Posturdex - Richard Helawell is a 47-year-old Palm Beach Gardens man who developed diabetes while in his 20s. If diabetes is not attended to, it can lead to major medical problems for the patient. Richard's diabetes led to uncontrolled high blood pressure, which caused abnormal blood vessels to grow in the back of the eye and bleed. This condition is called diabetic retinopathy, a complication of diabetes that affects vision and is the leading cause of blindness in Americans under the age of 65.

When blood fills the middle of the eye, called the vitreous, it prevents light from getting to the retina, causing blindness. By November 2004, Richard was blind in both eyes. Surgery is Current Treatment Standard - To help treat his diabetic retinopathy, Richard was led to Adrian Laviņa, M.D. of Retina Care Specialists. Dr. Laviņa and his colleague, Mark Michels, M.D., F.A.C.S. are board certified and fellowship-trained ophthalmologists who focus on diseases and surgery of the retina, vitreous, and macula. Through the use of laser and specialized instruments, Dr. Laviņa first operated on Richard's left eye to remove blood and scar tissue, which was caused by the abnormal blood vessels.

"I was very concerned that we might have difficulties restoring his vision," said Dr. Laviņa. Fortunately, Dr. Laviņa was able to restore the vision one eye at a time. His vision came back in each eye slowly after each surgery. One year and one half later, in February 2006, Richard was finally able to have surgery on his right eye. "First, I had no peripheral vision, I couldn't drive, and I had difficulty reading," said Richard. "Now, I have no problems seeing at all." As a result of his uncontrolled diabetes, in between the two eye surgeries, Richard suffered kidney failure and had to have a kidney t ransplant. Born with only one kidney, this was quite a challenge. Prior to the transplant, he was on dialysis three times a week. In addition, he underwent a pancreas transplant in order to treat the diabetes itself. The pancreas is the organ that produces insulin so that the body can process sugar.

"I want others to realize how important it is to take proper care of themselves," said Richard. "I wish I could go back in time and do things over again. Now I have a second chance at life." Richard is now insulin free since the transplants. His vision is great, "I can now drive, read, do all of the things I enjoy", said Helawell. He regrets that he never took proper care of himself, leading to such extreme medical conditions.

New Non-Surgical Treatments Promising

There are several forms of diabetic retinopathy. A promising new treatment has shown promise for patients with diabetic macular edema. Currently, laser surgery is the standard of care. But the standard may change. Drs. Laviņa and Michels recently began taking part in a clinical trial that uses a novel drug delivery system.

"We are trying to bring patients new technology that they may not be able to avail themselves of," said Lavina, referring to Posurdex, which is being touted as the first biodegradable micro-size drug delivery system designed to provide continuous drug therapy to the eye for a month at a time. The implant is injected directly into the eye after it is numbed. It is made up of a mixture of polylactic and polyglycolic acid, which are mixed with a steroid. When the body begins to break down the implant, it delivers the steroid in small amounts that help reduce swelling without the side effects of off-the-shelf steroids.

According to Allergan Inc., the California company that makes Posurdex, early studies show few complications. Drs. Laviņa and Michels have several patients enrolled in the three-year study. The data still must be gathered and submitted to the Food and Drug Administration, so approval is a few years off.

"Posurdex provides a niche for those patients who would not benefit from traditional treatment," said Dr. Michels. "The product has a lot of potential. In addition, traditional therapy of macular edema with laser only serves to prevent further visual loss. With Posurdex, we can more often make vision better. The nice thing about this is that it may be the way we deliver all kinds of medicine to the eye in the future without having to go to the operating room."