The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• Setting a New Daily Habit
• OCT: Add Value to Your Eye Exam in the Age of Online Refractions
• Professional Optical Laboratories
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message August 2016

August is Children’s Eye Health/Safety Month!

August is here and with it brings the beginning of another school year and naturally Children’s Eye Health and Safety Month!  Children are susceptible to a host of vision and eye problems such as injury, infection and increased nearsightedness.  It is our responsibility to provide services and information to the public that can help protect and preserve a child’s eye health for life.

With one in four children having an undiagnosed vision problem, the goal of the national observance is to educate about the importance of a child’s vision and eye health.  As we know, difficulties in school can stem from a learning-related vision problem.  Experts estimate 80% of what a child learns in school is presented visually, so visual problems are often seen as laziness, a learning disability, or even ADHD.  Many parents incorrectly assume when their child passes a school vision screening, there is no vision problem.  They are not aware that a child who can see 20/20 can still have difficulty with their vision.  While the most common vision problem is myopia, we know there are many more potential problems such as binocular and accommodative functioning issues.  We need to remember to educate our parents that every child needs a comprehensive eye exam to give them their best chance in school and protect their lifelong eye health.

Vision can change quickly, so remind parents to keep an eye out for the following between appointments:

• Squinting
• Closing or covering one eye
• Headaches/eye strain
• Short attention span
• Excessive blinking or eye rubbing
• Losing his/her place while reading or using a finger as a place mark while reading
• Holding reading materials close to the face
• Tilting head to one side

Between getting school supplies and new clothes, remind parents to get their child a complete eye exam and start off the new school year right.  Don’t forget that sunglasses and sports protection are also integral to a child’s eye health.  By providing protection against ultraviolet rays and sports-related hazards, you can help children protect their eyes and enjoy healthy vision for life.

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Retina Corner Squalamine Eyedrops: A Potential Adjunctive Treatment Option for Exudative Macular Degeneration

By Nikolas London, MD, FACS

Exudative macular degeneration is not the diagnosis it used to be 15 years ago. Before the advent of anti-VEGF injections (Lucentis, Avastin, Macugen, and Eylea), diagnosing a patient with wet AMD was depressing all around, and the bulk of the visit centered on counseling them about the future severe vision loss they were destined for. Laser could be attempted, but often only delayed the inevitable. These days, however, we have several excellent treatment options. The vast majority of patients (95% or more) at least maintain their current vision, and many patients experience a substantial improvement in vision after one or two injections. These days the expectation is that patients will do well, and while hundreds of new medications are in development, the bar is set high. While most of these medications continue to involve injections or even surgery, one interesting option may be more palatable for patients – an eyedrop. We are currently evaluating Squalamine in a large, international clinical trial with the hope that it will significantly enhance the effect of concurrent anti-VEGF injections.

Squalamine was developed by Ohr Pharmaceuticals and has already progressed through phase 2 clinical trials (the IMPACT study), the results of which were presented at the American Society of Retina Specialists in Vienna. Squalamine is a small molecule designed to penetrate the sclera to reach the choroid. There, it counteracts multiple growth factors in the angiogenic process, including vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). The drop was well-tolerated and exhibited no significant safety concerns. Moreover, there was a trend toward better visual outcomes, particularly with certain AMD lesion types.

It is currently being studied in a randomized, double-masked, placebo-controlled, phase 3 clinical trial at over 150 sites across the US and Canada, including our clinic. Eligible patients with a new diagnosis of exudative AMD will receive monthly injections of Lucentis and study patients will take the drop twice daily. The primary endpoint will be the difference in the proportion of subjects gaining 15 letters or more at month 9. After the first year, patients will be treated with Lucentis on an as-needed basis. These two years will answer two very important questions, the first year will tell us whether or not patients have improved visual outcomes while taking the drop, and the second year will tell us if patients receiving the drops will need fewer injections – both welcome improvements. One thing we are not looking at in this study, but would be very interesting is whether taking this eyedrop would lower the risk of developing wet AMD, particularly in patients with high-risk dry AMD.

We are very excited about this study, and think patients will be as well. If you have a treatment-naïve patient you feel may have exudative AMD and a good candidate for this or one of our other AMD trials, feel free to contact me or our study coordinator, Lydia Adams, at 858-451-1911. As with most clinical trials, insurance is not an issue and both study drug, Lucentis, and all testing and exams will be covered by the company sponsor.

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

AM I EXPLOITABLE? LET’S HOPE NOT – AND HERE ARE SOME TIPS TO HELP PREVENT IT FROM HAPPENING. Provided by Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)

In short, an exploit is a hole in your armor that is used against you. The vulnerability is the hole, and the risk is that it is exposed. This applies to many items and situations in our lives, but for the sake of this article, we’re limiting our focus to the computers technology you use at work. Now that we understand what they are, what can we do to best protect ourselves against these?

Please find below a list of recommendations that can help you protect yourself:

1. KEEP YOUR SOFTWARE UPDATED The easiest way to fill a security hole is to take the hole away. Knowing what you are updating (and what it affects) is key. We don’t want to have a good intentions produce unwanted results. Updating regularly helps prevent issues and reduces exposure risk by removing the vulnerabilities that can lead to exploitation. Examples of software that often need updating include: Microsoft or Apple operating systems, Adobe Flash, Adobe Acrobat, Microsoft Office applications. There are more but this gives you a good idea. If you have something you aren’t sure about, just give us a call and we’re happy to advise.
2. DECOMISSION ODER SYSTEMS Older systems like Windows XP, Server 2000/2003 are operating systems that are no longer supported by the manufacturer. Other programs, such as QuickBooks is only supported by Intuit for 3 years. An older version will still run on your computer, but support for stability and security will no longer be provided. Any program or operating system that is no longer supported, is a common place where vulnerabilities can be found
3. REVIEW CUSTOM DEVELOPED SOFTWARE AND WEBSITES When we use software programs from larger companies, they will continue to provide updates and support for a given period of time. But what if you had someone make a custom program or (or website) – how do we know that is safe?   Sometimes these can be protected, sometimes they can’t. The first step is in identifying if you have any of these. Once identified, we can see how they are used, if they are necessary and ultimately what can be done to ensure they are in as secure an environment as possible.
4. INSTALL ANTI-VIRUS SOFTWARE ON ALL DEVICES Anti-Virus software is an excellent resource for helping to ensure your computers and networks are better protected. It helps protect the both the machine and user from possible exploits that come through vulnerabilities that need to exist (i.e. email, internet surfing, etc.). Needless to say, keeping your anti-virus software updated, is as important (if not more) as updating all the other programs and operating system on each (device (computer, server, tablet, laptop, etc.).

If you have questions and would like a complimentary consultation on this, please give us a call (619-825-4797) or email (SDCOS@GSWS.com) to discuss. We are experts and we’re here to help – no strings attached.

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Eye See written by Dr. Byron Y. Newman The Search for Cures in Macular Degeneration

There’s no question that Macular Degeneration is affecting more and more people, especially with the increase in the amount of people reaching older ages. Studies abound, and now there is a new one coming out of Australia…. eating more saffron. It seems strange, but here is a bit about their clinical trials:

(information was found on the “Natural News” website)

The study was conducted by Jonathan Stone, a professor of Neurology at Sydney University. It involved 25 macular degeneration sufferers. Instead of depriving a placebo group from a product that could do something for their ailment, the study switched placebo subjects with saffron subjects half-way through the trial unbeknownst to all involved. The daily dosage was 20 mg of saffron.

The whole study was six months long, so each side of the 25 double blind subjects had three months of improved vision with three months of impaired vision. All 25 were tested for neuron electrical conductivity in the macula and retina, and 23 showed significant improvement. Those 23 also reported they could see much better.

Visual improvement began after only two weeks on saffron. When the saffron group was put onto placebos, they complained that their improved eyesight had begun diminishing again. Conversely, those on placebos for the first half of the trial began seeing better after three months of no improvement.

Professor Stone projects that after a year or more of ingesting only 20 mg of saffron daily, vision improvements should stabilize without requiring more saffron dosing.

Stone doesn’t know exactly how or why, but he became aware that saffron influences the neuron’s genetic code to restore its capacity for healing and protecting neuron cells. Neurons are responsible for transmitting electrical signals or impulses throughout the nervous system.

His results, combined with the Italian study, impressed Professor Stone enough to create his own line of saffron capsules for the market. He qualified it as a safe nutraceutical that shouldn’t require any more testing for FDA approval.

Don’t mention that it cures macular degeneration and you’ll stay out of trouble, mate. Just say it supports eye health (wink).

This is certainly enough of a study to look at Saffron Seriously.

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Setting a New Daily Habit

OD breaks out of mold of prescribing monthly replacement lenses and increases patient satisfaction

Some habits are hard to break. That was true for Jean-Paul Etienne, OD, both professionally and personally. He had been a fitter – and wearer – of monthly replacement contact lenses for more than a decade. “I had tried on different lenses, but as a high myope with spherical aberration, I hadn’t found anything that worked as well for me as the monthies,” he recalls. “And you fit what you’re comfortable with.”

But when his CooperVision representative encouraged him to try clariti® 1 day lenses, he decided it was time to test his old assumptions again. “With all the new 1-day lenses that had come on the market, I wanted to find out what worked. So I tried every daily disposable lens,” he says. The clariti 1 day lenses provided him with the best vision, without the nighttime glare and halos he so often experienced with other contact lenses. “Since then, I’ve converted myself to a clariti 1 day lens wearer,” he says.

That experience has reached over into his Pearle Vision practice in Bloomington, Indiana.

Etienne says that his experience with clariti 1 day lenses has changed his conversations with patients. “We’re all about getting to know the patients, talking with them about how they wear their lenses. Many tell me that they’re happy staying with the same brand of contact lenses they’ve worn for years. Now I tell them, ‘I know someone else who also was happy with what he was wearing.’ Then I tell them about how I changed lenses. That carries weight,” he says.

Etienne had presumed that 1-day contact lenses would be less attractive to his patients due to the cost. “My practice has a very high managed vision care population. But clariti 1 day lenses are available at a very good price point. With the instant savings and mail-in rebates – and calculating the cost of solutions – it’s actually comparable for most patients.”  Because the practice is located near Indiana University-Bloomington campus, these prices are also attractive to students, he says.

Current contact lens wearers who have experienced the inconvenience of cleaning contact lenses are eager to try these lenses. “The conversation is very easy with experienced contact lens wearers. They immediately see the benefits of putting in a fresh pair every morning and throwing them away at night,” he says.

The UV-blocking protection in clariti 1 day lenses is another plus, Etienne says. “If I’m fitting a young baseball player who is going to be outside for hours each day, the UV factor is important. We all need to protect our eyes from UV light, but it’s particularly important for young patients. Parents appreciate that we talk about that,” he says.

“With an affordable option for one-day lenses, there’s really no reason not to examine your prescribing habits. Patients want to know about this option,” he says.

Originally printed in Pearle Vision Eye Care Connections, 3Q 2015

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OCT: Add Value to Your Eye Exam in the Age of Online Refractions

By Aaron Werner, OD

SYNOPSIS The higher level of care that you can provide with an OCT adds value to your comprehensive exams. That is a powerful differentiator as online refractions become a reality.

ACTION POINTS

DELIVER IN-DEPTH CARE. Use the OCT to screen all patients age 18 and over for evidence of retinal disease.

EDUCATE PATIENTS. Point out what the OCT helps to monitor about the health of their eyes, and why their eye exam is more than just refraction.

ESTABLISH MEDICAL EYECARE IDENTITY. Market the full comprehensive exam you provide, including your use of advanced instrumentation like the OCT.

Now that patients can obtain a refraction online, as well as from one of your many competitors, the advanced technology of the OCT allows you to elevate the care you provide, add value to the patient’s exam, and differentiate your practice.

Adding value to the comprehensive exam is essential because patients often fail to appreciate all that goes into one. According to Jobson Optical Research, over 60 percent of U.S. ODs don’t believe their patients perceive a difference between a refraction and a comprehensive eye exam, and 97 percent of ODs are concerned, or very concerned, that the capacity for patients to do a refraction “at home” via Opternative will cause patients to miss out on their annual eye exam.

We have an Optovue iVue OCT with the iWellnessExam, and we charge $39 for a retina screening iWellness and photos. Our office has determined that the information we get by utilizing iWellness is invaluable. This test is a part of our pre-testing for patients 18 and over. We are not comfortable presenting this test as an “option” because we believe it enables us to provide a more comprehensive exam.

We have added revenue per exam by utilizing the iWellness technology, in addition we are able to detect retinal structural changes earlier than before, we see an increase in subsequent medical visits and medical reimbursement to further evaluate and treat the changes.

Try Out Different OCTs

At the end of 2013, we brought in different models of OCTs to evaluate. We wanted to make sure that the doctors were comfortable with the data that was being collected, and that our technicians were comfortable taking good images. Quality images are key, and making sure that everyone using the instrument is comfortable with it, was important to us. We were profitable with the OCT immediately, as it allowed us to screen for more pathology and follow-up with further testing if warranted.

It takes years to pay off a loan for an OCT, however the instrument was profitable immediately in that it allows us to diagnose and treat retinal disease earlier. The profitability is accounted for in the iWellness screening fees, additional office visits and diagnostic testing (OCT, as well as others). The additional visits and tests, including the OCT scans, generate more than the monthly note, which is why it is a profitable investment.

Deliver In-Depth, Efficient Care

We believe technology should be used to help us perform a more comprehensive eye exam in a more efficient manner. We also are strong believers in preventative medicine. The OCT is a wonderful tool to accomplish these goals. As noted, we have every patient 18 years old and over screened with iWellness during a comprehensive eye exam.

The technicians have the images open on the computer monitors in the exam rooms when we enter, and in a matter of seconds, we can quickly review the scans and get an excellent idea of the health of the macula. We also look at the Ganglion Cell Complex scan (GCC) as an additional glaucoma screening evaluation.

Educate Patients About Value of Exam

Too often patients do not understand what they cannot see, especially when we are discussing early signs of retinal structural changes that are painless and generally asymptomatic. The ability to show a patient scans of their own eyes is very powerful. For example, a patient with early macular drusen who sees 20/20 may not fully understand the doctor’s concern. But when the patient can see the structural changes on the OCT images, it becomes “real” for them.

Understanding of the disease deepens, and patients are much more compliant with treatment recommendations. When taking the OCT scans, our technicians explain what the test is doing and the importance of the results. In the exam room, the doctor takes a minute to “guide” the patient through their scans and provides the opportunity for the patient to ask questions. This approach has helped our practice to demonstrate the value of a comprehensive eye health exam while educating patients on the difference between a refraction and an eye exam.

Earn Patient Loyalty

We believe that the right technology will improve the quality of exam the patient receives while at the same time improving a patient’s experience in our practice. As such, patients have come to appreciate and expect new technologies to enter the practice. They are loyal because we strive to meet and exceed their expectations. We see referrals from existing patients because they value the experience they receive, which includes OCT screenings, as well as other equipment not found in all eyecare facilities.

Affirm Practice Identity as Technologically Advanced

Successful practices understand that their practice personality may not suit every patient. Maybe they are too expensive, not expensive enough, spend too much time with patients, or spend too little time with patients. I sometimes come across practices that are proud of the fact they still do things “old school.” There is nothing wrong with some “old-school” philosophies, but technological advances in quality of care, like the OCT, have improved, and as practitioners, we must keep up to date in order to provide quality care.

R. Aaron Werner, OD, is a partner at Werner Optometry, in El Cajon, Calif. To contact:  aaron@wernerod.com.

Reprinted from Review Of Optometry Business Sept 2015

Like so many other doctors in San Diego, let us prove similar value in your practice for 60 days at no cost to you.  Contact Andy Millsom (800) 945-8735 or andy_millsom@optovue.com to schedule your Free 60 Day Evaluation

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Professional Optical Laboratories

Professional Optical Laboratories (POL) is a full service ophthalmic prescription laboratory servicing the optical industry for over 18 years. Located in San Diego CA, Professional Optical Laboratories is an independent optical lab, providing a full range of optical lens products and services.

The management at POL understands the needs of the small business owners, their employees and their patients.  POL offers personalized service, superior quality, quick service and all this packaged with highly competitive prices.  It is POL’s goal to maintain these standards while keeping pace with their growing business and growth is achieved through adaptation and execution. The staff at POL is well versed in the needs of a optical practice and is committed to ensuring high standards meeting or exceeding their expectations. The value of this independent service has become more of an necessity and more so today because of the challenges of an evolving industry.

Professional Optical Laboratories is privileged to be a part of the San Diego County Optometric Society. The leadership at POL is committed to becoming an asset for the members of the society.

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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 Annual Sponsors

August 18, 2016 2-hour CE

Speaker:
Terence Daly, MD, San Diego Vitreoretinal Associates

Topic:
“Macular Degeneration and Parkinson’s disease New pathway for the preservation of vision for patients with Adult Macular Degeneration”

Click here for Lecture Handout

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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

Seeking Optometrist for Full Time and/or Part Time. Must have own liability insurance coverage. Office hours: Mon, Tues, Thurs, Friday: 10-6pm, last pt scheduled at 5pm; Weds: 11-7pm, last pt scheduled at 6pm.  Patients are scheduled every 20-25 minutes and 1 hour lunch. Please attach resume if interested. collegegroveoptometry@yahoo.com (09/16)

Optometrist needed Friday’s in Clairemont.  Please e-mail CV gsneag@pacbell.net  or call 858-560-5181 (09/16)

Part time and/or Fill In Optometrist – private sublease practice looking for part time OD or an OD looking for fill in opportunities with a flexible schedule. Please email CV to dreoptometry@gmail.com (09/16)

Optometrist – Hillcrest practice looking for vacation coverage any days during the last 2 weeks of August.  Preferably, familiar with ExamWriter and Topcon CV5000 refraction.  The right person may lead to future PT opportunity. Please email CV to eyedoc@urban-optiks.com (09/16)

A young, prepared, and energetic new graduate doctor is looking for a full-time/ part-time/ fill-in work in San Diego area. If you are in need of a vacation relief or looking to add a new doctor and grow your patient base, I would be delighted to talk to you. Please call/text (704)777-1986 or email DArdakani@yahoo.com. Thank you in advance for your interest.  (09/16)

Optometrist needed fill-in in San Diego and PT in Oceanside, CA. You will be working with an experienced and friendly optical staff. All the pre-testing will be done by our team.   We prioritize offering the best patient care. Please e-mail CV 1010eyedoc@gmail.com  or call 760-757-8771  (Oceanside) or 619-425-9001 (San Diego) (08/16)

Optometry Practice for Sale in San Diego County Established for 12 years. 1 fully equipped lane. 2015 Gross Income $491,787. Call ProMed Financial for more information on this practice.888-277-6633. 100% Financing Available. REF# OD208 (08/16)

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 toeye3231@gmail.com (08/16)

Optometrist(s) wanted 7 days/week multiple days available for two (2) OD’s P/T or possible permanent Costco Rancho Del Rey (Chula Vista). Immediate openings available, ideal for one OD 4-5 days/week or 2 OD’s to split days. New graduates and retirees encouraged to apply. Must have current insurance and OD license. E-mail CV and additional questions to Dr. Solis: ksolis1@hotmail.com (08/16)

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: VSP Mobile Clinic will be Sep 3rd and 4th– We need one or two optometrists for each day– please contact Dr. Meisel if you are interested in helping!
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

• Click here for most recent SDCOS Board Meeting Minutes

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Another Successful Annual Golf Tournament!

The 9th Annual SDCOS golf tournament was held on the 17th of July for the first time at picturesque Steele Canyon golf course in Jamul. Many members of the society participated and brought their teams to challenge for the top prize as well as participate in several contests at the course. Since Dr. John Riggs started this golf outing in 2008 to raise funds for two optometric charities several years ago, several players have participated in each of the subsequent tournaments. The Lions Optometric Vision Clinic as well as the California Vision Project were the beneficiaries again this year.

The winners of the handicapped team score were Dr. Dick Skay, Gary Deems, Tim Brand and Brian Walker, who barely edged out Dr. Bob Meisel, Craig Alder, Dr. Don and Janet Longacre. The course was tough for many high handicap players, but the format allowed every one of the 42 players to enjoy the challenge and share in the camaraderie. In addition, over 20 rounds of golf and prizes were raffled off at the end of the day.

The chipping contest, new this year, was won by Dr. John Fleming and the putting contest found Dr. Pat Noll as the champion. For the on-course contests, straightest drive was won by Capt. Gene Bailey, longest putt was claimed by Dr. Jason Tu and closest to the pin on a par 3 was Dr. Dick Skay.

Consider joining the golf outing next year, as it will be held on the third Sunday in July, course to be determined. It is for a good cause and is a lot of fun!

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Welcome, new members!!

• Kristin An, OD
• Judy Bavongkhoun, OD
• Jamie Bergmark, OD
• Sarah Chen, OD
• Tiffany Chen, OD
• Bill Codner, OD
• Megan Colletta, OD
• Michelle Cruz, OD
• Dana Gampel, OD
• Rachel Hodge, OD
• Valerie Kitamori, OD
• Anita Koo, OD
• Samuel Levin, OD
• Suzzan Li, OD
• Tina Licina, OD
• Ashley Nakamura, OD
• Phuong Nguyen, OD
• Tammy Nguyen, OD
• Sajal Patel, OD
• Michelle Pham, OD
• Soney Siriphone, OD
• Elesha Starkey, OD
• Kevin Tam, OD
• Kelly Tran, OD
• Monica Vu, OD

Upcoming Events

• 2 Hour CE- August 18th, 2016