Eye Injections to The Rescue

Treatment saves superhero fan from villainous diabetic retinopathy.

The blurriness in his vision now gone, Johnpierre can see clearly see to read his comic books.

Three years ago, Johnpierre Lebeau developed kidney failure and was forced to leave his job as a supervising forklift operator and go on disability. The 35-year-old father now spends the bulk of his time watching his children, ages 9 and 12, grow up.

“Right now, my kids are into superheroes,” Johnpierre shares. “They like Spider-Man, Venom, X-men, Batman, Aquaman and Wonder Woman. I like them, too, and have my own comic book collection. We go to a lot of comic book stores and comic book conventions, anything with superheroes.

“At the conventions, people dress up like their favorite superheroes or anime characters, and you can have your photo taken with them. The last convention we went to was in the spring at the Orange County Convention Center. We had a lot of fun there.”

What isn’t fun for Johnpierre is his kidney failure, which was likely caused by the Type 1 diabetes he developed when he was 9. Poorly controlled diabetes also negatively affected Johnpierre’s vision, causing a condition called diabetic retinopathy.

“I began having problems with my eyes five or six years ago,” Johnpierre recounts. “My vision became blurry, and I couldn’t read small print. I went to my regular eye doctor, who said he couldn’t do anything for me. He advised me to see a specialist who knows more about diabetic retinopathy.

“Over the years, I’ve undergone four eye surgeries. First, doctors went in and cleared out scar tissue from my retinas. They performed a laser procedure as well. I also underwent LASIK. During the last surgery, they removed cataracts.”

Recently, Johnpierre relocated to the Daytona Beach area. The move necessitated a search for a new retina specialist with expertise in diabetic retinopathy. His search led him to Ruwan A. Silva, MD, MPhil, a fellowship-trained retina specialist at Florida Retina Institute.

“Mr. Lebeau has a long history of diabetes and developed changes to his retinas consistent with advanced diabetic retinopathy,” Dr. Silva reports. “His previous physician performed a laser procedure, but when he came to us, there was quite a bit of bleeding and swelling in the back of his eyes, which is what we see with diabetic retinopathy.”

Diabetes Manifestation

Diabetic retinopathy is a manifestation of uncontrolled diabetes, Dr. Silva explains. Elevated glucose (sugar) in the blood damages the cells that control the blood vessels in the eyes. When this occurs, those blood vessels cannot maintain blood flow or preserve the integrity of the circulation.

“When there is damage to blood vessels anywhere in the body, those blood vessels tend to leak fluid,” Dr. Silva describes. “The smallest blood vessels also tend to disappear or die. When those blood vessels die, the organs they supply don’t receive the oxygen and nutrients they require to survive, and they begin to die as well.

“The retina is very metabolically active; it has a high demand for blood flow. We see changes to the small blood vessels in the back of the eye early on when a patient has diabetes. Consequently, there are also changes to the retina, which depends on those blood vessels for nourishment.”

When damage to the blood vessels supplying the retina is extensive, the body tries to compensate by growing new blood vessels. Unfortunately, the new blood vessels can become unstable, which may lead to a host of problems.

“Unstable blood vessels can leak fluid and blood into the retina, causing swelling and vision loss,” Dr. Silva elaborates. “Advanced blood vessel changes can cause elevation of eye pressure, leading to an extreme form of glaucoma. This can also result in formation of scar tissue and lead to a type of retinal detachment called a tractional detachment that is difficult to repair.

“Mr. Lebeau experienced several problems due to unstable blood vessels. There was substantial swelling and bleeding in the back of his eyes that impaired his vision. He also showed evidence of a tractional retinal detachment. Fortunately, that issue was caught and repaired relatively early, so he didn’t suffer permanent or severe vision loss because of it.”

Treatment Choices

There are three readily available treatments for diabetic retinopathy. The most common is an injection into the eyes of a medication that inhibits the production of a signal protein called vascular endothelial growth factor, or VEGF, which promotes blood vessel formation. The other treatments are a laser procedure and surgery.

“The treatment depends on the type of changes we see,” Dr. Silva contends. “If the patient has severe swelling, we tend to use injections. There are three commonly used FDA-approved anti-VEGF medications: bevacizumab, ranibizumab and aflibercept. The trade names for these medications are AVASTIN®, LUCENTIS® and
EYLEA®, respectively.

“The laser procedure treats those areas of the retina that are not getting proper blood flow. We apply a laser to those areas, which stabilizes problematic blood vessels. In most cases, any associated scar tissue regresses, and vision improves.”

“I can read the small print I couldn’t see before.” – Johnpierre

Surgery is generally reserved for patients with severe bleeding or a tractional retinal detachment. Surgery is performed in three steps. First, any blood blocking the patient’s vision is removed. Second, a laser is applied to the retina both stabilizing blood vessels and preventing growth of new scar tissue. Third, the detachment is repaired by removing any scar tissue already tugging on the retina.

“The key to preventing vision loss from diabetic retinopathy is early detection and treatment,” Dr. Silva asserts. “The most important thing you can do for yourself if you have diabetes is to visit an eye doctor at least once a year and have your eyes examined for early changes to your retinas.”

“I’m Very Happy”

Dr. Silva recommended injections to improve the blood vessels in Johnpierre’s eyes. He administered an injection into one eye on June 11 and into the other eye a week later.

“When I went back to see him about a month later, Dr. Silva was very satisfied with the improvement in my vision,” Johnpierre reports. “He didn’t need to give me another injection and said, “Check back in a month and we’ll go from there.

Johnpierre’s vision improved dramatically.

“There’s no blurriness now, and my reading ability is really good,” Johnpierre enthuses. “I can read the small print I couldn’t see before. All I need are over-the-counter readers; I don’t need my prescription glasses anymore. And I have my diabetes under control now, which makes a big difference. I’m very happy with the results of the injections.”

He’s also happy with his retina specialist, a true superhero.

“Dr. Silva is a good person,” Johnpierre states. “I felt comfortable from the first time I met him. We have a good connection and we communicate well. He’s a
great individual.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. js
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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

    • Ruwan A. Silva, MD, MPhil

      Ruwan A. Silva, MD, MPhil, completed his undergraduate education with highest honors at Harvard University in Cambridge, MA, majoring in neurobiology. He earned a Master of Philosophy degree in neurobiology from Cambridge University in En... Read More