The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• I Didn’t Go To School To Be A Network Engineer
• Vision Rehabilitation Services and your Essential Role as Eye Care Providers
• CE Corner
• Classifieds
• New Members
• Volunteer Corner
• SDCOS Announcements
• Upcoming Events

President’s Message January 2016

I hope everyone had a relaxing holiday season with your families and I wish you all a very happy new year!  Over the years I have gained so much professionally and personally through the San Diego County Optometric Society and therefore, am honored to have the opportunity to give back and serve as your new president in 2016.  We have an excellent group of volunteer doctors on our Board of Directors and I am excited for all we are going to accomplish together this year.

Thank you to Dr. Amanda Dexter for your leadership as president this past year!  Her ambitious and steadfast management brought many productive changes in our infrastructure and made for a smoothly run year.  Congratulations to Dr. Dave Sherman, our 2015 optometrist of the year, who had another successful year co-captaining the Diabetes Walk with Craig Hansen of Gordon Schanzlin New Vision Institute.  We also honored Dr. Ketan Bakriwala as our young optometrist of the year.  We are lucky to have such amazing doctors and leaders in our community!

I am committed to maintaining our legacy as one of the best optometric societies in the country.  In addition to being one of the largest in California, we are also one of the most active.  We provide a wealth of continuing education opportunities to our members, including 6 2-hour and 3 5-hour CE meetings, making it easy and convenient to keep up with your continuing education locally.  We also have many volunteer outreach programs which allow for our members to be active and give back to the community, including our Lions Optometric Vision Clinic and Monarch School Screenings.  I would encourage our members to take advantage of these programs, which not only make for an incredibly rewarding experience, but help to make us a strong force and presence in the San Diego!

As optometrists, it is important for us to continue support the needs and interests of our patients by reinforcing COA’s legislative efforts.  It appears that 2016 will be an exciting year at the capitol!  We will continue to fight for SB 622, legislation by Senator Ed Hernandez, OD, which aims to expand the scope of practice of optometrists.  We are also supporting the efforts of the State Board of Optometry to pass SB 402 which supports the need for an eye exam for children before they enter school.  The battle for Unilateral Pricing Policies (UPP) continues as we have learned 1-800 Contacts will be introducing another bill in 2016.  We will have to work together to explain the real health problems that can occur when contact lenses are purchased on-line and follow-up care is forgone.  In addition to keeping healthy communication with your local lawmakers, please consider joining us for Legislative Day on April 20th in Sacramento when we come together to educate legislators and support our profession.  Your presence will make all the difference!

As your SDCOS president, I promise to work hard to provide you with another great year of education, resources to enrich yourself and your practice, and opportunities to network with other doctors and vendors.  I will make myself available for any questions, comments, and ideas so our society can continue to grow and thrive.  I am confident that together we will have an amazing year!

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Retina Corner Highlights from the recent American Academy of Ophthalmology meeting: DRCR.net Protocol S

By Nikolas London, MD, FACS

One of my favorite things about practicing medicine is to witness the continued evolution of therapies – a constant push to improve outcomes, reduce collateral damage, reduce treatment burden, and, hopefully (but quite often deprioritized), improve cost-effectiveness. The recent publication of results from the Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol S is an interesting such evolution. Protocol S was a randomized clinical trial that compared pan-retinal photocoagulation (PRP laser) vs. intravitreal anti-vascular endothelial growth factor (VEGF) injections for the treatment of proliferative diabetic retinopathy (PDR). In short, the results showed that anti-VEGF injections worked well with several important advantages over laser, but also with important drawbacks.

Taking a step back, a reminder that PDR refers to the growth of neovascular tissue on the surface of the retina and/or optic nerve in patients with advanced diabetic retinopathy. In large part, this is due to the upregulation of VEGF in the vitreous in response to retinal ischemia. PDR is a leading cause of vision loss in diabetic patients, due to vitreous hemorrhage, retinal detachment, neovascular glaucoma, or tractional retinal detachment. PRP laser directed at ischemic peripheral retina (and therefore reducing VEGF levels) has been the standard of care for high-risk PDR for nearly 40 years, reducing the risk of severe vision loss by 50% over 5 years.

At the Retina Subspecialty Day of the recent American Academy of Ophthalmology conference in Las Vegas, Dr. Jeffrey Gross gave one of the most anticipated presentations of the conference regarding the results of DRCRnet Protocol S. The purpose of this study was to compare the efficacy of intravitreal ranibizumab to PRP. This is an important question. While we know that PRP is quite effective in preventing severe vision loss in patients with PDR associated with high-risk features (i.e. prominent neovascularization of the disk or neovascularization associated with pre-retinal hemorrhage), PRP is inherently destructive resulting in reduced peripheral vision, diminished night vision, and potentially exacerbation of diabetic macular edema (DME). As PDR is driven in large part by VEGF, serial anti-VEGF injections may prevent complications associated with PDR without the collateral damage associated with PRP.

This noninferiority study included 394 eyes with PDR and no prior PRP randomized evenly to ranibizumab with PRP as needed or prompt PRP. The primary outcome was the mean change in VA at two years. Important secondary outcomes included the number of eyes requiring PRP in the ranibizumab group, the need for supplementary PRP in either group, changes in the automated visual field, the number of patients developing VH and/or needing vitrectomy, and performance on the National Eye Institute Visual Function Questionnaire. The ranibizumab group did well. The mean VA change was non-inferior to (and slightly better than) PRP at two years. Moreover, the ranibizumab group fared significantly better with regard to visual field preservation, prevention of DME, and avoidance of vitrectomy.

The results are impressive, if not all that surprising. We know from other studies that anti-VEGF therapy can induce regression of non-proliferative diabetic retinopathy, and it makes sense that this also applies to PDR. The more complicated question pertains to the durability of PRP vs. anti-VEGF therapy and how we should implement these results in our clinical practice. Moreover, we must consider the relative cost of the treatment options. While full PRP costs the healthcare system about $1000 and is often permanent, each injection of ranibizumab (Lucentis) or aflibercept (Eylea) costs over $2000 with potentially no end in sight. Fortunately we also have bevacizumab available ($50/injection). The best option is likely a combination of targeted PRP and limited bevacizumab injections to maximize outcomes and cost-effectiveness, but that is a question for another study.

Thanks again for reading. Please don’t hesitate to contact me with any questions.

Best wishes, and until next time,
Nik

Nikolas London, MD
Retina Consultants San Diego, Poway, La Jolla, and Coronado
www.retinaconsultantssd.com
858-451-1911 (office)
415-341-5456 (cell)
nik.london@gmail.com (personal email)
retinaconsultantssd@gmail.com (RCSD email)

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A Word From One of Our Sponsors… I Didn’t Go To School To Be A Network Engineer

The good news is we did. We are as passionate about your network and computer solutions as you are about your patients.

The doctors we serve are focused on delivering care. Unfortunately, it often seems like technology is getting in the way instead of supporting your mission. We make sure your systems and software are supporting your mission.

Golden State Web Solutions (GSWS) is a San Diego based and owned company that was founded in 1994. We have a sterling track record and personnel who are properly certified and available to fix problems fast.

As you know, proper diagnosis and treatment require advice from a properly trained expert. Too often we are called in when a client has simply turned to the wrong person for help. The two most important certifications our personnel have and you should expect:

Certified HIPAA Administrator:

Healthcare privacy, confidentiality, data security, and HIPAA compliance

Certified Information Systems Security Professional:

Healthcare privacy, confidentiality, data security, and HIPAA compliance

How Much is Your Time Worth?

Your time is valuable, and when you aren’t focused on delivering care or acquiring patients you are losing money. We offer a variety of support plans that are designed for any practice or business. We’ve built a reputation on ensuring our clients don’t have to worry about their systems and equipment.  We stay cost competitive by leveraging the best tools available, allowing us to run lean and prevent problems before they happen.

Technology Based Compliance

We specialize in the systems and tools you need to make sure you are meeting HIPAA and EMR/EHR compliance requirements from a technology perspective. Whether you are on the cutting edge or worried about implementation, we can provide the support you need.

There is a Reason for Insurance

The worst time to buy insurance is after the accident. Our goal is to make sure you don’t have the accident in the first place. This requires a checkup so we can identify potential problems before they occur. Sound familiar?

Normally $250, we are offering SDCOS members a complimentary consultation with one hour of basic troubleshooting. There is no obligation and we’ll provide an assessment of your network, hardware, and systems based on your needs, as well as taking care of anything minor while we’re there. It’s your choice on what you choose to do with the assessment.

Simply call us at 1-866-999-GSWS (4797) or email us at inquiry@gsws.com and mention that you are a SDCOS member.  We’re eager to help.

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Vision Rehabilitation Services and your Essential Role as Eye Care Providers

The onset of low vision and/or blindness is a growing concern for many of your patients and their families as patients live longer and become more medically complex.  Services for persons with vision impairments may be limited most often due to inadequate insurance coverage, but there is a continuum of vision rehabilitation services that exists.  As optometrists, you play perhaps the most important role in this continuum by making sure your patients have access to the best care possible in their time of greatest need.

Optometrists are often the first person that a patient sees about eye or vision problems.  It is also quite common that the Optometrist first identifies a visual issue that the patient was unaware they were having.  At this time the patient is at a very vulnerable point in their care and it is in you, as the eye care professional, whom they trust to make sure appropriate recommendations are made.  Your role is to first determine a possible course of treatment and refer to other professionals who can assist in this case.  While the patient may be referred to others, that patient places much trust in your recommendations.

It then becomes crucial for you as eye care providers to understand the vision rehabilitation services available for your patient. You are very aware of the medical continuum of services available to assist your patients, and do a wonderful job preserving and restoring whatever you can of the vision they have. In severe cases it may seem like there is little or nothing you can medically do for your patients, but you can assist them in finding services to help them adjust to whatever vision is remaining.

Activities of daily living, mobility, and assistive technology training are some of the services you may recognize to be beneficial to your patients, yet the number of places to get such specialized training is very limited.  It has been my experience that Occupational Therapists are extremely capable of working with a myriad of cases.  However, when they only see one or two visually impaired clients a year, they themselves are looking elsewhere for guidance.

A place like the San Diego Center for the Blind is specially equipped to work with persons experiencing diverse vision problems.  Not only are we staffed with masters level Mobility, Technology, Low Vision, and Occupational Therapy professionals who possess a deep knowledge of vision rehabilitation and help them become more independent through our training, but we also aim to support the services that you provide as medical professionals provide.  As professionals we seek your understanding of each patient, and with our client’s consent inform you of their progress in our programs. We pride ourselves in creating a continuum of services where the client can receive skills that fit their individual needs.

If you would like to learn more about this continuum of Vision rehabilitation services or have us do and in-service for a group please contact us:

Israel Martinez
Director of Client Services
San Diego Center for the Blind
(619) 583-1542

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CE Corner We are committed to helping you fulfill your CE requirements through our local meeting with the support of our sponsors!

Thursday, January 14th, 2016: 2 Hours

Refractive Surgery Update: 3rd Annual Rapid Fire and Panel Discussion

Speaker: Mihir Parikh, M.D.
Topic: Impact of Refractive Surgery on Sports related Eye Trauma

Speaker: Angela B. Nahl, M.D.
Topic: Patient Selection for LASIK and PRK

Speakers: Michael Gordon, M.D. – David J. Schanzlin, M.D.
Topic: The Latest and Greatest in new Procedure’s for   LASIK and Presbyopia

All 2015 CE meetings are located at the Handlery Hotel, 950 Hotel Circle North, San Diego, 92108.

2 Hour CE

SDCOS Members:
Free if reserved 4 days in advance*
COA/AOA Members: $35*
Non-Members: $130
Registration and Social Hour 6:00 pm,
Dinner 6:40 pm, Lecture at 7pm.
Dinner included.

5 Hour CE

SDCOS Members:
$90 if reserved 4 days in advance*;
COA/AOA Members: $90*
Non-members: $325
Registration: 7am,
Lecture: 8am.
Breakfast included.

*Late registration and no-shows will result in an additional fee of $35 to cover the cost of food.*

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Classifieds

EQUIPMENT CLEANING: Keratometers, Slit Lamps, Phoropters, Lensometers, Projectors, Retinal Cameras, Visual Fields, OCT’s, Radiuscopes, Labscopes, Surgical Microscopes and more. Yearly maintenance contracts available. Servicing San Diego and Riverside County. Medical Equipment 4 Less Call/Text 951-225-5597 OR Email Med4lcleanings@gmail.com (01-16)

CA Licensed Optometrist needed for part time work at correctional facilities in Susanville, CA, Pelican Bay, CA and Salinas Valley, CA. Contact Tabitha Ford or Renika Williams, toll free 855-502-3600. (01/16)

For Sale Essilor Ultimate Edition Gamma Digital System Tracer/Edger system:  2 1/2 years old 2800 cycles. 24K or take over lease payments inventory of poly uncuts available. e-mail questions to eye3231@gmail.com (02/16)

Practice For Sale, part-time satellite office in North County. Right person can turn it into full time. Interested? Contact me at eye3231@gmail.com (02/16)

Part-time Optometrist needed for 1 to 2 days per week in two-location practice in North County. Number of days dependent on schedule availability. Must have EMR experience. Please respond with resume/CV to: villageidoc@sbcglobal.net (02/16)

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Carl Zeiss Meditec: Scott Tucker scott.tucker@zeiss.comCarl Zeiss Vision: Anna Perrino anna.perrino@zeiss.com

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Welcome, new members!!

• Alyxandria Morey, OD

Volunteer Corner

Monarch School Screening

Next Screening: To be announced soon
Contact Dr. Bob Meisel for more information at rmeisel@netscape.net ; www.monarchschools.org

Lion’s Optometric Vision Clinic

Volunteer OD’s needed for flexible shifts throughout the year according to each doctor’s availability. OD’s unable to volunteer at the clinic can see patients at their office.
Call 619-298-5273, between 9-1:00 pm.,
Monday -Friday ~ 1805 Upas St, San Diego, CA 92103

Doctors interested in donating glasses to the Lions Optometric Vision Clinic (LOVC) please bring them to a CE meeting or contact Nancy-Jo at 619-663-8439 to make arrangements for delivery.

SDCOS keeps a list of all doctors willing to speak in front of groups about various topics, do home visits for patients, and assist in student mentoring. ODs interested in the Speakers Bureau, Home Visits, Student mentoring, and Low Vision OD’s, please contact Nancy-Jo at 619-663-8439

SDCOS Announcements

2016 SDCOS Board Members

1. President: Allison Pierce, OD pierce.allison@gmail.com
2. President-Elect: Ketan Bakriwala, OD KBakriwala@gmail.com
3. Treasurer: Michael Morgan OD MichaelMorganOD@gmail.com
4. Secretary: Robert Grazian, OD rgrazian@sbcglobal.net
5. Past President: Amanda K Dexter, OD adexter.2010@gmail.com
6. Membership: Eric M. White, OD idoc@drericwhite.com
7. Vendor Liaison: David N. Sherman, OD eyesite@pacbell.net
8. Professional Affairs: Dawn Pewitt, OD, FAAO Dawn.Pewitt@va.gov
9. Governmental Affairs: Richard Skay, OD rmskay@yahoo.com
10. Co-Communications Liaison:  Lucia Millet, OD millet.lucia@gmail.com
11. Co-Communications Liaison: Nickolet Boermans, OD nboermans@outlook.com
12. Webmaster: Susan T. Cervantes, OD susan.truong@gmail.com
13. Public Awareness: Robert Meisel, OD, FAAO rmeisel@netscape.net
14. OD Relations: Jack Anthony, OD optojack@gmail.com
15. Peer Review: Paul Lavin OD paullavinod@aol.com
16. COA HCDS Liaison:  Andrew Fasciani, OD andrewfasciani@gmail.com
17. LOVC Liaison:  Erin Swift efswift@yahoo.com
18. Trustee: Julia Castronova, OD juliacastronova@gmail.com
19. Trustee: John Fitzpatrick, OD jpfod@aol.com
20. Trustee: W.J. Garvin, OD gr8rx2c@aol.com
21. Trustee: Claire Kosters, OD clkosters14@gmail.com
22. Trustee: Stephanie Le, OD stephaniethule@gmail.com
23. Honorary Trustee: Byron Y. Newman, OD bynewman@cox.net
24. Administrative Assistant: Nancy-Jo Sinkiewicz nancy-jo@sdcos.org

2016 Continuing Education Schedule

Thursday January 14, 2016

• Refractive Surgery Updates: 3rd annual Rapid Fire & Panel Discussion
  SDCOS Platinum & Sustaining Sponsors

Thursday February 18, 2016 – Glaucoma

• Glaucoma Case Challenges
  George Comer, OD, SCCO at MBKU

Sunday March 20, 2016

• Specialty Contact Lens Symposium & Workshop
  Brooke Messer, OD
  SynergEyes

Thursday May 19, 2016

• Amniotic Membrane in the Treatment of Corneal Disorders (1 hr.)
  Ocular Surface Neoplasia (1hr)
  Marc Bloomenstein, OD, private practice, Arizona

Sunday June 12, 2016

• Retina Symposium – rapid fire 25 minute presentations
  Ray Gariano, MD, PhD, Scripps Clinic Torrey Pines:  diabetic retinopathy & MacTel2
  Michael Goldbaum, MD, PhD, UCSD Shiley Eye Center Intraocular melanoma & Nonmelanoma intraocular tumors
  Atul Jain, MD, San Diego Retina Associates: CSR & CRC (crazy retina cases)
  Nikolas London, MD, FACS Retina Consultants San Diego:  Latest Advances & RVO
  Arash Mozayan, MD, Retina San Diego:    Recent developments for DME & Interesting cases referred by optometrists

Thursday August 18, 2016

• The Basics of Uveitis (1 hour); Update on Oral Medications (1 hour)
  Walter Whitley, OD

Sunday September 11, 2016

• Oculoplastic Symposium
  Dawn De Castro, MD Thyroid Eye Disease
  Srini Iyengar, MD Dermatochalasis vs Ptosis: diagnosis & management
  Bobby Korn, MD Challenging cases: case reports
  Asa Morton, MD
  David Samimi, MD Lower eyelid blepharoplasty

Thursday October 20, 2016 – Glaucoma

• Glaucoma

Thursday November 17, 2016

• Reading, Learning, Vision (1 hour)
  Adult strabismus (1 hour)
  David Granet, MD UCSD Shiley Eye Center

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Continuing Education Seminars are at the Handlery Hotel 950 Hotel Circle North, San Diego, 92108.
Two-hour seminar, Thursday, 7:00 pm – 9:00 pm. Buffet meal included and served ½ hour prior to lecture.

• SDCOS Members free, COA/AOA Members $35.00, Non-Members $130.00.

Five-hour seminar, Sunday, 8:00 am – 1:30 pm. Buffet meal included and served ½ hour prior to lecture.

• SDCOS Members $90.00. COA/AOA Members, $90.00 Non-Members $325.00.

Upcoming Events

January 14th, 2016: 2 Hour CE
February 18th, 2016: 2 Hour CE
February 26-27th, 2016: COA House of Delegates Meeting, Newport, CA.
February 28th: COA Optowest, Newport, CA
March 20th: 5 Hour CE: Specialty Contact Lens Symposium and Workshop