai, by an underlying thyroid condition or an autoimmune disorder like rheumatoid arthritis or Sjögren’s syndrome, as well as by environmental conditions or as a side effect of other medications. “These situations incite some inflammation, either within the gland around the eye or on the eye itself, and that inflammation is disruptive to the eye’s normal balance,” the doctor explains.

“When that balance is disrupted, the tears don’t lubricate the eye very well and the eye gets dry. Once the eye gets dry, patients will complain of feeling sand or grit in their eyes, a condition which incites more inflammation, a greater imbalance in the tears, and a very poor quality tear film, leading to more inflammation and irritation. To treat dry eye, we have to break that cycle.”

When a patient requires eye surgery, the procedure itself can often set that cycle into motion, or aggravate a pre-existing condition, according to Robert J. Weinstock, MD, known as “Dr. Rob” by his patients. Also in practice at The Eye Institute of West Florida, Dr. Weinstock is board certified by the American Board of Ophthalmology and fellowship trained in cataract and refractive surgery.

“With all the drops used after cataract surgery and the incisions made on the eye during cataract surgery, pre-existing dry eye disease can cause some post-operative problems,” he stresses. “We always screen our patients before cataract surgery and, if there is a significant amount of dry eye disease, we’ll have Dr. Desai put the patient through a course of therapy.   Once the surface of the eye looks clear and healthy, we proceed with surgery.”

During the surgery itself, Dr. Weinstock notes, he and his fellow surgeons do all they can to prevent further dry eye difficulties by using the most advanced surgical technology. “The good news about the way we do cataract surgery here at The Eye Institute of West Florida is that we use very small incisions, so very few nerves are affected,” he explains. “I’ve designed an entire set of instruments that are smaller than the standard instruments used in cataract surgery.”

The first eye surgeon to successfully remove a cataract through a 1.2 millimeter incision, Dr. Weinstock has been invited to lecture and teach other surgeons from around the world on this safer, less invasive technique for removing cataracts. “Our patients have the advantage of less risk of post-operative dry eye disease because of the smaller wounds. And if someone has pre-existing dry eye disease, it usually doesn’t make it worse.”

Like his colleague, Dr. Desai is also an internationally recognized surgical expert committed to limiting the potential side effects of surgery, but he adds that dry eye disease is always one of his early concerns. “I’m certainly evaluating my patients during that initial consultation. And if they have dry eye disease to begin with, I hold off until we treat it.

“It doesn’t matter how skilled your cataract surgeon is; if you’ve got dry eye disease, your vision is going to be affected because the surface of the eye has to be absolutely smooth in order to get the kind of result everybody wants to achieve.”

A revolutionary innovation

Though Karen had suffered with her dry eye disease for several years by the time she found her way to Dr. Desai, she says she was always determined to keep trying. “It’s important not to just settle for a condition and think that’s all that can be done, because there’s always something new.”

And in her case, that philosophy could not have been more true, though she had to begin with more traditional treatment steps. “Dr. Desai explained to me that it was a process, that the things he was going to try were like building blocks – first this drop, then that one, then stop that drop and add a new one – and that they would all build upon each other for better vision.”

Though she saw some improvement, Karen says it was not enough. “When I was on the steroid drop, my eyes felt better, but that’s not something you can do forever. So when that ended, just like when the antibiotic drop ended, I still had trouble with my dry eyes.”

The last therapy Dr. Desai tried, however, made all the difference.

“They make these eye drops from my own blood,” she marvels. “At first, I pictured putting blood in my eye, but as Dr. Desai explained, they were made from just the serum, which is clear.”

The treatment, known as autologous serum drops, is something the doctor says he has used on patients here in Florida, as well as in his previous practice at The Johns Hopkins Hospital, to successfully treat dry eye disease. “It’s like a perfectly matched eye drop, only for that patient,” he informs. “Basically, once the red blood cells are removed, you end up with a serum that is almost identical in its relative components to a good, healthy tear film.”

Additionally, he says, the serum contains many factors that help control inflammation, help control and prevent infections, and promote healing. “Those are all really, really good things to put on an eye that is dry and has a poor-quality tear film.”

To make the drops, the patient must first have about ten small tubes of blood drawn (less than 40 cc’s) using a tiny butterfly needle. The red blood cells are then spun out of the blood, and it is filtered so that only the serum, or plasma, remains. “I add an antibiotic, and then I send it to our compounding pharmacy, which dilutes it in a balanced salt solution. What starts out as maybe thirty cc’s of fluid yields about one hundred cc’s of these tears.

“The tears go into tiny little dropper bottles that are frozen. Every week, Karen pulls out a frozen bottle, lets it thaw, and uses it as if it were regular artificial tears.”

Because the drops contain no preservatives, a new bottle must be started every week. “It’s sort of a fresh product,” the doctor says, “almost like buying vegetables at the grocery store. You can’t keep it.”

That natural aspect, according to Karen, is one of the most appealing qualities of the treatment. “I embrace the natural,” she explains, “and this is not chemically made. There are no artificial ingredients. It’s something my body recognizes, and that drop on the surface of my eye is saying, Okay, here’s some good health. This is the right balance for you .”

And after using the serum eye drops for a couple of months, Karen is thrilled to report a significant improvement. “I love them,” she says. “First of all, because you keep them in the refrigerator, it’s a cool drop on the eye, which is refreshing, like having a sip of ice water.

“Even better than the refreshing feeling, though, is the fact that, since I’m using the serum eye drops three times a day, I have cut my over-the-counter eye drop use to four times on a really good day and about eight times otherwise. That’s a huge improvement from twenty,” she stresses.

Recently selected by Alcon Laboratories as a Dry Eye Center of Excellence for the west-central Florida region, The Eye Institute of West Florida is one of the few places in the country to offer this innovative therapy to its patients.

“I’ve seen patients who had exhausted every other commercially available and prescribable treatment, and when we put them on this autologous serum eye drop, they were just dramatically better,” says Dr. Desai. The patient simply comes to The Eye Institute a few times during the year to have the drop made up.

“The beauty of autologous serum eye drops,” he continues, “is that they’re custom-made for the patient, for their body, and for their condition, and they are preservative-free. A lot of eye drops that are available over the counter contain preservatives that incite a lot of inflammation. These preservatives can actually accumulate on the surface of the eye and cause harm to the surface cells.”

If not for the organic aspect of the treatment, Karen reveals, she might not have agreed to try the serum eye drops in the first place. “My sister is currently dealing with sudden, irreversible blindness due to a rare side effect of her rheumatoid arthritis medication. The fact that these drops were made from my own blood and were all-natural…well, that was the only way I could have done it.”

To others suffering from dry eye disease, she urges them not to lose hope. “Keep trying,” she says. “Sometimes, you just have to see a different doctor. And with this treatment, there’s really nothing to lose. You’re not going to have a bad reaction to your own blood.

“I hope Dr. Desai can use this to help others, because it’s been just fabulous for me.”

FHCN-Brenda Klettke