Over a decade ago, as a team ophthalmologist for various sports organizations, including the Memphis Grizzlies, I was exposed to the latest trends through athletes. These players often asked me medical questions, ranging from whether marijuana could help with glaucoma (before its legalization for recreational use) to emerging treatments in other fields. During preseason exams in 2011, I overheard players discussing Kobe Bryant’s trip to Germany for a procedure to rejuvenate his knees.1 Intrigued—especially considering my own knee issues from years of playing sports—I spoke with a player whose family was in medicine. He explained that Kobe had undergone a procedure called Orthokine, which involved injecting a serum derived from his own blood into his knees. After contacting a German physician, I learned they were successfully using platelet-rich plasma (PRP) injections for knee joint regeneration.
At the time, I was already using autologous serum (AS) combined with intense pulsed light (IPL) treatments for patients with severe dry eye disease (DED), particularly those with corneal defects.2 The concept of using autologous blood serum to treat eye disease dates back decades. In 1984, Fox and colleagues published a paper on the beneficial effects of artificial tears made with autologous serum for patients with keratoconjunctivitis sicca.3 Tsubota and colleagues later championed AS for treating dry eye in Sjögren’s syndrome.4-6 However, in orthopedics, PRP—which is richer in anti-inflammatory mediators and growth factors than AS—was yielding superior results.
Figure 1. Centrifuged blood illustrating the layers used for plasma-rich platelet (PRP) therapy in glaucoma. The bottom layer contains red blood cells, the middle “Buffy coat” layer contains the highest concentration of nerve growth factors and anti-inflammatory mediators, and the top yellow serum layer contains a lower concentration. Therapeutic PRP is derived from the Buffy coat to maximize nerve growth factor and anti-inflammatory content, whereas diluted serum preparations contain lower levels of these mediators and are less effective for regenerative or anti-inflammatory purposes.
Developing a Stable Formulation
Inspired, I began experimenting with PRP eye drops as an alternative to AS. I quickly realized that PRP’s tendency to clot posed challenges not encountered in orthopedics, where PRP is injected immediately after preparation. In eye care, we needed to store PRP for long-term use as eye drops. Freezing pure PRP caused clotting, certain preservatives triggered clotting, and without additives, bacterial growth was a risk. While clinicians diluted AS with balanced salt solution and froze it to avoid these issues, diluting PRP would negate its benefits. After testing various solutions, I developed a formulation that preserved PRP in the refrigerator, preventing clotting and bacterial growth while maintaining its efficacy. This formulation constituted less than 10% of the final solution (Figure 1). Testing confirmed that the PRP solution retained positive mediators over time, offering a viable alternative to AS drops.
Comparing PRP to AS drops in DED patients revealed significant improvements in signs and symptoms with PRP, as presented at the 2018 International Society of Ophthalmological and Therapeutics (ISOPT) meeting.7 I evaluated superficial corneal staining and Ocular Surface Disease Index (OSDI) scores. My primary interest, however, was whether PRP’s 20-fold higher nerve growth factor (NGF) content could alleviate pain. Many eye doctors had begun using AS drops for neuropathic pain, hypothesizing that inflamed tears damaged corneal nerves and other ocular structures. Corneal confocal microscopy (CCM) studies later confirmed that DED negatively impacts corneal nerves.
As I applied PRP drops to DED patients with neuropathic pain, PRP extraction technologies improved. A simple centrifuge separates serum from red blood cells (RBCs), but manually extracting PRP from the buffy coat (the layer between serum and RBCs) using a needle and syringe is variable and yields low PRP. As demand for PRP grew in fields like orthopedics, plastic surgery, and neurosurgery, companies developed technologies to increase PRP yield compared to manual methods. By continually upgrading our clinic’s PRP technology, I improved both yield and patient outcomes.
A growing number of DED patients report pain and allodynia, often dismissed by some doctors as psychological because symptoms outweigh clinical signs. However, CCM demonstrates that even mild DED can cause significant corneal nerve damage, correlating with pain levels. One effective treatment is NGF, delivered via PRP or the prescription drug Oxervate (cenegermin-bkbj; Dompé). Using CCM, I’ve shown that NGF visibly regenerates corneal nerves, with patients reporting symptom improvement.
Figure 2. Steps in plasma-rich platelet (PRP) therapy for ocular surface support. (A) Blood is drawn from the patient’s arm. (B) The sample is centrifuged to separate red blood cells, the Buffy coat (high concentration of nerve growth factors and anti-inflammatory mediators), and serum. (C) PRP is micro-needled into the skin surrounding the meibomian and lacrimal glands to enhance gland function and promote ocular surface health.
Safer Alternatives to Direct Gland Injection
Our clinic now uses PRP as an injectable for the lacrimal and meibomian glands. Studies have shown that injecting PRP into the lacrimal gland improves DED signs and symptoms.8 I’ve taken a different approach, which was inspired by our aesthetic clinic’s use of microneedling PRP into the skin to stimulate collagen and elastin production for improved facial texture, or into the scalp for hair growth (Figure 2). I now microneedle PRP into the skin around the meibomian and lacrimal glands to enhance their function. This may be safer than direct gland injections, which risk scarring, as microneedling allows precise depth control and uses smaller-gauge needles. PRP contains insulin-like growth factor-1 (IGF-1), which stimulates cell proliferation and improves gland function.
PRP injections and drops have improved meibomian gland structure, as measured by meibography, with a study on these results currently in progress. Unlike AS, which functions more as an artificial tear, PRP is widely used across medical specialties. Ophthalmologists should follow suit, using PRP as a therapeutic drop.
Paradigm shifts in ophthalmology, like my earlier adoption of IPL and low-level light therapy (LLLT) for DED,9 take time. When discouraged by slow adoption, I recall Dr. James Lind, who discovered citrus as a cure for scurvy in the 18th century. It took the Royal Navy 50 years to implement his findings after his book A Treatise on the Scurvy was published.10
Conclusion
The journey of integrating platelet-rich plasma (PRP) into ophthalmology underscores the unexpected origins of medical innovation. A casual conversation with basketball players about Kobe Bryant’s knee treatment in 2011 sparked a paradigm shift in my approach to dry eye disease and neuropathic pain. This serendipitous exchange, rooted in the vibrant world of sports, led to the adaptation of PRP—a therapy born in orthopedics—into a transformative tool for eye care. Just as Dr. James Lind’s discovery of citrus for scurvy took decades to gain traction, the adoption of PRP in ophthalmology may face similar hurdles. Yet, this experience reminds us that groundbreaking ideas can emerge from diverse arenas, even a locker room buzzing with athletes, inspiring eye doctors to push the boundaries of healing and improve patients’ lives. GP
References
1. McMenamin D. Kobe in Germany for PRP treatment. ESPN. October 4, 2013. Accessed October 1, 2025. https://www.espn.com/los-angeles/nba/story/_/id/9765198/kobe-bryant-los-angeles-lakers-leaves-country-medical-procedure.
2. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015;33(1):41-46. doi:10.1089/pho.2014.3819
3. Fox RI, Chan R, Michelson JB, Belmont JB, Michelson PE. Beneficial effect of artificial tears made with autologous serum in patients with keratoconjunctivitis sicca. Arthritis Rheum. 1984;27(4):459-461. doi:10.1002/art.1780270415
4. Tsubota K, Goto E, Shimmura S, Shimazaki J. Treatment of persistent corneal epithelial defect by autologous serum application. Ophthalmology. 1999;106(10):1984-1989. doi:10.1016/S0161-6420(99)90412-8
5. Tsubota K, Goto E, Fujita H, et al. Treatment of dry eye by autologous serum application in Sjögren’s syndrome. Br J Ophthalmol. 1999;83(4):390-395. doi:10.1136/bjo.83.4.390
6. Wróbel-Dudzinska D, Przekora A, Kazimierczak P, Cwiklinska-Haszcz A, Kosior-Jarecka E, Zarnowski T. The comparison between the composition of 100% autologous serum and 100% platelet-rich plasma eye drops and their impact on the treatment effectiveness of dry eye disease in primary Sjogren syndrome. J Clin Med. 2023;12(9):3126. doi:10.3390/jcm12093126
7. Toyos R, Toyos M. IPL therapy and PRP eye drops for dry eye disease. Presented at: International Symposium on Ocular Pharmacology and Therapeutics (ISOPT) annual meeting; Tel Aviv, Israel; March 1-3, 2018. https://www.youtube.com/watch?v=Tw3ksFY2IvY.
8. Mohammed MA, Allam IY, Shaheen MS, Lazreg S, Doheim MF. Lacrimal gland injection of platelet rich plasma for treatment of severe dry eye: a comparative clinical study. BMC Ophthalmol. 2022;22(1):343. doi:10.1186/s12886-022-02554-0
9. Toyos R. The effects of a red light technology on dry eye due to meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2017;68(6):2236.
10. Lind J. A Treatise on the Scurvy. Edinburgh, Scotland: Printed by Sands, Murray, and Cochran for A. Kincaid and A. Donaldson; 1753.