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  • Dr. Gilbard and TheraTears

    Hi all,
    I went to see Dr. Jeffrey Gilbard today as he practices monthly in Boston. he was fairly affable, and pretty generous with his time answering questions. He told me that he doesn't advertise his practice at all, and dry-eye sufferers pretty much just seek him out. In case any of you are like me in your diagnosis, I will describe Dr. Gilbard's advice in the hopes that it might help you. Firstly, Dr. Gilbard is VERY enthusiastic about the apparent merits of TheraTears Nutrition. I am skeptical, because I know that some on this site how not met with success using them. However, Dr. Gilbard says that he has quite a bit of research to back up the fact that they can be very effective in the treatment of dry eye/MGD. He also says that they can be useful in helping to restore salivary function in Sjogren's patients. Dr. Gilbard said he thought my blepharitis/clogged MG's was probably due to Rosacea even though I really don't have any facial manifestations of the diasease. Dr. Gilbard also said he noticed a slight reduction in tear volume in my right eye but a normal volume in my left. (Which has a lower plug-I guess it did work!) His reccomendation for MGD is 3 capsules of TheraTears nutrition in the morning in conjunction with minocycline. He noted that the TheraTears nutrition can take as long as 8 weeks to show substantial benefits. Also, he reccomended lid massage around 1PM in the afternoon (but I think you can do it as neccesary). As far as TheraTears goes, Dr. Gilbard gave the impression that they are the ONLY tears that should be used. He indicated to me that certain other brands can induce medicamosa (sp?) i.e. irritation due to preservatives etc. For instance, I told him that I was using Refresh Endura (PF) on occasion. He asked me if it stung when I put it in, I said "not at first, but then yes , for a few seconds." he replied, "Well, why do you think that is?" seeming to indicate that the formula was inherently irritating to the eye.
    His reccomended regimen for TheraTears was to saturate the eye 4 times daily with a preservative-free vial. In between doses, if neccesary, he said to apply one drop of TheraTears Gel for, as he described it: "a liquid bandage." Apparently these vials are re-sealable, so you can keep it on hand. (As a side note-I tried re-sealing one-it can be done, but you're gonna want to keep it somewhere clean and where the cap won't get knocked off. Dr. Gilbard didn't state this specifically, but I personally would discard the vial at the end of the day since the solution is preservative free)
    I would describe my visit with Dr. Gilbard as informative. He has spent a long time researching TheraTears, and obviously knows a dry eye when he sees one. My only concern is, that as far as the treatment of dry eye goes, as many of us know-that this is not a one-size-fits-all kind of thing. The reality is that TheraTears may work very well for some people, for others it may not. Dr. Gilbard seems to be justifiably proud of his accomplishments, both with TheraTears and the Omega-3 supplements, but at the same time is quite dismissive of other popular treatments, i.e. Restasis and TheraLife supplements, which I know have brought relief to many people. I will try Dr. Gilbard's regimen, but if this hasn't worked for you, there are plently of other options out there that seem to be effective. Hope this was helpful. Incidentally, The New England Eye Center charges $250 to see Dr. Gilbard.

  • #2
    Eli thanks very much for posting about your visit with Dr. Gilbard. Your comments are helpful, and very observative about Dr. Gilbard's entheusiasm for his own products. I use Thera Tears myself, in additon to other drops, including the ones available on this website.

    I find the comment about "increasing salivary function" on Sjogrens patients after taking TheraTears Nutrition "interesting". I'll see if I can find any studies confirming this, for my own information and possible use.

    Lucy
    Don't trust any refractive surgeon with YOUR eyes.

    The Dry Eye Queen

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    • #3
      Thanks

      Thank you Lucy,
      I'm glad you found this helpful.
      Best wishes for your eyes!

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      • #4
        Don't know if this will help

        I found this, I'm not sure if it will help or not.

        http://www.ophthalmologymanagement.c...?article=86063

        I haven't found any studies that Dr. Gilbard didn't author yet tho.

        Billye

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        • #5
          Hi Lucy,

          today I was thinking about sending you a PM after my 10th visit to the restroom to...relieve my salivary glands... I don't know if you do have a dry mouth, but I didn't, and I've been on TheraTears Nutrition for about a year. Well I don't know about the dry eyes, but in the last couple of months I seem to have an extremely wet mouth. Even my dentist noticed because his aspiration-cannula-thingy couldn't keep up with all this slob. He kept saying, "Well you certainly won't die of thirst..."( , again...)

          Re Dr. Gilbard: I have used TheraTears without success, Eli. Refresh Endura was a magic potion compared to TT. And I admit, I hate it when manufacturers like Doc Gilbard refer to lasik patients as "a whole new market for us" I am not naive, I know that people like me are a godsend to them, but I'd really appreciate at least a more respectful wording. I really think he needs a PR professional!

          However, I'll be looking forward to your updates. I've always been intrigued by the hyperosmolarity theory, even though it didn't hold true in my case.

          Comment


          • #6
            Cristina-have you autoimmune disease? Or just "lucky" to have lasik?
            Lucy
            Don't trust any refractive surgeon with YOUR eyes.

            The Dry Eye Queen

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            • #7
              Lucy,

              I'm the "lucky lasikee"... Just thought of you, as I've never had a wetter mouth in my life, and I can't think of another explanation but TheraTears Nutrition.

              Comment


              • #8
                (Not so)Dry Mouth

                That's really funny about your mouth Christina-
                I got a chuckle out of it. Sorry to hear that is not helping your eyes though. Like you, I am also intrigued by the hyperosmolarity thing. On this point, I feel like Doctor Gilbard may have a point. For instance, I know how much salty sweat burns when it drips in your eyes. See this link in case you haven't already:http://www.dryeyeinfo.org/pdf/Turn_t...ts_back_on.pdf However, there are probably a lot of other factors influencing why a particular artificial tear would benefit a particular individual. I would be interested to hear more about your experience with TheraTears-how long did you use them, etc. etc. For me, the TheraTears feel great when you put them in, but don't seem to last too long. Hope to hear from you.

                Comment


                • #9
                  Eli,

                  I didn't express myself correctly, OF COURSE TheraTears Nutrition helps my eyes! I know because once I took the softgels on an empty stomach, had a nosebleed (that's why we gotta be careful, OTC doesn't mean it's not medication) and quit taking them. After 2 weeks, I could tell the difference. I'm back on them, however what I meant to say was that my eyes are not as wet as...my mouth.... Glad you got a laugh! But seriously it's made such a difference that I don't know what to do with all this drool?!?!

                  The TT drops did not help me, period. They also don't even feel good in my eye. The gel feels better, but I have trouble blinking when using it. I much prefer drops like Refresh Endura, they're the best I've tried in my life, however the cost is out of this world. I've spent a LOT of money trying to improve dry eye, but even maintenance therapy with 2 vials of Endura a day would cost about 45$ a month, even more than my filling of Restasis prescriptions Endura vials are resealable as well, but the quantity of liquid they contain make this feature essentially useless.

                  The DEZ drops are also very good. I measure effectiveness by the time that they keep me comfortable. TT doesn't make it past one hour. And I really believe in limited instillations of artificial tears-the idea of "saturation dosing" for me is just plain painful.

                  Re hyperosmolarity: One argument that could be used here would be that decreasing tear evaporation for example can improve dry eye and hence reduce hyperosmolarity, right? I have posted somewhere around here a study by Dr.Holly that explains that the effect oh hypoosmolar tears is short-lasting. However, Dr.Gilbard says TheraTears have the precise composition of natural tears. I don't know about that, really don't.

                  Good luck to you, Eli, I hope it works for you !

                  Comment


                  • #10
                    Originally posted by cristinalatina
                    However, Dr.Gilbard says TheraTears have the precise composition of natural tears. I don't know about that, really don't.
                    If Dr Gilbard said that... well it's probably an overstatement!
                    Does TT contain growth factors, substance P, several types of electrolytes, several types of mucin, several lipids (including oleamide , now that we know it's there for a reason), specific natural antibiotics...
                    Toril, whom you all know, gave me a sample of TT, all i can say it's that the vial was very practical and the drops quite pleasant..
                    I've only tried one, one, in one particular day so that doens't mean anything. However, stating the precise composition of natural tears...I'm skeptical to say the least.
                    take care
                    K

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                    • #11
                      Hi Kakinda,

                      Probably my overstatement, I think he says they have the same electrolyte composition/balance as real tears.

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                      • #12
                        Now I'm All Confused

                        You know, it's fascinating to me that what works for one person can be nearly intolerable to another. So far I've noticed that TheraTears feel great upon instillation-but unfortunately they can, given certain environments, evaporate very quickly, leaving my eyes feeling kind of crusty. Ditto the theratears gel, which also initially feels good, but leaves crusty flakes all around my face as it dries. One thing that Dr. Gilbard stresses on his website (http://www.dryeyeinfo.org/) is that increased tear osmolarity (I asume long term) depletes corneal goblet cells, of which he has some neat pictures. Apparently these goblet cells are what secrete the mucus that becomes the key lubricating element in the tear film. He goes on to say that any significant loss of these cells contributes to to the discomfort of a dry eye patient. TheraTears (allegedly) is the most effective drop at lowering tear film osmolarity and thus allowing goblet cells to re-generate. To me, this helps explain one of the underlying causes of dry eye discomfort, but obviously there are others. Anyone else have any TheraTears/TheraTears nutrition stories for me? Anyone else ever seen Dr. Gilbard for a consultation? Does anyone else find that Refresh Endura stings temporarily?

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                        • #13
                          This is a very informative and interesting thread. Thanks to all who have contributed.

                          Eli,
                          MGD and blepharitis can be associated with (caused by?) atopic, sebhorreic, or contact dermatitis or rosacea. Some of those conditions cause or are caused by an allergic reaction or inflammatory response. I know that doesn't quite spell it out, but it is not really clear in many of these conditions (from what I have read) what comes first or what causes which reaction. Suffice it to say, they are linked together and it is not uncommon for someone to have more than one of these conditions that lead to or involve MGD or blepharitis, conjunctivitis, keratoconjunctivitis, meibomitis . . . you get the picture.

                          To make a long story short here . . . some people have an allergic response or sensitivitiy/inflammatory response to any type of artificial eye drop or topical medication. One size definitely does not fit all.

                          I personally cannot use a whole truck load of highly regarded drops (including some sold on this site) because of an inflammatory response or allergic reaction. It took me a long time to realize that when my eyes felt DRIER a few minutes after instilling drops in my eyes that it may not be that the drops weren't a good drop, but my eyes could not tolerate something that was in the formula. It wasn't really dryness, it was an inflammatory response.

                          My advice: keep trying different ones. I can tolerate NutraTear (sold on this site) very well and it lasts for a long time, but you will find your own by trial and error. However, if you find that a drop can cause a reaction . . . . flooding the eyes with that drop may not be such a good thing.

                          If there was a truer statement about dry eyes, I haven't heard one:
                          ONE SIZE DOES NOT FIT ALL

                          Scout
                          Last edited by Scout; 25-Jan-2007, 15:29. Reason: typo

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