Where to Access NGF Autologous Treatment
Autologous serum tears (AST) containing naturally occurring nerve growth factor can be prepared through specialized compounding pharmacies and blood banks, while FDA-approved recombinant NGF (cenegermin) is available through standard specialty pharmacies for neurotrophic keratitis. 1
Autologous Serum Tear Preparation Sites
AST must be prepared by specialized facilities due to regulatory and technical requirements:
Blood banks and eye banks are the primary facilities equipped to prepare autologous serum tears, as they have the necessary sterile processing capabilities and regulatory compliance 1
Compounding pharmacies with appropriate sterile compounding facilities can also prepare AST, though availability varies significantly by geographic region 1
The patient's blood is drawn (typically 60-120 mL), processed to separate serum, diluted to the prescribed concentration (most commonly 20%), and dispensed in sterile dropper bottles 1
FDA-Approved NGF Product Access
Cenegermin (recombinant human NGF) is FDA-approved specifically for neurotrophic keratopathy:
This formulation (20 μg/ml) is available through specialty pharmacies that handle orphan drugs and requires a prescription from an ophthalmologist 1
The approved regimen is 6 drops daily for 8 weeks, with follow-up extending to 24-48 weeks 1
This represents the only commercially available, standardized NGF product for ocular use 2, 3
Practical Limitations and Considerations
Several barriers affect AST accessibility:
Insurance coverage is typically lacking for autologous serum tears, resulting in significant out-of-pocket costs for patients 1
Storage requirements necessitate refrigeration or freezing, with specific thawing protocols before each use 1
Limited availability of preparation facilities means many patients must travel considerable distances or arrange complex shipping logistics 1
The lack of standardization in AST preparation (concentration, frequency, duration) means protocols vary between facilities 1
Clinical Context for NGF Therapy
NGF-containing therapies are indicated for specific neuro-regenerative applications:
AST at 20% concentration is recommended for neuropathic corneal pain with peripheral sensitization, applied 8 times daily until symptom resolution (typically 3-4 months), followed by very slow taper 1, 4
Cenegermin is specifically approved for neurotrophic keratopathy with persistent epithelial defects unresponsive to conventional therapy 1
Both therapies work through nerve regeneration mechanisms, with in vivo confocal microscopy demonstrating increased corneal nerve density and improved nerve morphology 1, 4
Important caveat: Anti-NGF agents (which block NGF) are distinct from NGF therapy and are not FDA-approved, with ongoing safety concerns regarding rapid joint destruction in osteoarthritis trials 1