The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• ProOcular® daily disposable contact lenses
• Helping Athletes Win with High Performance Contact Lenses
• A Novel Combination Therapy for Patients with Dry Eye Disease
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message October 2016

Walk with Us!

Every October the San Diego County Optometric Society comes together to support a cause near and dear to the optometric community:  the fight against diabetes.  We invite you to join us as we walk in Step Out: Walk to Stop Diabetes.  You can help make us stronger and increase awareness, by joining our team as a walker, virtual walker, or donor.

Click here to view the team page for San Diego County Optometric Society

If the text above does not appear as a clickable link, you can visit the web address:
http://main.diabetes.org/site/TR?team_id=731512&pg=team&fr_id=11539&s_tafId=617039

Why do we walk?  We walk because our friends and family are among the 30 million Americans living with diabetes and 86 million living with prediabetes.  We walk because in diabetic adults 40 years or older, 4.2 million (28.5%) people have diabetic retinopathy and 655,000 (4.4%) have advanced diabetes with severe vision loss, making diabetes the leading cause of adult-onset blindness.  An estimated 11.3 million will have diabetic retinopathy by 2030.  We walk in the hope that we can increase awareness, promote healthy habits to avoid diabetic risk, contribute to improving access to medical care and effective treatment, and ultimately reverse the Diabetic epidemic in our country.

So what are you waiting for?  You can make an impact in the fight against diabetes.  Join our team and walk with us!

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Retina Corner HORV: A Devastating Potential Complication of Cataract Surgery

By Nikolas London, MD, FACS

Last weekend was the 49th annual meeting of the Retina Society, a members-only meeting of some of the giants in our field. This year, Andre Witkin, one of my good friends and cofellow from Wills Eye Hospital was inducted in large part due to his recent work describing a potential complication of endophthalmitis prophylaxis, primarily during routine cataract surgery. Last year, Witkin and colleagues described a series of 11 eyes of 6 patients who developed this condition after uneventful cataract surgery. All eyes had a similar presentation: extensive retinal hemorrhage and vascular occlusion with severe loss of vision. All received 1mg of intracameral vancomycin at the end of the case. The authors called this condition hemorrhagic occlusive retinal vasculitis, or HORV. Patients presented with progressive loss of vision one day to two weeks after surgery and underwent an extensive and unrevealing workup. Most patients ended up at 20/100 or wore, 7 of 11 developed neovascular glaucoma, and 4 eyes ended up NLP.

While this complication appears to be quite rare, the prophylactic use of vancomycin is becoming increasingly common. A logical question is why. It likely stems in part from a 2007 ESCRS study that revealed a 5x reduction in endophthalmitis rates with the use of intracameral cefuroxime at the end of cataract surgery. Since this time, with the support of thought leaders and national organizations, the percentage of cataract using routine intracameral antibiotics has more than doubled from 15% to 36%. Most surgeons use vancomycin or moxifloxacin for logistical reasons. Of note, at least one large retrospective study failed to show any reduction in endophthalmitis rates with intracameral vancomycin. Moreover, there is the possibility of promoting drug resistance, and the CDCP recommends against the prophylactic use of vancomycin for this reason.

So, what is the etiology of this terrible outcome? Unfortunately it is not entirely clear, but it appears that it is a type of immune, or allergic reaction to the medication. This would explain the common exposure to vancomycin in all 11 reported cases, as well as the delayed reaction following surgery.

This small series has created quite a big stir, and is a topic of conversation at many recent meetings. Several recommendations have emerged. Witkin et al. recommend against the use of prophylactic vancomycin during surgery and if the medication is used, waiting at least two weeks before operating on the other eye. They suggest a suspicion of HORV if an eye presents with delayed vision loss following surgery. In terms of management, there is probably little hope of improving vision if there is substantial ischemia, but there may be some benefit from high-dose systemic and/or intraocular corticosteroids to mitigate further inflammatory damage. Pan retinal photocoagulation and anti-VEGF injections may also be helpful, particularly in preventing neovascular glaucoma. It is also prudent to avoid intravitreal vancomycin in cases where an atypical endophthalmitis is suspected, as this could compound the problem.

As with other rare complications of surgery, this is another thing we can warn our patients about, but reassure them that it is very unlikely to happen. It will be interesting to see what we discover over the next few years about this condition.

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!

MEET PHIL THE PHISHERMAN

By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com) Meet Phil. Phil seems like a nice guy and someone easy to get along. Truth is, Phil is not a nice guy. He’s really someone skilled in social engineering and is just telling you what you want to here for his own benefit. He knows how people behave, react emotionally and ultimately want to be trusting of others. Phil will use everything he knows for his own gain – at your peril.

This month’s article covers some of Phil’s different tricks and methods, along with tips so you can better avoid the Phil’s in your life.

1. PHISING
   This is when Phil sends you emails that try to lure you into providing personal information. The emails look like they are from legitimate organizations, often ones you know. They ordinarily use threats, warnings, or enticements to create a sense of urgency. You’re usually asked to click on a link. If you do, it can lead to a spoofed website. The site looks real enough to trick you into entering personal information.
2. SPEAR PHISHING
   This form of phishing targets individuals or companies. The emails appear to be from an entity you know because spear phishers use information they already have about you to create more personalized, real-looking emails
3. SMISHING & PHISHING
   Very similar to phishing, this is when criminals use automated dialing systems to call or text you with messages intended to trick you into sharing personal information. The message will direct you to a phone number or website that asks you for the information.
4. AVOID PHISING, SMISHING & VISHING
   Here’s some tips to help keep Phil at bay:
   1. Never click on links in pop-ups or those in emails and text messages from unknown senders. Be cautious about clicking email and text message links even from known senders.
   2. Don’t trust contact information provided in emails, text messages or pop-ups. Check into its reliability on your own.
   3. Don’t respond to text or automated voice messages on your mobile phone if they are from an unknown or blocked caller.
   4. Know that most legitimate companies and organizations won’t request personal information via email.
   5. Be cautious about downloading email attachments. Ensure you know and trust the sender.

Got questions, or had a special experience with Phil yourself you can share? Give us a call (619-825-4797) or email (SDCOS@GSWS.com). We’d love to hear it – and are happy to help best we can – no strings attached.

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ProOcular® daily disposable contact lenses

Introduced to the optical market in Q1 of 2016, Comfort Vision was launched with the goal of providing consumers with superior vision health and wellness, plus a better quality of life, through revolutionary eye care technology and high-quality supplements.

ProOcular® daily disposable contact lenses offer unique design, affordability and convenience by helping first time wearers see their best every single day. More than just affordable, the lenses have a dual aspheric design with distinctive front surface engineering that brings all light rays to a focal point to improve vision, while the back surface fits the cornea for improved wearability.

To deliver a more comfortable lens, Comfort Vision™ integrates unique wetting agents in an exclusive formulation that is new to the U.S. market and made with dry weather and tear circulation in mind. The broader, multi-curve design on Comfort Vision™ lenses makes wearing them a cinch.

ProOcular® daily lenses are sold in both 30 Pack and 90 Pack configurations. ProOcular Lenses are only available through your OD office.

For more information about Comfort Vision products visit: Comfort-Vision.com

Media Representative

Trevor Whitehead
Marketing Coordinator
Email: Trevor.whitehead@carlsbadtech.com
Ph: 760.431.8284 ext 277

Robert Peel
Sales Representative – San Diego County
Email: robert.peel@comfort-vision.com
Ph:858-260-9298

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Helping Athletes Win with High Performance Contact Lenses

Sharp, stable vision is more than a luxury for athletes—it’s a necessity for competitors, student athletes and weekend-warriors.  Athletes often prefer doctors with a reputation for serving their unique needs. Specialty contact lens expertise can help ODs develop a winning reputation in the eyes of athletes. Here are three ways to serve this exciting niche.

1. Put your Best Foot Forward

Is a serious runner more likely to spend $50 on department store shoes or $100 on custom orthotics?  Passionate athletes will rarely be satisfied with off-the-shelf options, instead purchasing equipment from someone knowledgeable about their specific needs. There’s no reason why that someone can’t be you.

But where should you start? “If you are serious about helping athletes, you have to have the best products available,” says Alan Berman, OD. “In order to start helping athletes see better, you have got to put them in a product that will give them their maximum vision.”

2. Offer the Necessary Equipment

If you want to make sports equipment for eyes your specialty, consider the playing environment as well as the physiological characteristics of the patient’s eye.

Wearing contact lenses instead of glasses or goggles provides many benefits for athletes. However, GP lenses may not be best for athletes who require superb optics, due to lens movement, awareness, and risk of debris getting under the lens. Thankfully, hybrid lens designs resolve the need for compromise. They deliver GP vision, with a soft skirt that provides comfort and prevents dust from getting under the lens.

3. Hone In On Specifics

When selecting a contact lens for athletes, dynamics of play and the patient’s position are critical.  Does the patient require stability in a prolonged upward gaze or is rapid eye movement typical in the sport? Reagrdless, you will need to ensure positional stability.

Fitting contact lenses on athletes with astigmatism presents challenges. Even small amounts of cylinder can impact performance. However, lens rotation is not ever acceptable. “Athletes are in various positions,” says Dr. Berman. “Their head, their body, the ball that they are looking at is in motion, so it is important to have a lens that is stabilized.” Toric lenses can be troublesome in this regard, since athletes can’t risk waiting for lenses to reorient.  A hybrid lens like Duette that is not affected by lens rotation is preferable in such cases.

Everyone Wins

“Athletes are very competitive people and will do whatever it takes to get better,” says Dr. Berman. “All it takes is helping one or two athletes and they are going to tell their teammates; they are going to tell their parents; they are going to tell their friends — and it just kind of mushrooms”.  Fitting custom lenses like Duette can give athletes the edge they need to win, while building loyalty within your patient base, and reaping the benefits of referrals too.

Learn more about Duette hybrid contact lenses at SynergEyes.com, or contact Tera Baratta: 760-419-5958 or tbaratta@synergeyes.com.

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A NOVEL COMBINATION THERAPY FOR PATIENTS WITH DRY EYE DISEASE

Authors: William D Smith, OD, Department of Veterans Affairs, Assistant Clinical Professor, University of Incarnate Word, Rosenberg School of Optometry and David McMahon, MBA, OcuSci Inc.,

ABSTRACT:

PURPOSE: To better understand the efficacy of a proprietary daily Dry Eye Protocol consisting of Omega 3 dietary supplement and daily ocular compress, on patients with established ocular surface disease based on clinical findings and the Ocular Surface Disease Index (OSDI).

METHODS: This four-week, clinical-based, open-label, multi-center cohort study recruited 37 subjects to use a combined daily protocol of nutritional therapy via an oral triglyceride form omega-3 supplement (Ultra Dry Eye TG, OcuSci Inc. Del Mar, CA) and the application of a moist, heated eye compress (Dry Eye Compress, OcuSci Inc., Del Mar, CA) for four weeks.

RESULTS: A total of 33 patients between 18-75 years of age completed the four-week protocol.  The patients on the Dry Eye protocol showed significant improvement from baseline demonstrated by a decrease in OSDI scores by 54% (P=0.0015) on average with over half of the patients reported becoming asymptomatic of dry eye symptoms.  Improved tear breakup time (TBUT) and Meibomian function was also appreciated during the study.

CONCLUSION: Tear film improvement highly correlates with a modified dry eye severity scale, where function of Meibomian glands and stabilization of the lipid layer greatly reduce patient symptoms.  Daily use of the Dry Eye Protocol showed significant improvement in OSDI and should be considered as a first line therapy for patients with dry eye disease.

Keywords: dry eye disease, warm compress therapy, ocular nutraceuticals, omega 3, meibomian gland disease

Contact Author: William D Smith,  Email: awqwadoc@gmail.com

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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

October 20, 2016 2-hour CE

Speaker: David Sendrowski (Click here for brief bio)

Topic: Updates in Glaucoma: Advances in Monitoring Glaucoma Patients (1hr) and Clinical Cases in Glaucoma (1hr)

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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

Practice wanted. Local Optometrist interested in purchasing a private practice in San Diego.  Please contactdr2020eye@yahoo.com (10/16)

For Sale Volk double aspheric 78D lens. Ophthalmoscope Welch Allen 2.5 V rechargeable handle. Best offer. Old A O spot retina scope (free) Please call 619 461 8254 (10/16)

Optometrist needed Friday’s in Clairemont.  Please e-mail CV gsneag@pacbell.net  or call 858-560-5181 (10/16)
Dr. Jack Anthony, the Society Optometrist Relations Liaison, offers a unique service to the San Diego County optometric community. Several lists are kept on file for doctors seeking the following, or any combination thereof:  • positions   • fill-in work • part-time work • full-time work • to purchase a practice • to fill positions • to partner in a practice • to sell a practice There is no charge for this service.  Please contact Dr. John Fitzpatrick at E-mail: jpfod@aol.com to put your name on the list.

For Sale In San Diego Excellent net profit makes this a great opportunity. In a free standing building with great parking. The business has been established since 2003. Opportunity to grow, for more information reply back at americaneyeglasses@gmail.com (09/16)

OD wanted 1 day a week to start, Tuesdays   Rancho Penasquitos area. Contact Dr Ring at: eye3231@gmail.com (10/16)

Dr. Jack Anthony, the Society Optometrist Relations Liaison, offers a unique service to the San Diego County optometric community.  Several lists are kept on file for doctors seeking the following, or any combination thereof:  • positions   • fill-in work • part-time work • full-time work • to purchase a practice • to fill positions • to partner in a practice • to sell a practice There is no charge for this service.  Please contact Dr. Jack Anthony at E-mail: odjobs@sdcos.org  to put your name on the list.

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Volunteer Corner

Monarch School Screening

Next Screening: VSP Mobile Clinic will be October 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

Please join us in participating in the annual Step Out Walk to Stop Diabetes. You can sign up to fundraise or walk, or you can make a donation. The best choice is to do all three! For any of you who are new to this SDCOS annual event, fundraising is easy and the walk is fun! This year it is on a Saturday morning (October 22 @ 8:00 AM). Team SDCOS has been the top fundraising team in our category for years we would love to keep our streak going!! Click HERE for more details and to register.

• Click here for most recent SDCOS Board Meeting Minutes

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Welcome, new members!!

• Rambod A. Esfandiari OD

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Upcoming Events

• October 20th: 2 Hour CE: Glaucoma Update
• October 22nd: Annual Step Out Walk to Stop Diabetes 5K
• November 17th: 2 Hour CE: Reading, Learning, Vision (1 hour) & Adult strabismus (1 hour)
• December 3rd: SDCOS ANNUAL HOLIDAY PARTY- Stay Tuned for Details!!!