This week’s Bulletin discusses Macular Degeneration, along with the latest updates on COVID-19:
Macular Degeneration is the leading cause of vision loss, affecting more than 10 million Americans – more than cataracts and glaucoma combined. This eye disease occurs when there are changes to the macula, a small portion of the retina that is located on the inside back layer of the eye. In early stages, macular degeneration does not affect vision. Later, if the disease progresses, people experience wavy or blurred vision, and, if the condition continues to worsen, central vision may be completely lost. Dr. Carl Kupfer, the former Director of the National Eye Institute, NIH, has stated that Macular Degeneration will soon take on aspects of an epidemic as the Baby Boomers’ age with 6.3 million Americans affected by the year 2030. Presently, macular degeneration is an incurable disease.

A study conducted at New York Presbyterian/Columbia University Irving Medical Center, and published in Nature Medicine, indicates that patients with macular degeneration who get COVID-19 are at a higher risk for complications. Macular degeneration is a disease driven by a hyperactive complement system (part of your immune system) and COVID-19 patients requiring ICU care also exhibited hyperactivity of their immune systems. This was published before vaccinations began.

Prevention of AMD

  1. Smoking tobacco increases the risk of AMD by two to three times that of someone who has never smoked, and may be the most important modifiable factor in its prevention
  2.  omega-3 fatty acids may decrease the risk of AMD
  3. Exposure to UV light from sunlight has been associated with an increased risk of developing AMD
  4. Elevated cholesterol may increase the risk of AMD
  5. AMD is a highly heritable condition.[13] Recurrence ratios for siblings of an affected individual are three- to six-fold higher than in the general population

There are two basic types of Macular Degeneration: “dry” and “wet.” Approximately 85% of the cases of Macular Degeneration are the “dry” type and 15% are the “wet” type.

  1. Wet AMD or “Exudative”:  occurs when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. You lose vision faster with wet AMD than with dry AMD.
  2. Dry AMD or “Atrophic”::  occurs when parts of the macula thin with age, and tiny clumps of protein called drusen grow. You slowly lose central vision.
Treatment of AMD varies depending on the category of the disease at the time of diagnosis. In general, treatment is aimed at slowing down the progression of AMD.  As of 2018, there are no treatments to reverse the effects of AMD. Early-stage and intermediate-stage AMD is managed by modifying known risk factors such as smoking and atherosclerosis and making dietary modifications. For intermediate-stage AMD, management also includes antioxidant and mineral supplementation.

Current and Pending Treatments for wet AMD

  1.  Anti-VEGF drugs: blocks a protein called vascular endothelial growth factor (VEGF). Blocking VEGF inhibits the growth and then leakage of new retinal blood vessels The drug must be injected into the eye on a regular basis. The problem is most people need an injection every four to eight weeks to keep their vision. This can be a difficult schedule to maintain
  2. Gene Therapy – provides a ‘one-and-done’ treatment by helping the eye make its own anti-VEGF medicine. Two different methods are under investigation: One injects the gene therapy underneath the retina in a surgical procedure; the other injects it into the eye just like a routine anti-VEGF treatment is done in the doctor’s office.
  3.  A port delivery system (PDS) –  a tiny refillable device that stores the anti-VEGF drug Lucentis. No bigger than a grain of rice, the port is implanted into the wall of the eye, just under the eyelid, during a surgical procedure. The device continuously releases drug to the back of the eye over time instead of an injection every six to eight weeks
  4. Combining two drugs – Cosopt (dorzolamide-timolol), an eye drop already used to treat glaucoma, is being tested in combination with anti-VEGF injections. Studies have shown that the duo can reduce retinal fluid accumulation and last longer than an anti-VEGF injection alone.
  5. Longer lasting anti-VEGF treatments – new drugs are being tested that allow 3-6 months between injections

Current and Pending Treatments for dry AMD

  1. AREDS2 formula –  a formulation of antioxidant vitamins that can help reduce the risk of vision loss. Only for intermediate disease.
  2. Two new drugs that target the immune complement cascade and stop it from attacking the retina have recently advanced to late-stage clinical trials. These drugs are injected directly into the patient’s eye and trial results are expected in about a year.
  3. Replacing some cells that begin to die in late-stage dry AMD –  Stem cells may be able to replace the retinal cells that are killed off by this disease. It may take about 10 to 15 years for these therapies to be proven effective in humans.

True or False? 

If a vaccine has 80% efficacy, then that means the vaccine will only work 80% of the time.

FALSE:  Having an efficacy of 80% means that out of all the VACCINATED people, 80% fewer people will get the disease when they are in contact with the virus.


  • According to The Wall Street Journal, federal regulators will likely approve a third COVID-19 shot for fully vaccinated adults starting at least 6 months after the second dose — rather than the 8-month gap announced previously — a person familiar with the plans told the Journal. Data from vaccine manufacturers and other countries under review by the Food and Drug Administration is based on boosters being given at 6 months, the person added. The unnamed source also told the Journal that approval for boosters for all three COVID-19 shots being administered in the United States — those manufactured by Pfizer-BioNTech, Moderna, and Johnson & Johnson — is expected in mid-September.
  • Philadelphia will likely hit 80% adults vaccinated with at least one dose, and 65% of adults fully vaccinated by the end of this week. Almost 1.9 million shots have been administered in the city, with more than 807,000 residents fully vaccinated and almost 987000 at least partially vaccinated. (Philadelphia is home to about 1.6 million people, including children who are not yet eligible for the vaccine.)
  • Three of Philadelphia’s largest downtown theaters will require proof of vaccination from all attendees of shows during the upcoming fall season, which starts Sept. 18, officials with the Kimmel Cultural Center said Monday. The requirement will be for all shows at the Kimmel Center, the Merriam Theater and the Academy of Music. Children under the age of 12 will be exempt from the requirement.


  • The FDA approved the Pfizer/BioNTech COVID-19 vaccine on Monday, the first vaccine against the novel coronavirus to receive full approval. The vaccine will be marketed as Comirnaty, and can be used for individuals ages 16 and older to prevent COVID-19. However, the vaccine is still under emergency use authorization (EUA) for adolescents ages 12-15, the agency said. By giving its formal blessing to the Pfizer-BioNTech vaccine, the Food and Drug Administration lifted it out of the emergency-use category and effectively put it on par with other vaccines required by public health authorities, universities, employers and others.
  • Within hours of the Pfizer vaccine’s FDA approval announcement:
  1. The Pentagon mandated COVID-19 vaccinations for our 1.4 million service members. More than 800,000 service members have yet to get their shots, according to Pentagon data.
  2. Vaccine mandates for college students gathered pace
  3.  CVS said its pharmacists would have to be fully vaccinated by Nov. 30 and that all corporate employees and other workers who interact with patients had until Oct. 31 to comply.
  4. Disney World said unions representing more than 30,000 employees had agreed to a mandate, that would require workers to be vaccinated by Oct. 22.
  5. Chevron became the first major American oil producer to require its field workers to get vaccinated
  6. New York City announced that every employee of the city’s Department of Education, from principals to janitors, would have to receive at least one dose of a coronavirus vaccine by Sept. 27.
  7. United Airlines recently announced that its employees would be required to show proof of vaccination within five weeks of regulatory approval.
  8. All-staff vaccine mandate passes unanimously by the Philadelphia Board of Education: 7-0. This will affect about 20,000 employees of the School District of Philadelphia.
  • Unvaccinated individuals are 29 times more likely to be hospitalized from COVID-19 than those who are fully vaccinated, according to a study from the Centers for Disease Control. The study, based on data from the 43,127 cases in Los Angeles County from May 1 through July 25, was published by the CDC’s Morbidity and Mortality Weekly report. The study also found that those who are unvaccinated are almost five times more likely to contract COVID-19 than those who are fully vaccinated.


  • By virtue of its geographical isolation and stringent government restrictions, Hawaii maintains its position as the state with the lowest rates of Covid cases and deaths. But in recent months, as restrictions have loosened and travel has resumed, case numbers have skyrocketed. On July 1, the state’s seven-day average was 40 new cases daily. By Aug. 19, the new case reports had peaked at 729 a day, according to a New York Times database, more than double the state’s previous high in September. And, with just 55 percent of the state’s population fully vaccinated, according to a New York Times database, health care providers worry that the worst is yet to come. And at a news conference Monday, Gov. David Ige discouraged tourists from coming.
  • Columbia University pediatrician Dr. Edith Bracho Sanchez spoke with ABC News’ Linsey Davis about the importance of getting a COVID-19 vaccine during pregnancy and while nursing. Recent health data from the U.S. Centers for Disease Control and Prevention has shown that three out of four pregnant women in the U.S. are unvaccinated, and the numbers are lower for Black pregnant women, with nine out of 10 unvaccinated. Sanchez, who is eight months pregnant and vaccinated, told ABC News that expecting mothers are more vulnerable to diseases and the current data shows the vaccines are safe for them. “We now know from over close to 40,000 women that there is no increased risk of miscarriage of early delivery of your baby, which are the things that worry a lot of pregnant women,” she said.
  • Facebook said that an article raising concerns that the coronavirus vaccine could lead to death was the top performing link in the United States on its platform from January through March of this year, acknowledging the widespread reach of such material for the first time. White House officials have alleged that many Americans are reluctant to take the coronavirus vaccine, in part, because of false or misleading information they have read on social media services, including Facebook.
  • Researchers at the Children’s Hospital of Philadelphia have identified unique biomarkers in the breath of children infected with COVID-19. Their findings, they say, could lead to the development of a quick and easy breath test to detect COVID-19 in children. “Given the cost, discomfort, and false-negative results associated with current testing methods, a breathalyzer test may provide an inexpensive, noninvasive, rapid and highly sensitive alternative for screening of large numbers of people, like at airports, large indoor events, or even school settings,” said Dr. Audrey R. Odom John, chief of CHOP’s division of pediatric infectious disease. COVID-19 is currently diagnosed through a nasal swab test either using polymerase chain reaction to scan for specific nucleic acids or a rapid antigen test.
  • If more Americans get vaccinated against Covid-19 in the coming months, the United States could reclaim a “degree of normality” by next spring, White House Chief Medical Advisor Dr. Anthony Fauci told CNN Monday — but another variant could emerge if the virus is allowed to fester, he warned. Fauci thinks an uptick in immunizations could give the U.S. broad protection against Covid-19 by next spring, allowing people to safely return to restaurants and theaters.
  • A study published in  the Journal of Adolescent Health finds that during the COVID-19 pandemic, alcohol use has actually decreased among adolescents age 10 to 14, however, the use of nicotine and the misuse of prescription drugs has increased. The researchers observed an augmented use of nicotine and misuse of prescription drugs. They postulate this is because the latter are easier to hide from their families during quarantine. Moreover, the study found that substance abuse was higher in families that experienced financial and/or material hardship during the pandemic. Overall, the results indicate that amplified stress, depression and anxiety were all markedly linked with youth substance abuse.
  • Johnson & Johnson said Wednesday that studies show a booster shot of its vaccine provides a “rapid and robust increase” in Covid-19 antibodies when used on people who have already received its first dose. The interim data showed people who already had been given the J&J vaccine experienced a ninefold increase in spike-binding antibodies compared with 28 days after the first dose, the drugmaker said in a statement. The drugmaker said it was “engaging” with the Food and Drug Administration and the Centers for Disease Control and Prevention, as well as the European Medicines Agency, which is the main regulator in Europe, and the World Health Organization, about using its shot as a booster.
  • The Archdiocese of Philadelphia will require all students and staff to wear masks when classes begin after Labor Day. The order applies to all elementary and secondary schools, as well as schools of special education in Philadelphia and suburban counties, and is based on CDC and local health department recommendations, officials said. “We hope this requirement will be temporary,” said Kenneth Gavin, archdiocese spokesperson. The archdiocese would not require staff to get COVID-19 vaccinations,
  • The Broadway production of Wicked, which has been closed since March 2020 due to the coronavirus pandemic, flies back into the Gershwin Theatre September 14. The international hit musical Mamma Mia! resumes performances August 25 at the Novello Theatre in London following the pandemic that shuttered theatres worldwide. The U.K. and Ireland tour of Disney’s Beauty and the Beast launches August 25 prior to an official opening August 29 at the Bristol Hippodrome. The Broadway reopening of Chicago, resumes performances at the Ambassador Theatre September 14.
  • Two months after Goldman Sachs Group Inc. led Wall Street’s return to the office, they are requiring employees to don masks and prove they’ve been vaccinated against Covid-19 to enter the firm’s U.S. workplaces. The decision means all six U.S. banking giants have now instituted some sort of broad mandate that employees get shots or don masks inside buildings — or in some cases do both.
  • Delta Air Lines employees not vaccinated against COVID-19 by Nov. 1 will be charged a $200 a month health insurance surcharge, CEO Ed Bastian said Wednesday. Bastian said unvaccinated employees will also be forced wear a mask at all times and undergo weekly COVID-19 testing. But for now, the company isn’t mandating all employees get vaccinated.
  • According to Yahoo! News, health officials agree that if you are newly diagnosed with COVID-19 and have an above-average risk of getting seriously ill, you should quickly seek treatment with Regeneron Pharmaceuticals’ monoclonal antibody therapy. Yahoo reported that the federal government is covering the costs, with some states setting up free infusion centers for the antibody cocktail that’s been shown to reduce hospitalization rates by 70 percent for people at high risk of severe COVID-19 when they’re treated within 10 days.
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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147