Article

CLINICAL: DRY EYE

MAIL-ORDER OPTIONS

New delivery options can remove barriers to compounded drugs

James Steidl/ 3Dmask/stock.adobe.com

Today, almost anything can be purchased with the click of a button: groceries, school supplies, medical devices and even compounded pharmaceuticals for dry eye disease (DED), the topic of this month’s column. That’s right! New avenues have emerged recently, allowing for the mail order of special tears and prescription drugs.

Here, I discuss these offerings.

VITAL TEARS

This is an autologous tear online subscription service through the doctor’s office (vitaltears.org ). Once the doctor submits the prescription and order, the patient is sent for a blood draw from a designated local lab. (See “Prescribing Autologous Serum,” below.) The blood is then shipped for serum processing, and the product is sent directly to the patient’s home. The payment is coordinated with the patient for purchase of the serum tear product.

Eye care providers have relied on autologous tear preparations for their moderate to severe DED patients, as the treatment offers good results. That said, barriers, such as lack of patient transportation to labs and compounding pharmacies, have hindered prescriptions, making Vital Tears a welcomed service.

PRESCRIBING AUTOLOGOUS SERUM

The greatest limiting factor for prescribing an autologous tear is often the “how to” for the doctor. The prescription should include the generic name of the active ingredient, such as n-acetylcysteine or methylprednisolone, as well as the strength or dosage (for example, milligrams or percentage).

For autologous serum tears, a percentage per blood sample is prescribed (for example, 20%). The prescription should also include the dosage form, such as ophthalmic solution or transdermal gel, and quantity of medication. Finally, the patient’s directions for use and number of refills concludes the script.

IMPRIMIS PHARMACEUTICALS

This company (imprimisrx.com ) provides compounded cyclosporine, 0.1%/chondroitin sulfate ophthalmic emulsion, a drug often used to increase tear production (the percentage of cyclosporine differs from other formulations commercially available). Imprimis offers other products, such as non-preserved glaucoma drugs, compounded with components often used to treat DED. Doctors submit prescriptions, and orders are shipped to the patient’s residence.

OCULAR SCIENCE

This company (ocularscience.com ) created Genesis tears, which provide amniotic cytokine extract (ACE) for DED treatment. This is beneficial, as cytokines housed within amniotic membranes are highly susceptible to loss during tissue processing for wound healing. ACE has properties that potentiate healing in the cornea and conjunctiva of DED patients and modulate the inflammatory response. The drops remain frozen until used by the patient and are instilled twice daily.

The eye care provider submits the prescription to the company for fulfillment, and the product is then shipped directly to the patient.

REGENERATIVE NETWORK INTERNATIONAL

This company (rni.solutions ) offers Regener-Eyes, a sterile, acellular biologic moisturizing drop made from inflammatory cytokines and growth factors. The drop works as a natural biologic. Depending on the severity of the patient’s condition, the drop may be prescribed once or twice per day. The eye care provider submits the prescription to the company for fulfillment. The company, in turn, contacts the patient regarding payment and delivery preferences.

ANOTHER APPROACH

New delivery routes of compounded products have removed barriers to these important drugs, enabling the patients who need them to achieve relief of their symptoms. OM