The San Diego View

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
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message June 2016

Welcome New Graduates!

June brings with it sunshine and summertime, but also graduation season!  Across the United States, young doctors are being released into the wild filled with the excitement and enthusiasm such an achievement deserves.  Some will be moving on to residencies and fellowships to further their specialization and experience.  For many graduates and residents finished with their training, the surging feelings of excitement may give way to some feelings of anxiety as the reality of finding a job and impending student loan payments sets in.  Many may find themselves wondering… what now?

The California Optometric Association (COA) is here to help!  Student membership in the COA is free and so optometric schools often encourage doctors to apply while they are students.  Graduating student members receive the entirety of their graduation year for free and do not have to begin paying for membership until January.  As a result, most graduating students are automatically new member doctors and can enjoy the benefits of COA membership in their search to begin their careers.

The COA offers its members an Optometrist Resource Guide.  This manual is available online and can be useful to new doctors as well as current doctors looking to update or change the focus of their practice.  The guide walks members through getting their state license, DEA number, NPI, become a provider for difference insurance plans, and getting started in practice, whether that is starting a private practice or becoming an employed optometrist.  COA’s online educational resource EyeLearn provides numerous free business and career success webinars.  Additionally, COA offers classifieds and job matching services to connect those looking to hire an OD or sell a practice with those seeking employment or a new practice.

The San Diego County Optometric Society (SDCOS) offers local resources to new graduates as well as those seeking a change in their practice.  We offer a unique job connection service which is run by Dr. Jack Anthony our Society Optometric Relations Liaison.  Dr. Anthony coordinates local doctors seeking full or part-time positions and fill-in work, as well as those interested in purchasing, partnering, or selling a practice.  Please contact Dr. Anthony if you would like his assistance (optojack@gmail.com).  Furthermore, Dr. Eric White currently serves as the Society Membership Chair and can also help with networking and connecting new members with current SDCOS members (ericwhite@gmail.com).  In addition, the SDCOS newsletter and website keep a current list of classified ads that can include potential work opportunities.  Plus, don’t forget our fantastic and free local continuing education to fulfill requirements to maintain your license.

This year we are throwing a new member BBQ for new optometrists on June 5th from 1-4pm.  If you have graduated within the last few years and either live or are considering practicing in San Diego, we would like to get to know you better and welcome you to the family of SDCOS.  Contact nancy-jo@sdcos.org to RSVP and get further details.  Ours is a fulfilling, but challenging profession which has the opportunity to be redefined with each legislative cycle.  With every member we make each other stronger and we would love for you to stay lifelong members.  Congratulations and welcome new doctors!

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Retina Corner High-dose Statin Use May Induce Regression of Macular Degeneration

By Nikolas London, MD, FACS

Hope is a powerful thing, and sometimes all we have to offer our patients. In fact, one of my goals with all of my patients who learn about a terrifying diagnosis is to always leave them with a silver lining. I will tell my patients with a retinal detachment or macular hole that part of surgery is to remove the vitreous, which removes floaters and haze in the vision, and that some patients go to great lengths to have this done. For diabetic patients with macular edema I let them know that anti-VEGF injections can actually reverse signs of diabetic retinopathy, sort of a fountain of youth for the retina. For my patients with wet AMD I let them know about the wonderful drugs that we now have that have revolutionized the visual prognosis – that we can likely improve vision with treatment, and that millions of dollars are currently being invested in the “next big thing” that promises even better outcomes and less treatment burden. For my patients with severe geographic atrophy that has left them visually handicapped I describe the wonderful tools available through a low vision optometrist that can enhance their visual function and enable more independence. And for the end-stage patients I let them know about things like the implantable miniature telescope or Argus II retinal implant that has enabled vision in completely blind patients. Sometimes hope is difficult to instill in patients with dry AMD, who might feel that they are destined to develop wet disease and lose vision. However, a new study that I would like to review this month will be a tool in my armamentarium – a study that demonstrated the regression of drusen in patients taking high-dose statins.

The study was out of Massachusetts Eye and Ear Infirmary and was based on the correlation between cardiovascular risk factors and the development and progression of macular degeneration. It is proposed that the diseases share a common pathogenesis and that drusen formation under the retina may be similar to the development of atherosclerosis, corroborated by the similar molecular makeup of drusen and atherosclerotic deposits. Given the positive effect of statin therapy on atherosclerosis, it is hypothesized that statins might also be useful in preventing or treating drusen. This idea is not new and several studies investigating it have led to conflicting results. The study I would like to review here took a slightly different approach, essentially stacking the deck in their favor. The authors included only patients with large, soft drusen (the highest risk for progression) and placed them on a fairly high dose of atorvastatin, 80mg daily. Although this was a small, pilot study, the drug does appear to have an effect.

Patients were examined every three months with exam, OCT, and fundus photographs. They also had blood work for potential damage to the liver and/or kidneys. In short, after about 12 months of drug use, visual acuity improved slightly and the drusen regressed in 10 patients, nearly half of the cohort. The imaging shown for one of the patients is impressive (Figure). There was no obvious explanation for why some patients responded while others did not, but responders were slightly older and more often female. Importantly, no significant side effects were observed and patients did not appear to develop RPE atrophy, which is sometimes seen with spontaneous or laser-induced regression of drusen.

Figure 1. Color fundus images of a 63-year-old man with AMD and large soft drusen and drusneoid pigment epithelial detachments. Upper panel at presentation, middle panels one year later at start of atorvastatin and lower panels a year after atorvastatin treatment.
Figure 2. High resolution optical coherence tomography of patient in Fig. 1. Upper panel prior to initiation of atorvastatin treatment and lower panels a year after atorvastatin treatment.

With new information should always come more questions. Touching back on the article from last week on macular microperimetry, I would be interested in knowing if drusen regression is associated with any improvement in macular sensitivity. Looking forward, we might wonder if patients with a high genetic risk, which we can now identify with genetic sequencing, might benefit from prophylactic statin use.

While not groundbreaking, these results are fascinating, and an important step in the right direction. Hopefully with larger trials and further research we will discover more effective ways to turn back the clock on this prevalent and potentially devastating disease. At the very least, I can mention studies like this to my AMD patients, remind them of the wonderful recent advances in AMD care, and exciting advances to come in the near future.

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)

Reference:
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.

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Tech Corner Got Tech questions? We’ve got Answers!

KIDNAPPINGS AND RANSOM: NOT JUST FOR HUMANS ANYMORE – RANSOMWARE 101
Content for this article is reposted from www.Intermedia.net with permission.

It’s a typical work day. You’re going to meetings, getting things done, feeling productive.  Then you notice something weird. A pop-up appears. It’s a ransom note. It says that your files have been encrypted and that the “kidnapper” wants $500 in bitcoins to free them up.

WHAT HAPPENED?
Ransomware is one of the fastest-growing trends in cybercrime. A clicked URL here, an opened file there, and suddenly your computer is infected with malware that either prevents you from accessing your machine or, worse, encrypts your work documents so you can’t access them. By the time you recognize something is wrong, it’s too late. Cybercriminals have kidnapped your data and want you to pay up to get it back.

HOW A RANSOMWARE INFECTION HAPPENS
How does a laptop get infected with ransomware? Typically, it starts with a malicious email that contains an infected attachment or tricks you into downloading the virus from the web. One example is a Word document that tricks you into executing the malware when you open it. There are many other ways you might get tricked into installing ransomware, including opening an infected file on a thumb drive or downloading one from a malicious website. These files might look like innocent documents, but are, in reality, carriers of embedded malware.

HOW CRYPTO-RANSOMEWARE ENCRYPTS YOUR FILES
Once a computer is infected, crypto-ransomware acts quietly in the background. It searches for documents, spreadsheets, presentations, images, text files, video, music and other kinds of files that contain information you might be willing to pay to retrieve. It searches My Documents, your desktop, the shared files you sync with cloud- or network-based file servers, and so on. Then it individually encrypts each file.

You may not believe it. You may try to open your files anyway. At that time, you may notice that some of them now have weird extensions; others may have weird icons. When you try to open them, you’ll get an error message, or a bunch of gobbledygook. No matter what you try to do, you won’t be able to get the file to open.

If it’s a shared file, the problem is even worse: anyone else who needs access to that file won’t be able to get their work done, either.

SHOULD YOU PAY THE RANSOM?
The ransom amount varies. These days, it’s a few hundred dollars per user. The FBI reports that it’s seen ransoms as high as $5,000 per user. However, as criminals get more savvy in targeting business users, you can expect the ransom amounts to go much higher.

Unfortunately, you’re extremely unlikely to be able to crack the encryption. So the decision to pay often comes down to whether or not you have another option.

No backup? Pay the ransom. If you lack any form of file backup, you have no choice but to pay the ransom and hope you get your files back. (According to our survey of 300 experts, 19% of victims that paid the ransom still didn’t get their files back.)Try restoring from backup. If you have a backup, you can try restoring clean versions, though, your users will be down during the hours and days it takes to restore their files.

THE THIRD OPTION: BUSINESS CONTINUITY FOR RANSOMWARE ATTACKS
“Business continuity” is the ability for the business to continue operations even while a disaster is ongoing.

Many businesses have plans in place for natural disasters, power outages or other disruptions. Fewer have “e-crisis” response plans for cyber threats such as ransomware. That’s one of the reasons ransomware has been so disruptive to businesses and so profitable for criminals: business continuity solutions have not previously existed.

Learn more about how best protect yourself by giving us a call (619-825-4797) or email (SDCOS@GSWS.com) and to discuss. We are the experts and we’re here to help – no strings attached.

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Eye See written by Dr. Byron Y. Newman THE GREEN PRESCRIPTION

Having extensively searched for the explanation of “The Green Prescription”, it boils down to being a practitioner’s advice being written down for the patient (perhaps on an Rx form) as a part of the patient’s health management.

As nearly as I can determine, it started and continues to be used by physicians in New Zealand as a way to increase the physical exercising among their sedentary patients. Through the years, I have always written down on an Rx pad what I’d like my patients to do. In some cases, I would hand out pre-printed Rx forms detailing specific home exercises to practice, for example, pushups and rotation exercises. For ODs, I think instructions on taking medications would be much more effective if written out, and also for contact lens care patients, especially peroxide users.

One particular study was set up to determine whether written advice from general practitioners would actually increase physical activity among sedentary people more than verbal advice alone. Sedentary patients (n = 456) received verbal advice on increasing physical activity and were then randomized to an exercise prescription (green prescription) group or a verbal advice group. (A group receiving no advice was not included in the study.)

RESULTS: The number of people engaging in any recreational physical activity at 6 weeks increased substantially, but significantly more so in the green prescription group. Also, more participants in the green prescription group increased their activity over the period. CONCLUSIONS: A written, goal-oriented prescription, in addition to verbal advice, is a useful tool for practitioners in motivating their parents to increase physical activity.

So, thanks to New Zealand for this idea, I hope they don’t mind if we use it here in optometry and use the name.

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ZEISS DriveSafe Lens Aims to Provide a Better Behind the Wheel Experience

There is something captivating and invigorating about driving a car; and yet many still feel insecure and inadequately supported by their glasses in compromised conditions – such as during a storm or in low-light conditions. In addition, traditional progressive lenses are not necessarily user-friendly when driving a car. By combining an optimized lens design with a special coating, ZEISS has redefined the driving experience. ZEISS DriveSafe lenses offer wearers a lens for everyday use with special features to enable a more relaxed and safer driving experience.

In fact, ZEISS DriveSafe lenses are a visual dream come true for a multitude drivers who rely on eyeglasses. Users can wear DriveSafe lenses just like normal glasses and benefit from the built-in features designed to create a safer driving experience. The benefits of DriveSafe are many and include:

• A more relaxed feeling when in the low-light or bad weather conditions.
• Reduced discomfort glare for drivers who are frequently irritated by oncoming headlights and the scattered light from street lamps.
• And for progressive lens wearers—optimum vision comfort when looking at the road, dashboard, and the rear-view side mirrors.

The bottom line is that whether one drives a lot or a little, good vision while behind the wheel  is critical. When those who wear glasses while driving compile their list of optimum features, the list tends to contain three key elements. Specifically, drivers who wear glasses want:

1. Better vision in bad weather, and at night, dawn, or dusk
2. Less glare
3. Fewer vision problems when shifting focus

DriveSafe meets these demands for single vision as well as progressive lenses by combining versatility with functionality, resulting in glasses that can be worn for the entire day, and it all starts with ZEISS technology:

• ZEISS Luminance Design® technology — ZEISS DriveSafe features an optimized lens design that takes into account the size of our pupils in poor light. The result is improved and unimpaired vision when driving in poor light.
• ZEISS DuraVision DriveSafe lens coating —ZEISS has used a special new coating to take into account the many different driving situations when one’s eyes are confronted with glare. The DuraVision® DriveSafe coating by ZEISS partially reflects wavelengths in the high-energy, visible portion of the blue light spectrum, including the band around the wavelength of 450 nm..
• ZEISS DriveSafe lens design for progressives — ZEISS offers a special design to make driving with progressive lenses more comfortable and safer. The optimized vision zones make it easier for the eyes to refocus when moving between the road ahead and the dashboard and the rear view or side mirrors, reducing horizontal movements of the head. At the same time, the near zone is designed so that DriveSafe glasses are also suitable for other activities, including reading.

The goal of DriveSafe is to use industry-leading optical technologies from ZEISS to empower eye care professionals to provide a better and safer driving experience for their patients, while still satisfying their everyday vision needs, thus improving their quality of life. To learn more about ZEISS DriveSafe lenses and other game-changing technologies from ZEISS, call 800-358-8258 or visit www.zeiss.com/lenses.

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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!

Featured Event Sponsors

June 12, 2016 5-hour CE

Speakers and Topics:

Ray Gariano, MD, PhD – Diabetic Retinopathy – MacTel2

Michael Goldbaum, MD. PhD – Intraocular melanoma

Atul Jain, MD – Central Serous Chorioretinopathy – Crazy Retina Cases

Nikolas London, MD. FACS – Retinal Vein Occlusions – Latest advances in retina

Arash Mozayan, MD – Recent developments for DME – Crazy cases referred by ODs

Frank Tsai, MD – AMD scenarios

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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.

Classifieds

FirstSight Vision Services has several positions for Optometrists in the San Diego area. We have a sublease opportunity in El Cajon and are currently offering a $5,000 referral fee. We are also offering generous compensation for permanent part time and fill-in coverage for the San Diego Area. Please email me at Delaney.Bashaw@firstsightvision.net or call me at 909-920-5008 ext. 2062 as I would love to speak with you about these opportunities! (06/16)

For Sale Essilor Ultimate Edition Gamma Digital System  Tracer/Edger system  2 1/2 years old, 3000 cycles. Just serviced about 1500 inventory of poly uncuts available. Make me an offer. E-mail questions to eye3231@gmail.com

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Volunteer Corner

Monarch School Screening

Next Screening: Fall 2016 – details TBA
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

A Special Monarch School Screening

For the past several years, the San Diego County Optometric Society has had an outreach program that assists the K-12 Monarch School for the Homeless. It is the only school of its kind for students who are homeless or at risk of being homeless. Every six months, volunteer ODs perform an extensive vision screening on all of the student population and refer those who need further evaluation. The most recent cycle was held in March 2016. The new downtown San Diego campus now has an enrollment of nearly 300 students.

With the superb help of 5 VA residents and 2 UCSD pre-optometry students, the screening identified many Monarch students who were in need of eyewear. Starting in the fall of 2014, a Vision Service Plan (VSP) Mobile Clinic has traveled to Monarch to provide two examination areas, ophthalmic frames, and a fabrication lab. In previous years, many students found to need glasses would not have the means or transportation to obtain their needed eyewear. With the Mobile Clinic on site, this loop was closed.

Two weeks after the screening this spring, a total of 85 patients, including a few parents, were examined by SDCOS volunteers, Drs. Jack Anthony, Dick Skay and Bob Meisel, the clinic coordinator. A highly competent team of VSP volunteers, led by Emma Crews, did all administrative tasks, selected frames, fabricated lenses and dispensed new eyewear. 79 patients were found to need glasses and all but 15 Rxs were provided that day. The prescriptions that contained high cylinders and/or high spheres were later made at the VSP lab and sent to the school nurse, RN Rosemary Jankowski.

This year, VSP celebrated helping one million eyes during their nationwide charitable projects over the past several years and decided to highlight this historic milestone at Monarch. All students were presented with Nike sunglasses and backpacks at an enthusiastic assembly, attended by several VSP executives, including CEO Jim McGrann, and Monarch School officials. Dr. Meisel was honored for his coordination of this project for the past several years, after succeeding Dr. Byron Newman, who initiated the SDCOS program at Monarch.

Another cycle of screening and examinations will take place in the fall semester. If you would like more information or if you would like to assist in this rewarding outreach, contact Dr. Meisel at rmeisel@netscape.net.

The Screening Team: Dr Meisel with VA residents: Drs. Cathleen Yuen, Wendy Gross, Dinika Bagga, Jason Tran, and Nicola Gough, and UCSD students Ariel Chen and Kevin Chan

Dr. Dick Skay refracting a Monarch student

Fabrication of lenses inside the Mobile Clinic

VSP team ouside of the Mobile Clinic

YouTube Video

SDCOS Announcements

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Welcome, new members!!

• Michael Santarlas, OD
• Howard Wang, OD

Upcoming Events

June 12th, 2016: 5 hour CE- Retina Symposium
July 17th, 2016: 9th Annual SDCOS Golf Tournament