The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• ProOcular® daily disposable contact lenses
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message November 2016

So Long and Thanks for All The Fish

As 2016 comes to a close, I’d like to take a moment to reflect upon the fantastic year we have had as a society in this, my final president’s message.  We have accomplished many things this year, including working hard to promote optometry’s political interests, caring for our community through free screenings and exams, and prioritizing improving our skills with quality continuing education.  We did these things together and I have been honored to lead you as president this year.

Being president of the San Diego County Optometric Society is a challenging, but rewarding endeavor and I would encourage any optometrist who has an interest in becoming more involved in the optometric community to consider joining our society’s board.  While this year and the years leading up to presidency on the board has required a great deal of time and commitment, it would not have been possible without support.  First to thank are our society members who are generous enough to volunteer their time in numerous ways.  You have done things such as fly up to the Capitol to talk to our political representatives about optometry on COA’s Legislative Day, volunteer for Monarch School Eye Exams, and walk with us for Step Out Walk for Diabetes (where we made over $6,000!).  Without volunteers our society would not be as extraordinary as it is!

Of course, I must thank those who are in the trenches with me on the SDCOS Board.  We had a very strong board this year including Drs Amanda Dexter, Ketan Bakriwala, Michael Morgan, Robert Grazian, Eric White, David Sherman, Dawn Pewitt, Richard Skay, Lucia Millet, Nickolet Boermans, Susan Cervantes, Robert Meisel, Jack Anthony, Paul Lavin, Andrew Fasciani, Erin Swift, Claire Kosters, John Fitzpatrick, Stephanie Le, W.J. Garvin, Michelle Biaggi, and Byron Newman.  These are the unsung heroes behind the scenes who allow our society to be successfully run.

Our vendor sponsors allow our society to function on the next level with their financial support and enthusiasm for assisting our members’ success with their products and services.  Thank you to all those companies who recognize optometry’s importance and I would strongly encourage our members to support those who choose to support us!

And finally, I must thank the angel of our society who is the face and constant over the years, Nancy-Jo Sinkewicz.  You will find her at all our meetings with a smiling face waiting to check you in.  She is the one behind the curtain, answering your questions by e-mail or phone.  She is the right hand to all of our board members.  On behalf of myself and all the presidents before me, thank you for all your hard work!

It is with bittersweet emotion I write my final message and send-off.  Thank you for the honor of being your president.  Working hard for you has made me a better optometrist and I will always value my time on the SDCOS board.  I look forward to an exciting new year with Dr. Ketan Bakriwala and wish him all the best.

But the year is not over yet!  On November 17th we have our CE event with Dr. David Granet focusing on Reading, Learning, Vision and Adult Strabismus.  Don’t miss our Holiday Party on December 3rd at Tom Ham’s Lighthouse!  Our featured entertainment will be singer/songwriter/DJ Michael Tiernan as we dance and eat the night away on the water.  I look forward to seeing you all there!

---

Retina Corner Update on the Management of Central Serous Chorioretinopathy

By Nikolas London, MD, FACS

Last weekend I had the pleasure of attending the 2016 American Academy of Ophthalmology Annual Meeting in Chicago. The weather was incredible and there was a buzz in the city as the Cubs were about to take on the LA Dodgers for the National League Championship Series. While the AAO meeting wasn’t nearly as exciting, it did present a series of excellent series of lectures during the Retina Subspecialty Day meeting. One of the lectures, given by Jennifer Lim of UIC, gave an update on the management of central serous chorioretinopathy (CSCR) – a condition we all see frequently. In particular, she focused on recent meta-analyses of the efficacy of photodynamic therapy.

We are all familiar with CSCR. Patients tend to be young, type A men, often experiencing stress at home or at work. They often come to us with a short history of central vision loss in one eye and have a normal examination except for a macular serous retinal detachment, maybe with some central retinal pigment epithelium (RPE) changes in one or both eyes. OCT often clinches the diagnosis with the telltale pocket of subretinal fluid, typically associated with a tiny RPE detachment, as well as a thick choroid. Atypical findings would be any macular edema, hemorrhage, uveitis, optic nerve swelling, or multifocal serous detachments, and should make you consider other potential diagnoses. In CSR, fluorescein angiography would reveal a small point of hyperfluorescence that slowly expands.

The vast majority of cases resolve spontaneously, recover to at least 20/30 acuity, and do not require treatment. Up to 50% of cases can recur, and about 5% of cases are chronic, with multiple recurrences, more prominent RPE changes, and more severe vision loss. In cases that do not resolve after about 3 months, and in recurrent cases associated prior vision loss we consider treatment. Most of the time treatment does not improve the final visual outcome, but does hasten visual improvement. One important management point is to identify and eliminate any corticosteroid use, including inhalers and dermatologic creams, if possible.

Numerous treatment options have been explored, and the majority of these have been underwhelming despite good rationale. We have tried agents that inhibit the production of or increase the metabolism of intrinsic glucocorticoids such as epleronone, spironolactone, mifepristone, ketoconazole, and rifampin, we have tried anti-VEGF injections, we have tried aspirin, and we have tried eradicating the common GI bug H. pylori, all with minimal effect. The most effective option is one that has been around for about two decades, photodynamic therapy (PDT). This treatment involves the infusion of intravenous Visudyne, a green dye that is inert until activated by a particular wavelength of light. The Visudyne collects in the blood-rich choroid after 15 minutes, and we then shine a non-thermal laser onto the macula in the area of the leak for 83 seconds. While not a slam dunk, the treatment is effective. During her lecture, Dr. Lim summarized several randomized studies and meta analyses that revealed PDT to be superior than observation and many of the options listed above (all of those that were tested).

While not the sexiest topic, the presentation was probably one of the most evidence-rich and clinically-relevant of the day. CSCR is a disease we all see frequently, and the type A personalities of the patients can lead to long and high-level discussions of the disease and treatment options. It is always nice to come to that discussion armed with the latest understanding of the data.

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)

---

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

DO/DID YOU YAHOO?

By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)

Back in August, Yahoo formally announced that their email service had been hacked. The disclosure was the responsible step to thing to do, but the list of details they DIDN’T disclose is pretty long – and makes the whole incident much more serious. This month’s article covers the details that haven’t been covered as much, and definitely are items to be aware of, especially if you use (or used) their email service at some point in time. Needless to say, we recommend switching to an email service provider other than Yahoo.

1. THE HACK ORIGINALLY OCCURRED IN 2014 Yahoo! Publicly announced the breach in 2016. That alone sounds respectable, but not when you learn they were aware of the situation 2 years earlier. That means people continued to use (and trust) their service with potentially private information up to 2 years before they were made aware of the situation. That non-disclosure most likely led to other issues (bank account info, passwords, private info, etc.) in their account users lives. This makes the issue about more than just the email account itself.
2. THE AMOUNT OF ACCOUNTS AFFECTED WAS GROSSLY UNDER-REPORTED When Yahoo! disclosed the breach, it was initially reported as 200 million accounts compromised. That number was revised to 500 million accounts over the following couple days. 500 million alone is a huge number, but it was still a grossly under-reported count. By the time the dust settled, the accurate number was revised to be over 1 billion. 1 billion accounts makes this the largest hack in the Internet’s history.
3. REQUESTS & RECOMMENDATIONS TO IMPROVE SECURITY WERE DENIED Dating back to 2010, Yahoo! got hacked, along with other email providers at the time (one being Google). This was a separate incident, but Google was quick to make security a top priority. Yahoo! was much slower to act, if even acting at all. Over the years, Yahoo!’s security team repeatedly requested additional resources to improve the security of their services but were continually denied, fearing it might have ‘a negative effect on their users experience’. This led to sub-standard security, ultimately resulting in the breach we are covering in this article.
4. YAHOO HAS BEEN SPYING ON YOU It has now been disclosed that Yahoo! built a custom software programmed to secretly scan all of its users’ emails for specific information, and the results were provided to the US Government. The tool was built in 2015 after company complied with a secret court order to scan hundreds of millions of mail accounts at the behest of either the NSA or the FBI.
   The email search tool was so secretive that even Yahoo’s own security team was unaware of the program. When Yahoo’s CISO Alex Stamos (at the time) found out CEO Mayer had authorized the surveillance program, he resigned from the company, telling his subordinates that “he had been left out of a decision that hurt users’ security.” Stamos now works for Facebook.
5. YAHOO! MAIL DISABLED AUTO-FORWARDING, MAKING IT HARDER TO LEAVE Last month, Yahoo! disabled the ability to forward your email to a different account. No reason in particular was given other than the statement ‘this service is under development’. Keep in mind, forwarding isn’t complicated – it simply take a copy of an email and sends it to another account. In English this means they acknowledge their services are insecure, but have decided to make it that much more difficult for their users to switch to a different/secure service.
   * UPDATED 10/14/2016 – it was reported on 10/14/2016 that Yahoo has re-enabled email forwarding after ‘platform upgrades’. Updated info was posted on ZDNet.

Got questions, or would like additional information? You can reach Dave directly at (619-905-4468) or email dave@GSWS.com.

---

Eye See written by Dr. Byron Y. Newman ZIP CODES: MORE THAN JUST FOR MAIL

Zip Codes have been used for many things since the US Postal Service first established them to ease the delivery of mail. They do not generally respect political or census statistical area boundaries. In fact, a zip code can span in size from a single building or company with a high volume of mail, to large areas that cut across states and the routes for one zip code may intertwine with those of one or more other zip codes, such that the area becomes more conceptual than geographic.

Which brings up the problem of Health Statistics by Zip Code.

Some years ago, the American Journal of Public Health published an article showing that hundreds of articles on health were indexed by zip codes. And, it’s still going on. And, what complicates it even more is the fact that zip codes come and go. Hundreds have been added as well as discontinued. Thus, research in all areas of health, rather than random sampling across state lines, now deal with census tracts, block groups and zip codes, and the results are still being studied to determine which are more appropriate for monitoring socioeconomic inequalities in health.

Perhaps one day you will be able to claim that your zip code is the healthiest in the nation.

---

Is Tactical Marketing Right for Your Practice?

When it comes to marketing your practice, there is no such thing as one approach fits all. Effective marketing needs to be based on what you are trying to accomplish for your unique practice growth needs. We think of practices in one of three stages.  This helps us to formulate the right marketing approach every time.

Stage 1: The Growing Practice 

Tactical marketing is optimal for a practice that is:

• Less than 10 years old
• Has 1 doctor
• Has 1 location
• Generates less than $700,000 in revenue
• Operates in a small to medium sized market

The focus of marketing a young practice is to leverage as much of the yearly calendar as possible to drive product and special appointment sales as the time of year warrants.  This means you use seasonal opportunities such as Dry Eye Treatment Campaigns in the winter, Use It Or Lose It insurance campaigns in December, Sunglass Sales in the summer, Back-to-School Eye Exams in late summer, etc. to create campaigns to drive new patients and build your base. All new patient appointments are good appointments.

Stage 2 – The Mature Practice

As your practice grows and your appointment schedule fills, a new patient marketing strategy suited for a larger practice emerges. If you’ve been in practice over 10 years, or you’ve added a second OD or a second location, or perhaps you are generating over $700,000 in annual revenue, it’s clear that something very right is happening.

Your established practice wants to bring in new patients, but most importantly, you want to bring in the right kind of new patients – patients that are there to take advantage of your specialties (having a specialty is also a part of a stage 2 practice). It may be orthok, scleral or hard-to-fit lenses, low vision, or pediatrics.  The specifics are not important.  The fact that you are expert in something does.

Stage 2 specialties require a lot of community education and so your marketing focuses on one topic for at least a three month period rather than a different topic every month.  We call this type of marketing strategic marketing because you are sending out focused, educational messages that come together to build up your reputation as the local expert.

Stage 3 Marketing: The Thriving Practice

Your practice that is truly thriving has already differentiated itself in the marketplace and is now looking to dominate the local market. Your practice has broken through all barriers; it has been around 15 or more years, has more than three doctors, numerous locations, making upwards of $1.5 – 2 million in revenue.  It is likely operating in a larger market, in which it has already created a distinguished name for itself – which is how it got to this size in the first place.

A practice this size needs to generate a lot of patients, ALL THE TIME!   In order to attract a patient-base of 10,000+ per year … sometimes even 20,000+, your practice needs to completely dominate all the local search results, for miles around.  When patients think of eye care, they must think of your practice first.  Period.

Your stage 3 practice needs to leverage its impressive size, strength and reputation to circle back to the beginning to reel in lots of new patients. Because of its larger size and revenue, a practice of this kind can invest more on its marketing strategy to be everywhere that there are patients searching for anything related to optometry in the area. Your online strategies have now been enhanced by:

• Advanced SEO: Advanced search engine optimization strategy, including on-site and off-site tactics to ensure you are the top local presence in the search results.
• Integrated Campaigns: Incorporate customized online marketing campaigns that reach audiences across many channels with messages that are unique to their practice. Sometimes multiple campaigns are deployed to different audiences.
• PPC (Pay Per Click Advertising): Focused Google Adword campaigns that will bring more attention to your practice on Google search directed toward the people that matter.

The goal of stage 3 marketing is to bring your local online presence from good to the best, in order to experience tremendous growth and visibility that will help you to rise above the competition and stay there.

Which stage best describes your practice?

---

 

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

 

November 17, 2016 2-hour CE

Speaker: David Granet, MD

Topic: Reading, Learning, Vision (1 hour) & Adult strabismus (1 hour)

---

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

Permanent part-time optometrist needed in Chula Vista Tuesdays (9-5) and Saturday’s $400/day (Saturday 9-3) please send resume to sweeterhome2@gmail.com  (11/16)

For Sale Optometric Office San Diego Naval Base (exam and contact lens sales)
3 doctor days (Tues Thurs and Sat (9-4))  sweeterhome2@gmail.com (11/16)

Looking for a permanent part time optometrist in an established family practice in Santee.  Position is for Mondays and Tuesday from 9-6 pm.  Great work environment with knowledgeable and friendly staff. Please email resume or questions    to dreyerene@gmail.com (11/16)

I am offering a full time permanent associate OD position at my office in North County San Diego (San Marcos, CA).  (4 days per week, with potential future partnership/buy-out opportunities).  Position is available as of November 1st.  Please send resumes to drmikafu@hotmail.com(11/16)

Seeking OD for busy practice in UTC area. Need OD for full time and/or part time beginning November. Please contact Dr Elliott Shapiro ateshapiro2956@gmail.com or call 858-774-2931. All inquiries will be kept in full confidentiality. (12/16)

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)

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.

---

Volunteer Corner

Monarch School Screening

Next Screening: March 2017 — 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
• Click here for the new 2017 CE schedule!

Proposed 2017 SDCOS Board Members

1. President: Ketan Bakriwala, OD, FAAO
2. President-Elect: Michael Morgan OD
3. Treasurer: Robert Grazian, OD
4. Secretary: Michelle Biaggi, OD
5. Past President: Allison Pierce, OD, FAAO
6. Membership: Eric M. White, OD
7. Vendor Liaison: David N. Sherman, OD
8. Co-Professional Affairs Liaison:  Dawn Pewitt, OD, FAAO
9. Co-Professional Affairs Liaison:  Amanda K Dexter, OD
10. Governmental Affairs: Richard Skay, OD
11. Co-Communications Liaison: Lucia Millet, OD
12. Co-Communications Liaison: Nickolet Boermans, OD
13. Webmaster: Susan T. Cervantes, OD
14. Public Awareness: Robert Meisel, OD, FAAO
15. OD Relations: John Fitzpatrick, OD, FAAO
16. Peer Review: Paul Lavin OD, FAAO
17. COA HCDS Liaison: Andrew Fasciani, OD
18. LOVC Liaison: Erin Swift, OD
19. Trustee: Patty Cheng, OD
20. Trustee: Tammy Nguyen, OD
21. Trustee: Tina Licina, OD
22. Trustee:  Michael Kling, OD
23. Honorary Trustee: Byron Y. Newman, OD
24. Administrative Assistant: Nancy-Jo Sinkiewicz

Please stay for a few minutes after the November CE to vote on our 2017 slate of officers!!

---

Welcome, new members!!

• Rambod A. Esfandiari OD

---

Upcoming Events

• November 17th: 2 Hour CE: Reading, Learning, Vision (1 hour) & Adult strabismus (1 hour)
• December 3rd: SDCOS ANNUAL HOLIDAY PARTY- Stay Tuned for Details!!!