Ophthalmologist's Guide to Platelet-Rich Plasma

Our eyes help us make sense of our world. Yet many people take their vision for granted – until they experience something that affects their visual acuity.

As an ophthalmologist, you have a deep appreciation for eye health and the numerous conditions that can affect it. But you’ve also likely experienced frustration when your patients’ condition(s) don’t respond to conventional therapy, leaving them with little hope for improvement.

Platelet-rich plasma (PRP) therapy is a revolutionary tool that can renew your patients’ sense of hope. Below you’ll find examples of how ophthalmologists can benefit by implementing PRP therapy in their practice.

Evidence-Based PRP Benefits in Ophthalmology

1. PRP May Help Treat Dry Eye Disease

Dry eye disease (DED) is a common condition that affects between 5% to 50% of Americans, though it can be as high as 75% among adults over the age of 40.¹ Currently, the first line therapy for DED are artificial tears, which reduce symptoms by moistening the ocular surface. But artificial tears don’t target the underlying causes of DED. They also need to be applied frequently, and they may lose efficacy over time. Topical corticosteroids and other anti-inflammatory agents may also be used for more severe cases.

Autologous serum has also been raised as a possible alternative approach. However, several comparative studies found that autologous serum had no significant advantage over artificial tears in terms of tear film stability, tear-film break-up time, Schirmer’s test, or fluorescein staining.^2,3 Autologous serum is also poor in growth factors, which appear to be a key factor in treating DED.

So, can PRP help treat DED?

A publication by Alio and colleagues in 2017 reported the findings from a prospective, interventional, non-randomized study involving 368 patients with moderate to severe DED. Two hundred thirty-two patients (63%) had evaporative DED, while 136 had aqueous deficient DED (ADDED). After being treated with PRP, 322 patients (87.5%) reported improvements in their symptoms. What was even more remarkable was that 237 (64.4%) of the treated patients only received one round of PRP (6 weeks consecutively). The huge benefits seen in this study show that autologous PRP treatments can be an attractive and effective option for moderate to severe DED.⁴

2. PRP May Promote Healing of Corneal Ulcers

Corneal ulcers are an ocular emergency with vision-threatening potential. If left untreated, the ulcers can lead to endophthalmitis and even loss of the eye.⁵

Treatment of corneal ulcers depends on the cause. First line treatments for bacterial keratitis and corneal ulcers consist of topical antibiotics, such as ciprofloxacin or ofloxacin. Performing a culture of the ulcer is recommended to minimize the development of antibiotic resistance. Systemic antibiotics and adjuvant corticosteroids may be necessary in some cases. Corneal ulcers caused by herpes simplex virus (HSV) and fungal infections should be treated using antiviral and antifungal therapies, respectively.

But even with treatment, some patients may suffer from complications that include corneal scarring, glaucoma, cataracts, vision loss, and posterior synechiae. Some experts think PRP could help, thanks to its rich supply of growth factors that mediate corneal wound healing.

One study tested this hypothesis on 38 patients with dormant corneal ulcers. Patients were divided into two groups: group 1 (26 eyes) received topical eye drops of autologous PRP, and group 2 (14 eyes) was treated surgically with a solid clot of autologous PRP placed under an amniotic membrane transplantation to seal an impending or existing corneal perforation.⁶

The results from this study were astounding. In group 1, 13 (50%) eyes healed, and 11 (42%) showed significant improvements. No patient in this group experienced a recurrence during the follow-up period of 6.3±4.2 months. Vision also improved up to 12 lines.

In group 2, 10 (71%) healed and 4 (29%) improved significantly. They also had no recurrences during the follow-up period of 11.1±3.2 months. Many patients in this group also had vision improvements, up to 11 lines in the best case.

Similarly, a case study published by Rechichi and colleagues documented the treatment of a patient with a persistent wide corneal ulcer and severe paracentral corneal thinning. The patient had been treated with artificial tears, antibiotics, and therapeutic contact lenses with little success. However, after just 15 days of administering PRP every 2 hours, the patient achieved complete resolution of the ulcer with regrowth of the epithelium and a reduction in corneal opacity.⁷

3. PRP May Improve Symptoms of Ocular Surface Syndrome Post Laser In Situ Keratomileusis (LASIK)

LASIK is a popular corneal refractive surgery known for its outstanding safety and effectiveness. Still, no surgery is without risks, and LASIK is no exception. Nearly all patients experience temporary signs and symptoms of tear dysfunction after the procedure, though some may develop chronic ocular surface syndrome (OSS).

Post-LASIK OSS describes a spectrum of symptoms, which include:⁸

• Dry eye disease
• Persistent neurotrophic epitheliopathy
• Tear film instability
• True aqueous tear deficiency
• Decreased corrected distance visual acuity
• Decreased visual quality
• Neuropathic pain states

Autologous blood derivatives like PRP may be a powerful therapy for patients with post-LASIK OSS. In one clinical trial, 156 eyes of 80 affected patients were treated with PRP 6 times a day for 6 weeks. By the end of the trial, 68 (85%) patients reported improvements in their symptoms, while only 12 (15%) patients experienced no improvements.⁹

Additionally, 104 (89.6%) eyes demonstrated improvements by at least 1 point in the modified Oxford scale or in at least one quadrant to total disappearance in positive corneal fluorescein staining. Three eyes also presented severe punctate keratitis at baseline and were all completely healed after 6 weeks of treatment.

PRP Therapy Offers Hope to Ophthalmology Patients

Because we rely so heavily on our vision, experiencing eye problems can be disruptive and traumatic. Unfortunately, many conventional treatments don’t address the underlying issue(s), resulting in only temporary relief, if at all.

But PRP therapy can offer your patients a renewed sense of hope. As we’ve discussed above, patients treated with PRP may show remarkable improvements despite having no success with previous treatments. And prompt treatment with PRP can affect outcome. This is why we believe all ophthalmology practices should offer PRP therapy.

If you want to provide high quality PRP to your patients, check out our kits and centrifuges in our online store. Our friendly customer service reps are also available to answer any questions. Call us today at 844-377-7787 (DR-PRP-US) .