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Intravitreal injections halt vision loss from diabetic retinopathy.

Roland Bavota, 72, dreamed of becoming a French chef. So, once he retired from his marine engineering job at Sun Oil Company, he headed directly to Tampa Bay Cooking Academy in St. Petersburg for four years of culinary training. Roland had big aspirations for that training.

Photo by Jordan Pysz.

Roland Bavota

“My plan was to open a restaurant,” he divulges. “But at the time, I was fifty-eight years old, and I realized that the restaurant business was more for younger men. It requires a great deal of time on your feet. So now, I just cook for family and friends. I make pretty good meals at home, which makes my wife happy.”

It was a brief stint as an assistant chef that keyed Roland into the rigors of restaurant work. He could have continued in that position full-time, which would have involved extensive traveling, but the demands of the job discouraged him, and family responsibilities took precedence.

“Right after I graduated from culinary school, I worked for Cirque du Soleil® for eight weeks as a trial to see how things work in a real kitchen,” Roland recounts. “They offered me a regular position, but I turned it down. I remember thinking, Here I am, fifty-eight years old with an opportunity to run away with the circus, but my wife won’t let me!

Roland, who is a Vietnam veteran, relocated from his native Baltimore, Maryland to Inverness in 2003. When he began having trouble with his vision two years ago, he visited the eye clinic at The Villages VA Clinic. Doctors there told Roland that he had diabetic retinopathy and required specialized care.

Stock photo from istockphoto.com.Diabetic retinopathy is a complication of diabetes that affects the eyes. It’s caused by damage to the microcirculation of the retina from consistently high levels of glucose (sugar) in the bloodstream. The microaneurysms associated with diabetic retinopathy can leak fluid into the back of the eye, which can lead to vision loss, a condition known as diabetic macular edema, or DME.

“At that time, I was having difficulty seeing the crossword puzzle,” Roland recalls. “The little boxes in the puzzle, for instance, I couldn’t see the entire box. Some of the lines were missing. And I couldn’t make out the numbers inside the boxes. They were blurry. I couldn’t tell if it was a six, five or eight.

“I thought I simply needed a new prescription for my glasses, but the doctor at the eye clinic said, You’ve got some swelling in the back of your eyes from your diabetes. That’s not something we treat at the VA. They recommended an outside facility. It was Florida Retina Institute.”

The doctor at the VA eye clinic told Roland that his diabetic retinopathy would need to be treated. When Roland arrived at Florida Retina Institute, Matthew A. Cunningham, MD, a board-certified, fellowship-trained retina specialist, told Roland that the swelling in his retina could be treated with intravitreal injections.

“Like many patients with diabetic retinopathy, Roland came to us experiencing a decrease in his vision,” Dr. Cunningham remembers. “Upon examination, we discovered that he had DME, which is an accumulation of fluid in the central part of the retina. DME is the leading cause of vision loss from diabetic retinopathy.

“After performing some ancillary testing and discussing treatment options with Roland, we started him on a series of monthly intravitreal injections in both eyes. The aim of the injections is to decrease the swelling and leakage of the blood vessels near the center of the retina.”

A New Standard

The retina, which is the thin layer of tissue located at the back of the eye, functions like the film in a camera, Dr. Cunningham points out. It takes light that comes in through the lens and turns it into messages that are sent via the optic nerve to the brain, where the images are developed. Without a normal film in the camera to translate the light, the images can be distorted or blurred.

“The retina has multiple layers, and at its center is the macula,” Dr. Cunningham informs. “The macula is responsible for central vision acuity and color vision. A decrease in central vision causes problems with common daily functions such as reading and driving.

“When the macula is affected by DME, as was the case with Roland, people typically present with central vision loss or blurring of their central vision. There was a time when we solely used laser in the treatment for DME. But treatment for DME has changed over the years.

“Now, intravitreal injections are the standard of care. For those injections, we can use steroids or a class of medications called anti-vascular endothelial growth factor, or anti-VEGF. These injections have been found to work extremely efficiently to not only improve DME, but also to improve vision in patients who have DME.”

“Using the injections, my vision is excellent. I can see with no trouble at all. All the blurriness is gone.” – Roland

Retina specialists at Florida Retina Institute typically begin treatment of diabetic retinopathy and DME with anti-VEGF injections, and there are several anti-VEGF medications to choose from. If patients continue to experience leakage with anti-VEGF medications, the retina specialist generally switches to intravitreal steroids.

“When injecting steroids, we often use a steroid medication in the form of a pellet, called OZURDEX®,” Dr. Cunningham describes. “We implant the OZURDEX pellet in the vitreous cavity, and it lasts for three months. And just like we do with anti-VEGF injections, we implant the OZURDEX pellet in the office after we fully numb the patient’s eye, so it is a painless procedure.”

Despite the use of a numbing agent on his eyes, Roland says he was “freaked out” by the idea of Dr. Cunningham sticking a needle into his eyes. But he quickly adds that his fears were soon eased by Dr. Cunningham’s professionalism and manner.

“Dr. Cunningham has a certain way about him,” Roland says. “He had a comforting demeanor when he explained exactly what the injections were and what happens during the injection procedure. With his encouragement, I began injection therapy that same day.”

In keeping with Florida Retina Institute’s usual treatment protocol, Dr. Cunningham began Roland’s injection therapy with anti-VEGF injections. But Roland’s right eye did not respond to the various anti-VEGF injections, so Dr. Cunningham soon switched to OZURDEX injections in that eye.

Photo by Jordan Pysz.

Injection therapy has greatly improved Roland’s vision

“When Dr. Cunningham performs the pellet procedure, he does the injection from the side of the eye, then turns the needle and places the pellet,” Roland explains. “He told me that without the pellets, my right eye would leak.”

“My Vision Is Excellent”

Roland has been seeing Dr. Cunningham for injection therapy for close to two years now. He receives the injections every five to six weeks, and the combination of anti-VEGF injections and steroid pellets has worked wonders for him. Not only has his vision loss been halted, his vision has also improved with treatment.

“Using the injections, my vision is excellent. I can see with no trouble at all,” Roland raves. “All the blurriness is gone. I play guitar and drive a motorcycle, so my eyesight is very important to me. I need clear vision to see the road and read the music.

“I still wear glasses, but my vision is fine, so I can do the crossword puzzle with no problem. I have no trouble seeing the boxes and numbers now. I do a crossword puzzle every morning as a brain exercise.”

Roland is grateful to Dr. Cunningham for the exceptional outcome of his treatment. He has a high regard for the retina specialist.

“Dr. Cunningham is very knowledgeable, and his skill set is top-of-the-line,” Roland says. “He not only treats my symptoms and problems, he also treats my entire psyche, which calms me down. He treats my feelings and anxieties and goes through the entire treatment process with me. He makes me feel comfortable, important and special. It’s great to find that in a doctor.

“Dr. Cunningham told me that diabetic retinopathy is not something that heals, so I imagine I’ll be getting injections forever. But I couldn’t get any better care than what I get from Dr. Cunningham. He really cares about his patients. I absolutely recommend Dr. Cunningham and Florida Retina Institute.”

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    • Florida Retina Institute

      Founded by James A. Staman, MD in 1979, Florida Retina Institute has 19 locations throughout Central Florida, North Florida, and Southeast Georgia. They have proudly delivered Excellence in Vitreo-Retinal Diseases and Surgery for 40 years. T... Read More

    • Matthew A. Cunningham, MD

      Matthew A. Cunningham, MD, is board certified by the American Board of Ophthalmology. He earned a bachelor of science degree from the University of Florida in Gainesville and a Doctor of Medicine degree cum laude with honors in research from t... Read More