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Robert Gerald MD Appointments Panhandle Eye Group 7308 Fleming Ave Amarillo TX 79106 Phone 806-359-7603 Fax 806-355-2837 Biographical information Certified by the American Board of Ophthalmology: Yes Medical school: University of Texas Southwestern Medical School (Dallas; grad. 1974) Residency Program: University Medical Center, Louisiana State University Eye Center, New Orleans (grad. 1978) Fellowship: American Academy of Ophthalmology/American College of Surgeons Approx. percentage of practice dry-eye related 34-45%
OPINION QUESTIONS What is the most frequent cause of dry eye amongst patients you have treated? Here in the panhandle of Texas, the environment is dry and often windy, associated with allergies. These conditions are concomitant and require treatment separately or together in order to improve the vision as well as to relieve many of the symptoms of dry eye associated with allergies. Allergies associated with dry eye is difficult to treat at times, because the allergic symptoms are very commonly treated by the patient's primary care physician with decongestants and antihistamines, which compounds the dry eye problem. In addition, many of our elderly patients have collagen vascular disease (commonly associated with dry eye syndrome) or immune complex disease and are on multiple medications, many of which have side effects of dry eyes, resulting in a deficient precorneal tear film. These medications many times counter the commonly used dry eye treatments such as artificial tears. I would say these conditions are the most frequent causes of dry eye in my practice. What advice do you most frequently find yourself giving to dry eye patients? I routinely tell patients that a very effective way of treating the dry eye is daily and effective lid hygiene of cleansing the lids and lashes, as well as warm compresses to the lid margins to treat meibomian gland disease, which is many times the the culprit, rather than lacrimal insufficiency. Instructions are given in a pre-printed sheet including instructions to monitor their vision for fluctuation with variable tear film lubrication. I also explain to the patients that topical artificial tear therapy is a very inefficient way of treating dry eyes in the long term, and is only effective in relieving immediate discomfort but this does have its place. I recommend Restasis 0.05%, usually prior to temporary punctal occlusion with silicone plugs, rather than intracanalicular plugs. I have almost universally started recommending Omega III fatty acids as a dietary supplement in the form of gel capsules or liquid, and I recommend fish oil over flax seed oil, though both are good. What makes you exceptionally well qualified to help dry eye patients? I feel quite qualified to treat dry eye patients, since I feel that I am quite familiar with the systemic illnesses and medications that the patients are taking which frequently exacerbate a dry eye problem. The systemic disease must be known as well as being familiar with the medications that the patient is using, to be sure that there may not be contraindication to some of the common therapies for dry eye. For example, topical cyclosporine may be contraindicated with a history of herpes viral keratitis. This is not always the case, and has not been proven, but studies have not been shown that it is safe in such cases. Another example is using cyclosporine with some of the statin drugs, such as Lipitor for elevated cholesterol levels, which may be contraindicated in certain situations. A dry eye patient is a systemic disease and not just an ocular condition by itself and thorough medical knowledge is mandatory to be able to successfully treat a long standing and chronic condition such as this.
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