What is your educational background?

I received a Bachelor of Arts chemistry degree from Princeton University, followed by my graduation from Harvard Medical School in 1988. That was followed by a residency in ophthalmology training at USC-LA County Medical Center, Doheny Eye Institute in Los Angeles. Once I finished my ophthalmology residency, I did subspecialty training in vitreal retinal surgery at the Massachusetts Eye and Ear Infirmary, which is the Department of Ophthalmology for Harvard Medical School.

What areas of ophthalmology do you focus your research on?

Our research program has been in existence in the region since 1994. Our focus has been primarily in diseases of the vitreous and the retina because my mentor was the individual who proposed the concept of the importance of vascular endothelial growth factor in different pathologies of the eye. We have been involved with all the major clinical trials using anti-VEGF factors for different conditions of the retina. The primary interest for us has always been diabetes because this is a condition that is the leading cause of blindness in individuals in the productive age group, from 20 years to the age of 70, around the world.

The impact that these drugs have had on reducing blindness from diabetes and other retinal vascular conditions has been dramatic. We now use these drugs as the standard of care for managing diabetic-related complications of the eye. These same drugs have been studied, and we have been involved with their use in wet macular degeneration. And again, that's the standard of care for treatment of macular degeneration and other retinal vascular conditions such as the occlusion of the different veins in the eye, so branch retinal vein occlusions and central retinal vein occlusions.

Our research program has also expanded into development of new instrumentation for surgical management of the different complications ranging from trauma to diabetic changes in the eye. More recently, we have established a program in the leading site for implantation of stem cells in the approach of trying to solve the problems associated with dry macular degeneration in elderly patients, primarily. We've also received our certification in clinical research involving gene therapy. So everything from inherited retinal conditions, such as retinitis pigmentosa and Stargardt's, are going to be now evaluated for potential treatment with different agents using gene therapy. So it's very broad but primarily in conditions of the retina.

What do you think sets Gulf Coast Eye Institute apart from other eye care centers?

I think what sets Gulf Coast Eye Institute apart from other centers is the combination of factors that are important in being able to provide cutting-edge treatment for the patients. Of course, you start with a very solid, well-trained faculty. The staff is very diverse in their training. The majority of the providers have some specialty training aside from just general ophthalmology. Either they've had a retina fellowship, they've had a glaucoma fellowship, or they've had a cornea fellowship on top of just the standard ophthalmology residency. When you combine a group of very well-trained sub-specialized individuals with leading-edge research, you elevate everybody to that next level. I think that's one of the factors that's been very important in helping us not only provide the patients with the leading-edge care that's widespread and available now as a standard, but also we're able, through our research protocols, to provide patients access to drugs or therapies that may not be available for the general population until three or five years down the road.

What made you want to specialize in retinal health and the retina specifically?

Well, the reason I'm interested in retinal health has been my interest in diabetes. As a second year medical student, I had the opportunity to rotate into one of the leading retina centers in the world in Boston. It's called the Joslin Diabetes Center. I met some patients that really had a life-changing impact on me. I remember meeting a patient that told me something that really resonated to me the need for something dramatic to be done, and it was a patient who said, "Before I found this center, I would always practice putting my makeup on with my eyes closed." And I asked, "Why would you do that?" And she says, "Well, I was getting ready to be able to put on my makeup when I went blind from diabetes." And that was it.

After that, I knew where I was headed because she was so right in saying that diabetes can do that to a lot of individuals. Having had the opportunity to spend some time with my mentor, and learning about the vascular endothelial growth factor and the fact that we were beginning to have that association between what was happening with diabetic retinopathy and what we could potentially do if we could block that factor, really encouraged the group of us to do this. And fortunately, that man was right. He was brilliant. And we were able to move that forward into clinical research and now clinical application. About 25 years later, it's the standard of care for treatment of diabetic retinopathy worldwide.

Unfortunately, he died unexpectedly, but had he lived, he would have received a Nobel Prize for that which signifies the importance of his research. That's one of those awards that you have to be around to receive, which is a shame because he deserves it. The change I've seen and what I've been able to do for my diabetic patients like that individual I mentioned has been dramatic.

What is your patient philosophy?

You always wonder what makes a doctor a good doctor, right? I mean, of course, you've got to have good training, you've got to have empathy, you've got to have an interest in your patients, but the bottom line is, if you can't bring your patient in as a partner in what you're doing, you're going to be banging your head against the wall. My philosophy is no matter how well-trained I am or what advanced medications I have access to, if I can't earn the trust of the patient and make them my partner in their care, the odds that I'm not going to succeed are pretty high. So I think I try to create a partnership of respect and trust with every patient that I have. I think that's one of the reasons why I've been able to bring a lot of people forward from very difficult situations.

What are the three most common retinal procedures that you perform?

The number one procedure involving the retina right now are intravitreal injections. These injections are being used around the world because our ability to treat diabetes, macular degeneration, and different retinal vascular problems with these agents has just been dramatic because there's so many of them. The second most common would be retinal lasers. And again, the combination of the drugs with laser surgery can dramatically increase the number of people that benefit. Not everybody gets one hundred percent resolution with the injection and not everybody gets one hundred percent resolution with a laser, but you treat them with the anti-VEGF first along with the injection. So the first two go hand in hand.

And then of course the third most common procedure is something called vitrectomies. And this is where I go into the eye through special ports to help relieve the different tractional factors that have developed inside the eye from various conditions. These conditions could be things like diabetic retinopathy, trauma, or other abnormalities that can affect the gel of the eye, called the vitreous. These conditions result in traction, tugging, or ripping of the retina. The only way to resolve these conditions would be to go in and relieve the traction using a special method that involves a special gas or oil to push it back into place. A laser is then used in this procedure to, in a sense, spot weld it into place once the oil or the gas is removed. That's called a vitrectomy.

What is the most time consuming procedure that you perform?

The most time consuming procedure is definitely the vitrectomy because sometimes we combine the vitrectomy with something called a scleral buckle. So when going into the eye and cutting the gel is not enough to relieve the traction to reattach the retina, now you have to sew a special little belt onto the outside of the eye to help indent the eye.

Imagine you have a rubber band that's extended and attached to the two opposing walls in a room. The rubber band is stretched out, so there's tension on the wall on both sides. The way you relieve that tension in the rubber band is either cutting the rubber band in half or bringing the two ends of the rubber band closer. The vitrectomy involves trimming it in the middle, so you're cutting the rubber band. If you can't cut the rubber band, then you have to bring the two ends of the wall closer together, and that's what a scleral buckle does. So it's a very time-consuming procedure. The combination of the two actions helps increase our ability to reattach retina in a large percentage of patients.

How are you involved with the University of Texas Rio Grande Valley?

Well, the University of Texas Rio Grande Valley has recently opened a new medical school here. I'm happy to say that we've graduated our first class, so that's four plus years of operation. It's been a project that's been 20 plus years in the making, and I've been involved in different aspects of it. More recently, I've been involved with the development of the curriculum that was needed to bring the medical school to life. I was very privileged to have been selected to be involved with that group, and I can tell you it was a lot of work. There were a lot of people who were involved. We were able to write and bring together a curriculum that was certified by the National Certification Boards, and that's what allowed us to be able to open the medical school and move forward.

I've also been involved with the university in general, as a board member of the foundation for the school. We help raise money for the university and provide support for different activities ranging from helping the president with very focused acquisitions that he's interested in for the university to having scholarships for students who were hit hard by COVID. I'm also a clinical faculty for the medical school and I enjoy interacting and teaching the medical students and residents.

After you left California, what made you want to open an eye center in McAllen and what's kept you there?

When it was time to finish my retina training, I had a very tough choice to make. I was offered an incredible job to go back to California. With all the time I had to spend working hard and getting to know the retina doctors in the LA area, I had some very good job offers in California. One of the most prestigious groups in the area offered me a position but I was interested in making sure I was able to have access to communities outside that area as well.

When I was rotating through the Joslin Diabetes Center, I ran across some literature on the diabetic rates in the Lower Rio Grande Valley, which is where I am currently. I was interested in doing some work across the Mexican border as well as teaching there. I'm actually dual licensed in both countries now because I wanted to make sure I had the opportunity to teach. When I saw that the majority of the population down here spoke Spanish, I felt that this would be a good place for me to do a couple of things. Number one, come to an area where there's a lot of diabetes where my background was going to be impactful. Number two, be able to use my language skills and the English and the Spanish to do what I always wanted to do and that is educate my patients because I thought that was important.

I came down here, established the retina program back in 1994, and I've been fortunate to make it grow from just a small program in the City of Harlingen to a full retina program now that encompasses different providers that I've attracted down into this area. We have been able to provide retina care both for adult and pediatric patients all along the Rio Grande Valley from Laredo down to McAllen. This area is a place that fulfilled all my needs, both personal and practice related. I wanted to make sure I had a significant impact on the patient population, and I have had the opportunity to be able to grow the practice from ground level to where we're at now.

Tell us about your newest location in Laredo.

We have had great success with managing the diabetics here originally, considering the diabetic situation along the border is very significant. I have been invited to Laredo by the ophthalmologists and the primary care doctors there multiple times for over a decade now, but we haven't really had the clinical support locally for us to be able to do that. Now that we've built the team in the region, we felt that there was a large need to do the same type of program in the Laredo-Eagle Pass area.

About a year ago, we had the opportunity to join forces with a physician who had been in Laredo for over 30 years. He had an established practice that did not have a retina specialist or a lot of subspecialty-trained individuals. He was interested in transitioning, but wanted to make sure that he left a very well-rounded program as his legacy. I can tell you that just in the six months that we've been up practicing in the area, the impact we've had on the diabetic blindness problem has had a dramatic effect on the population locally. This is due to our ability to take care of cataracts in combination with managing the retina issues all in one procedure. Presently, we are recruiting a full-time doctor there that will continue to do what we're doing.