“February is national age related macular degeneration (AMD) and low vision awareness month. AMD is the leading cause of low vision and blindness in Americans age 60 years and older and affects 1.6 million Americans.  As the Baby Boomer generation ages, the rates of AMD are expected to reach “epidemic proportions”.  AMD is a progressive disease with no known cure. It slowly steals vision as it affects the retina, a paper-thin tissue lining the back of the eye, and causes the cells in the area to die. As a result, if you have AMD, you see blind spots, grayness and other distortions in the center frame of your vision.”

UF Health – Department of Ophthalmology college of medicine                                                                       (https://eye.ufl.edu/2021/02/01/february-is-amd-macular-degeneration-low-vision-awareness-month/)

Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula. The macula is a small area in the retina — the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly.

The macula makes up only a small part of the retina, yet it is much more sensitive to detail than the rest of the retina (called the peripheral retina). The macula is what allows you to thread a needle, read small print, and read street signs. The peripheral retina gives you side (or peripheral) vision. If someone is standing off to one side of your vision, your peripheral retina helps you know that person is there by allowing you to see their general shape. 

Many older people develop macular degeneration as part of the body’s natural aging process. There are different kinds of macular problems, but the most common is age-related macular degeneration.

Signs and symptoms of Macular Degenerative Disease:

With macular degeneration, you may have symptoms such as blurriness, dark areas or distortion in your central vision, and perhaps permanent loss of your central vision. It usually does not affect your side, or peripheral vision. For example, with advanced macular degeneration, you could see the outline of a clock, yet may not be able to see the hands of the clock to tell what time it is.

• Blurry distance and/or reading vision
• Need for increasingly bright light to see up close
• Colors appear less vivid or bright
• Hazy vision
• Difficulty seeing when going from bright light to low light (such as entering a dimly lit room from the bright outdoors)
• Trouble or inability to recognize people’s faces
• Blank or blurry spot in your central vision. *                                                                                                                The risks of Macular Degeneration:                                      For Developing Age-Related Macular Degeneration

The risk factors we can control=Modifiable Rish Factors:

1. Smoking: Current smokers have a two-to-three times higher risk for developing age-related macular degeneration than people have who never smoked.
2. Artificial fats: Usually labeled “partially-hydrogenated vegetable oils,” these artificial fats are pervasive in foods and particularly in low-fat bakery goods. Low-fat foods are good options if they’ve achieved their low-fat status through a process that physically removes the fat, as in skim milk or low-fat cottage cheese. Low-fat bakery goods are different, however. If you remove all or half the fat from a cake recipe, it won’t turn into a cake; thus, when cakes and bakery goods are labeled low-fat or no-fat, it means they contain artificial fats, or laboratory-produced chemicals. These chemicals are not food and our bodies can’t metabolize them.
3. Sunlight: It is the blue wavelengths from the sun that damage the macula, not the ultraviolet (UV) rays.
4. A diet high in processed, packaged foods and low in fresh vegetables: Vegetable oils are added in the packaging process. These oils are rich in omega-6 fatty acids, which promote inflammation.
5. Uncontrolled hypertension and high cholesterol: Research by the National Eye Institute indicates that persons with hypertension are 1.5 times more likely to develop wet macular degeneration than persons without hypertension.
6. Obesity: Being overweight doubles the risk of developing advanced macular degeneration.

The four risk factors we can’t control=Unmodifiable Risk Factors:

1. Advanced age: Although AMD may occur earlier, studies indicate that people over age 60 are at greater risk than those in younger age groups. For instance, a large study found that people in middle age have about a 2% risk of getting AMD, but this risk increased to nearly 30 percent in those over age 75.
2. Race: Whites are much more likely to lose vision from age-related macular degeneration than are Blacks or African-Americans.
3. A gene variant that regulates inflammation: While not all types of macular degeneration are hereditary, certain genes have been strongly associated with a person’s risk of age-related macular degeneration, and genetic predisposition may account for half the cases of age-related macular degeneration in this country.
4. Family history: Studies indicate that your chances of developing age-related macular degeneration are three to four times higher if you have a parent, child, or sibling with macular degeneration.

Treatment of Macular Degeneration:

People who develop significant age-related macular degeneration (AMD) typically compensate with large-print publications and magnifying lenses for everyday activities. In addition, evidence suggests that certain vitamins and antioxidants — vitamins C and E, beta-carotene, and zinc — may help reduce or delay the risk of severe vision loss. Ask your eye doctor about using nutritional supplements.

1. Treatment for Dry Macular Degeneration

Dry macular degeneration, the most common form of AMD, cannot be cured at this time, but patients with the condition should continue to remain under an ophthalmologist’s care to monitor both eyes. If the one eye is healthy, screening should still continue.

2. Treatment for Wet Macular Degeneration

A variety of treatments are available for wet AMD. Successful treatment may not restore normal vision, but it will improve sight and prevent central vision loss from worsening. While laser procedures can destroy the abnormal blood vessels, they also damage neighboring retinal tissue.

Medications, such as Eylea, Lucentis, and Macugen, have become the preferred treatment for acute wet macular degeneration, helping to prevent the growth of leaky blood vessels in your eye. Lucentis is given once every month, although some patients may need treatment only once every three months. Macugen is given every six weeks. Eylea is given once every two months after three once-monthly injections.

Laser photocoagulation destroys leaking blood vessels that have grown under the macula and halts the leakage. Laser therapy is helpful for about 10%-20% of people with wet macular degeneration. Some vision loss may occur, because this treatment creates scar tissue that is perceived as blind spots; however, even more vision would be lost if nothing is done at all. Up to half of patients who elect laser therapy may need repeat treatments.

Photodynamic therapy (PDT) uses a different, non-heat-generating laser to treat abnormal blood vessels. Visudyne is injected into the patient’s arm and flows through the vessels in the eye. Upon exposure to the laser, a chemical reaction occurs that seals off the leaky vessels. Since the dye is light sensitive, you must stay out of the sun or bright light for several days until the dye has passed from your system. Laser photocoagulation must be done before the abnormal blood vessels cause irreversible damage to the retina. More blood vessels could grow later on, so people who undergo this treatment also need to continue with regular follow-up appointments.

Vitamins. A large study performed by the National Eye Institute of the National Institutes of Health, called AREDS (Age-Related Eye Disease Study), showed that for certain individuals, vitamins C, E, beta-carotene, zinc and copper can decrease the risk of vision loss in patients with intermediate to advanced dry macular degeneration. In addition, there was a correlation between the hormone DHEA and the degree of macular degeneration. DHEA can be purchased over-the-counter.

“Prevent Blindness has declared February as Age-related Macular Degeneration (AMD) and Low Vision Awareness Month. According to the American Academy of Ophthalmology, AMD is a leading cause of vision loss in people 50 years or older, and more than 2.9 million Americans age 40 and older have low vision. Low vision is defined as a visual impairment that is not correctable through surgery, medicine, eye glasses or contact lenses.

AMD affects central vision, where sharpest vision occurs, causing difficulty conducting daily tasks such as driving, or reading. The most common form of AMD is “dry” AMD, caused by the appearance of small yellow deposits called drusen, which form under the retina. Dry AMD usually progresses slowly. “Wet” AMD generally causes more rapid and more serious vision loss. In this form of the disease, tiny new blood vessels grow under and into the retina. These blood vessels are fragile and often break and leak, causing a loss of vision.”

Prevent Blindness (https://preventblindness.org/february-age-related-macular-degeneration-amd-low-vision/)

“This year marks the 50th Anniversary of American Heart Month. For the past 55 years, the American Heart Association (AHA) has used the month of February to partner with the media, medical providers and community organizations to spread the word about heart disease prevention and treatment. Heart disease is a leading cause of death for both men and women.”

American Heart Association AHA (https://www.heart.org)

“Sports help children develop physical skills, get exercise, make friends, have fun, learn teamwork, learn to play fair, and improve self-esteem.  It is important to remember that the attitudes and behavior taught to children in sports carry over to adult life. Parents should take an active role in helping their child develop good sportsmanship. To help your child get the most out of sports, you need to be actively involved.  Although this involvement takes time and creates challenges for work schedules, it allows you to become more knowledgeable about the coaching, team values, behaviors, and attitudes. Your child’s behavior and attitude reflect a combination of the coaching and your discussions about good sportsmanship and fair play.”

American Academy of Child and Adolescent Pschiatry (https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Sports-061.aspx)

“National Burn Awareness Week is a window of opportunity for organizations to mobilize burn, fire, and life safety educators to unite in sharing a common burn awareness and prevention message in our communities.  Avoid a dangerous balancing act.  Never carry a child or be right next to a child when carrying or sitting with a hot food plate or hot drink in your hand.”

American Burn Association (https://ameriburn.org/education/burn-reconstruction/)

“Nurses working in preanesthesia and postanesthesia care, ambulatory surgery, and pain management are dedicated to caring for patients and their families. They are passionate about what they do as nurses. Every year, the American Society for Perianesthesia Nurses (ASPAN) recognizes and honors perianesthesia nurses across the country during this week.”

American Board of Peri-Anesthesia Nursing Certification ABPANC  (https://www.cpancapa.org/nurse-leaders/perianesthesia-nurse-awareness-week/)

“Most cardiac arrests occur when a diseased heart’s electrical system malfunctions. This malfunction causes an abnormal heart rhythm such as ventricular tachycardia or vent.”ricular fibrillation. Some cardiac arrests are also caused by extreme slowing of the heart’s rhythm (bradycardia).  There are other rhythms that can also cause cardiac arrest.”

American Heart Association (https://www.heart.org/en/health-topics/cardiac-arrest/causes-of-cardiac-arrest)

“A stent can cause blood clotting, which may increase the risk of heart attack or stroke. The National Heart, Lung, and Blood Institute state that about 1 to 2 percent of people who have stented arteries develop a blood clot at the site of the stent. Doctors will usually prescribe one or more drugs to prevent clotting.”

MAYO CLINIC (https://www.mayoclinic.org/tests-procedures/coronary-angioplasty/about/pac-20384761)

Stents are used in cases of “restenosis”, which refers to the re-closing of arteries after balloon angioplasty. In carefully selected patients, the use of stents can dramatically reduce restenosis following balloon angioplasty or other catheter-based procedures. Stents are used frequently to hold open the arteries that have been damaged, torn, or dissected by balloon angioplasty or other catheter-based procedures. Like plumber or mechanic, get it.

Stents allow angioplasty to be done in patients with severe and long-segment obstruction of coronary arteries. As soon as the I initial part of the block is widened, a stent is place, which holds it open allowing further opening to proceed. Stents have also allowed angioplasty to be performed in patients with blocks of multiple vessels, and in multiple blocks in a single artery.

Risks of getting cardiac stents:

Risks include the standard risks of an interventional, catheter-based procedure, which should be specifically discussed with your doctor. Lesions treated with stents can “restenosis” (re- narrow with in weeks to months after the procedure) similar to restenosis associated with angioplasty. This is why patients after having a stent put in they are on a medication for example like Plavix for life to prevent this occurrence from happening. It is a anti platelet medication, meaning it doesn’t allow clotting to happen in the stent so blockage doesn’t reoccur through clotting.

Many new technologies are being tested to reduce the problem of restenosis, meaning close up. These technologies include coating and coverings for the stent, new materials, and radiation. These new technologies are primarily experimental at this point and will reach soon to the market if not already. Technology allows the medical field to continuously expand and this will be replaced at one point but isn’t yet. Just give it time. At one point we had no CABG (coronary artery bypass) but now the stent in certain cases is replaced by angiograms to further expanding to angioplasties and stents furthering allowing the surgery to take place 1x hopefully if the patient is compliant in diet, exercise, and following the doctors orders with meds, activity and follow up visits (which are so vital).   A lot is up to the patient in caring for themselves to prevent having this take place again.

St John’s Hopkins Medicine states that the risks of getting a stent are the following:

Possible risks linked to angioplasty, stenting, atherectomy, and related procedures include:

• Bleeding at the site where the catheter is put into the body (usually the groin, wrist, or arm)
• Blood clot or damage to the blood vessel from the catheter
• Blood clot within the treated blood vessel
• Infection at the catheter insertion site
• Abnormal heart rhythms
• Heart attack
• Stroke
• Chest pain or discomfort
• Rupture of the coronary artery or complete closing of the coronary artery, needing open-heart surgery
• Allergic reaction to the contrast dye used
• Kidney damage from the contrast dye

Follow up Instructions

Your doctor will recommend blood thinning medications following your stent procedure. These agents are usually given for one month post procedure along with aspirin and then continued indefinitely. Your doctor may also prescribe antibiotics for a period of time after the stent procedure, to be taken anytime you have a medical or dental procedure. Preventing infection.

MRI tests should not be done for at least eight weeks without your doctor’s approval. Metal detectors do not present a problem. Stents appear to be safe in the long-term; there are no long-term complications associated with a permanent stent.