San Diego County Optometric Society
The San Diego View
Volume XVII, No. 5 – May 2016
Inside this Issue:
- President’s Message
- Retina Corner
- Tech Corner
- Eye See
- The vital conversation most ECPs aren’t having with their patients
- Practice Improvement Ideas from Vision West
- CE Corner
- Volunteer Corner
- SDCOS Announcements
- New Members
- Upcoming Events
California Optometric Association Legislative Day Recap
On April 20th, San Diego optometrists joined together with ODs and optometry students from throughout California to make our voices collectively heard at the capitol. COA’s Legislative Day is an annual tradition which allows us to show our strength in numbers and advocate for our profession and for our patients. Together we can make the legislative changes possible to ensure accessible, safe, and quality eye care for all those in need in California. Throughout the day, we met with local legislators to discuss our role as eye care providers, the training we receive, and how we can be better utilized to meet the needs of our patients. I’m confident we made a positive impact on legislation and we will see the benefits of our efforts as the year progresses. If you were not able to make it to Legislative Day, we still appreciate your support as a COA member. You can always help locally by showing support of optometry’s issues with your legislators. Grassroots efforts in the form of calls, letters, and e-mails to your local assemblyperson and senator are powerful as legislators will always prioritize the interests of their vocal constituents.
This year we came to the capitol with a focused agenda. To quote COA’s President-Elect Dr. Sage Hider, “We have one job today, to pass SB 622.” SB 622 is a bill introduced by Senator (and Optometrist) Ed Hernandez which aims to expand the scope of practice of optometry and increase access to affordable eye care for Californians. This bill has two main provisions:
- Clean-up provisions. This includes language that cleans up the practice act and consolidates referral requirements. This has not been controversial.
- It also creates three new certifications that glaucoma certified doctors may obtain with post-graduate training:
- Lasers: for glaucoma and Yag capsulotomy
- Minor procedures: removing small skin tags, cysts, and warts from the eyelid
- Immunizations: limited to flu, shingles and pneumococcus for those over 18 years old
SB 622 will achieve the goal of expanding access to eye care. Doctors of optometry already provide 81 percent of the eye care under the Medi-Cal program. SB 622 will significantly reduce waiting times and assist a large portion of California’s population, particularly in rural and medically underserved areas of the state.
The bill builds upon the framework approved by the Assembly Business and Professions Committee last year and has been further fine-tuned by the Senate Business and Professions Committee this year. As such, the bill was unanimously supported by Senate Business and Professions Committee and Senate Appropriations Committee. It passed the Senate Floor by an overwhelming 34-4. It is currently in the Assembly Business and Professions Committee.
Thank you to the San Diego doctors who took time out of their busy schedules to better inform legislators at the capitol! Please feel free to personally thank Drs. Robert Meisel, Richard Skay, Jason Tu, Robert Grazian, Ketan Bakriwala, Greg Hom, and Douglas Osborne if you get the chance! I also have especially exciting news to announce as Dr. Robert Meisel won COA’s Key Person of the Year! Congratulations to Dr. Meisel, it is an award well deserved!
Microperimetry: A Robust Analysis of Macular Function
By Nikolas London, MD, FACS
We all know that Snellen visual acuity is a fairly rough method for measuring visual function – it give us a patient’s ability to resolve a single black letter on a high-contrast background, but that is about it. The test tells us nothing about one’s ability to use that acuity, and is unable to adequately measure the functional impact of macular disease. Moreover, visual acuity may be significantly affected my media opacity such as dry eye and cataract, muddying the waters when we want to know the relative contribution of the macula to a visual deficit. One technology that helps us in this regard is microperimetry. Our practice recently acquired the MAIA microperimeter (CenterVue, Padova, Italy), piquing my interest in the technology. The more I learn about it, the more excited I get about using it to help my patients understand their visual function.
Taking a step back, microperimeters have been used in Ophthalmology and Optometry for over 10 years and have evolved into sophisticated and reliable analyses. Microperimeters provide a detailed map of macular sensitivity. In the case of the MAIA, this is acquired using Scanning Laser Ophthalmoscopy (SLO) along with eye-tracking to ensure fixation and enable accurate comparisons over time. Over the course of 2-3 minutes per eye, 36 points are tested in a 10-degree area. This is typically centered on the fovea, but may be directed elsewhere as needed. Patients’ results are compared to a normative database, and a color-coded map of retinal sensitivity is displayed.
The potential utility of this information is intriguing. The first thing that came to mind for me was the group of patients sent to us for evaluation of otherwise unexplained vision loss, such as a post-operative cataract patient with an unremarkable exam and 20/40 Snellen acuity. Along those same lines, it might also be a useful adjuvant to surgical planning for patients considering multifocal intraocular lenses – to ensure adequate macular function and minimize the chance for an unhappy outcome. Of course, microperimetry could also be quite useful to follow progression in patients with macular disease, to educate them on why their vision might be declining, or, conversely, to reassure them that things are improving after macular hole repair or epiretinal membrane removal, where the recover period can extend for many months. For Low Vision specialists, macular function mapping has profound implications in educating patient on preferred retinal loci, such as in a patient with a central scotoma due to geographic atrophy. The technology is also useful in screening for macular disease, and is even part of the American Academy of Ophthalmology guidelines for screening for plaquenil retinopathy. Last but not least, the technology has fascinating research potential – for example to monitor and quantify the impact of an intervention on macular function. Next month I will be discussing a widely-available oral medication that has been observed to eliminate drusen in certain patients with macular degeneration. If by doing so it simultaneously improved macular function that would be very exciting.
In the end, there is no perfect tool for monitoring real visual function in our patients, but I think that microperimetry is a powerful supplement to standard visual acuity, and I think my patients will benefit from the data it provides. The more we learn about visual function for a patient, the more likely we will be able to facilitate functional vision.
Thanks again for reading. Please don’t hesitate to contact me with any questions.
Best wishes, and until next time,
Nikolas London, MD
Retina Consultants San Diego, Poway, La Jolla, and Coronado
email@example.com (personal email)
firstname.lastname@example.org (RCSD email)
1. Brilliant et al. Mining Retrospective Data for Virtual Prospective Drug Repurposing: L-DOPA and Age-related Macular Degeneration. American Journal of Medicine. 2016; 129:292-298.
Got Tech questions? We’ve got Answers!
COMPUTER AND COMPUTER DATA SECURITY TIPS
Content for this article is reposted from www.OnGuadOnline.gov with permission.
Scammers, hackers, and identity thieves are looking to steal our information (and money). But there are steps we can take to protect ourselves, like keeping your computer software up-to-date and giving out your personal information only when you have a good reason. Below provides a list of suggestions, where we can better protect ourselves against someone with malicious intent.
TREAT YOUR INFORMATION LIKE IT IS CASH
Don’t hand it out to just anyone. Your Social Security number, passwords, credit card numbers, bank and utility account numbers can be used to steal your money or open new accounts in your name. So every time you are asked for your personal information – whether in a web form, an email, a text, or a phone message – think about whether you can really trust the request. In an effort to steal your information, scammers will do everything they can to appear trustworthy.
CHECK OUT COMPANIES TO FIND OUT WHO YOU ARE REALLY DEALING WITH
When you’re online, a little research can save you a lot of money. If you see an ad or an offer that looks good to you, take a moment to check out the company behind it. Type the company or product name into your favorite search engine with terms like “review,” “complaint,” or “scam.” If you find bad reviews, you’ll have to decide if the offer is worth the risk. If you can’t find contact information for the company, take your business elsewhere.
Don’t assume that an ad you see on a reputable site is trustworthy. The fact that a site features an ad for another site doesn’t mean that it endorses the advertised site, or is even familiar with it.
GIVE PERSONAL INFORMATION OVER ENCRYPTED WEBSITES ONLY
If you’re shopping or banking online, stick to sites that use encryption to protect your information as it travels from your computer to their server. To determine if a website is encrypted, look for https at the beginning of the web address (the “s” is for secure).
Some websites use encryption only on the sign-in page, but if any part of your session isn’t encrypted, the entire account could be vulnerable. Look for https on every page of the site you’re on, not just where you sign in.
PROTECT YOUR PASSWORDS
Here are a few principles for creating strong passwords and keeping them safe:
- The longer the password, the tougher it is to crack. Use at least 10 characters; 12 is ideal for most home users.
- Mix letters, numbers, and special characters. Try to be unpredictable – don’t use your name, birthdate, or common words.
- Don’t use the same password for many accounts. If it’s stolen from you – or from one of the companies with which you do business – it can be used to take over all your accounts.
- Don’t share passwords on the phone, in texts or by email. Legitimate companies will not send you messages asking for your password. If you get such a message, it’s probably a scam.
- Keep your passwords in a secure place, out of plain sight.
BACK UP YOUR FILES
No system is completely secure. Copy important files onto a removable disc or an external hard drive, and store it in a safe place. If your computer is compromised, you’ll still have access to your files.
For any specific questions you have, give us a call (619-825-4797) or email (SDCOS@GSWS.com) and let us know how we can assist. We are the experts and we’re here to help – no strings attached.
written by Dr. Byron Y. Newman
THE NOCEBO EFFECT
We all know about the placebo effect, which has been a part of medical lingo since the late 1700s. However, the nocebo effect, a modern word that accounts for negative factors that might affect treatment, was just coined in the 1960s. Since that time researchers have become more aware of nocebo effects, according to an article by Michael Woods in the March 15, 2004 issue of The San Diego Union-Tribune, sent to me by Greg Hom, OD.
Placebo is a Latin term meaning “I will please,” which is a fake pill given to a group of people who think it’s real medicine. Twenty-five percent of the people in the group will feel better.
The nocebo is a fake pill as well, meaning, in Latin, “I will harm.”
The subjects are told that the pill will make them feel badly, and some will feel badly.
Think sick, get sick. Expect the worst for your health and you may get it. Over the years, says Woods, women with a negative mindset who believed they would get heart disease, for example, were four times more likely to die from heart attacks than women who did not have bad expectations.
In one study, researchers told college students to expect a headache after a mild electric current passed through their heads. The experiment was a fake, with no electricity, and yet, two out of three students got a headache. In another study, more than 70% of patients experienced side effects from taking a fake pill.
Is a drug side effect occurring because of what the medicine does to the body? Or, does it occur because of what the size, shape, and even color of the pill does to the mind? Apparently, the color counts. People expect light blues and greens to have a calming effect, and bright reds and oranges to be stimulating.
But both Nocebo and Placebo effects involve more than pills. Many other factors can affect a person’s medical beliefs and expectations, says Woods. A doctor, for example, can phrase bad news in positive terms, making a patient expect to beat a serious disease, and negative phrasing could have the opposite effect. One textbook even advises doctors to write their prescriptions with a flourish to make patients believe in the medicine.
A New Way to Invest in Cures for Tomorrow
Imagine if you could make an impact on the lives of people tomorrow in addition to the work you are doing to take care of their vision needs today. You can do that by partnering with The Vision of Children (VOC) Foundation and investing in research to find cures for genetically caused blindness and vision disorders.
The San Diego-based non-profit recently unveiled an innovative new cause marketing program, called the Vision Hero Network, designed to engage the Optometric industry. For the past 25 years, VOC has been at the forefront of unlocking the secrets to cures for hereditary blindness and vision disorders, such as ocular albinism, oculocutaneous albinism, blue cone monochromacy and myopia.
“Our researchers have made extraordinary progress,” said Samuel A. Hardage, VOC Board Chairman. “Among many breakthroughs, they have isolated genetic mutations for eye diseases and developed genetic tests. Now, we are funding research focusing on remedies using induced adult stem cell therapy, genetic reprograming and medication trials.” Hardage, a San Diego businessman, co-founded the organization with his wife, Vivian, after their son was born with ocular albinism type 1. He added that research funded by VOC has broad implications for hundreds of genetic eye disorders.
Optometrists across the country are invited to join the Vision Hero Network through the Foundation’s website, and selecting one of three annual membership levels.
The program can be an important part of your marketing strategy and budget, enhancing your social responsibility profile, building goodwill with patients and employees, and increasing customer loyalty. In addition, the expense is considered a tax deductible donation.
Prominent San Diego County Optometric Society members have already joined. “I am honored to be an Optometrist Partner with The Vision of Children Foundation,” said Stephen J. Moffett, OD, APC, who has offices in Encinitas and Coronado. “My patients are thrilled to know that a percentage of their exam and eyewear fees is being invested in cures for children’s genetic blindness and vision disorders. I sincerely hope that my colleagues across the country will embrace this program. Imagine the powerful message optometrists can send by investing in cures for tomorrow, in addition to providing families with clear vision today.”
Dr. Moffet added that his staff is very excited to wear the Vision of Children T-shirts. The Foundation will also provide other marketing materials, such as displays, brochures, window decals, eyeglass cleaners and other support items to help promote optometrists’ involvement and to increase customer awareness.
Additional information is available by contacting The Vision of Children Foundation:
12555 High Bluff Drive, Suite 330
San Diego, CA 92130
Got Questions? ABB OPTICAL GROUP Consulting Team Has Answers
|Maria White, ABB OPTICAL GROUP Account Manager for San Diego and Arch Holcomb, Consultant, Specialty Contact Lens Division of ABB OPTICAL GROUP were at the SDCOS 5 hour CE and Wet Lab on Scleral Lenses co-sponsored by ABB OPTICAL GROUP. Scleral lenses are one of the fastest growing treatment options among eye care professionals. ABB OPTICAL’s advanced designs like ICD family of lens designs, can provide outstanding comfort, optics and successfully fit even your most visually challenged patients. For more information, please reach out to Maria White at email@example.com.
The team of GP and specialty contact lens consultants at ABB OPTICAL GROUP have probably heard just about every kind of question about specialty contact lens fittings. Some practitioners call for a finer point of adjusting an Rx; others call to deliver some key measurements and ask the consultant to design the lens from there. “I get callers who say, ‘The patient in my chair is wearing this kind of lens and it’s fitting high or low.’ Maybe I’ll ask the ECP to describe the fluorescein pattern or the ECP may video the movement and send that. Whatever level of help people want, we can provide it,” says Ann Shackelford, NCLC-AC, director, consultation and special services for the Specialty Contact Lens Division at ABB OPTICAL GROUP, who has been consulting on GP and Soft lens fits for 35 years.
“All of our consultants have worked in the contact lens industry a long time,” she says. “We understand the lens designs for any lens in our portfolio and the designs for any competitor’s lenses. That’s important because if a practitioner wants to convert someone from another brand, it’s good to know what kind of adjustments to make,” she says.
That means that any ECP who calls ABB OPTICAL GROUP at 800-852-8089 and presses option 4 for consultations will be able to reach one of the 10 consultants between 8 a.m. and 9 p.m. eastern time. “You can call us, you can email us. You can use the live chat feature on abboptical.com and talk with us. I’ve even stopped by if a local doctor calls,” she says. Their support extends beyond the consultation, too. “If I have a particularly challenging case, I’ll usually follow up with the doctor a few weeks later to make sure the patient is doing well.”
The consultants can answer questions about any product that ABB OPTICAL GROUP distributes or manufacturers. Shackelford says, “We deal with a number of outside vendors, so it’s important to realize that during the consultation, we will recommend the lens design that is most appropriate for the patient. It may not always be an ABB OPTICAL GROUP lens, manufactured by our specialty lens laboratory. We want to help you find the lens that is going to be the best for you and your patient.”
We are committed to helping you fulfill your CE requirements through our local meeting with the support of our sponsors!
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Social Hour Sponsor
May 19, 2016 2-hour CE
Skin Cancer and the OD’s Role: “Demystifying the Diagnosis of Eyelid Lesions”
Marc Bloomenstein, OD
Dr. Marc R. Bloomenstein is a 1990 graduate of the University of California at Los Angeles with a degree in Biology. He received his optometric degree from the New England College of Optometry in 1994. After graduation Dr. Bloomenstein finished a residency in secondary ophthalmic care at the Barnet Dulaney Eye Center in Phoenix, Arizona. He received his fellowship from the American Academy of Optometry in December 1998 and is a founding member of the Optometric Council on Refractive Technology (OCRT), serving as President from 2009-2011. Moreover, Dr. Bloomenstein is an Adjunct Assistant Professor at the Southern California College of Optometry and Arizona College of Optometry.
Currently Dr. Bloomenstein is the Director of Optometric Services at the Schwartz Laser Eye Center in Scottsdale, Arizona and President of MRB Eye Consultants. Dr. Bloomenstein is on the editorial board of Primary Care of Optometry News, Review of Optometry, Optometry Times, Advanced Ocular Care and a frequent contributor to various optometric journals. Dr. Bloomenstein currently serves as a board member of the Ocular Surface Society of Optometry (OSSO) and on the OCRT, as well as serving as a member of the AOA Continuing Education committee. Dr. Bloomenstein has served as the President of the Arizona Optometric Association, Legislation Chair and President of the Board of the Arizona Optometric Charitable Foundation. Dr. Bloomenstein has delivered over 500 invited lectures worldwide and serves as a consultant to numerous industry-leading pharmaceutical, biomedical and information technology companies.
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.
North County SD optometric practice looking for optometrist to work Thursdays, Fridays and one Saturday per month. For the right doctor, available days will soon expand to also include Wednesdays. Experience with EHR, fitting specialty contact lenses and treating ocular disease required. Please respond with CV/resume to firstname.lastname@example.org. (05/16)
Monarch School Screening
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
Welcome, new members!!
- Jennifer Chinn, OD
- Trinh Doan, OD
May 19th, 2016: 2 Hour CE
June 12th, 2016: 5 hour CE- Retina Symposium
July 17th, 2016: 9th Annual SDCOS Golf Tournament
Phone: 619 663 8439
Fax: 800 643 8301
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