The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• DIGITAL EYE LAB a division of ABB OPTICAL GROUP
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message February 2017

A couple of years ago I spent a weekend in Monterey in order to attend COA’s President’s Council. As the new SDCOS president, I am particularly interested in learning ways in which our society can become as powerful as possible and continue to be a strong presence at the local, state, and national levels.

What it comes down to is membership: STRENGTH IN NUMBERS.

Being associated with AOA, COA, and SDCOS allows us all to give our voice, create change, achieve goals, and ensure the future of our profession. The more people that we have standing and working together, the louder our voice will be, the more support we will have to create change, the easier it will be to achieve goals, and the stronger we will be to ensure our future. I encourage you all to continue your membership and become as involved as possible. I ask you to reach out to our colleagues who are not aware of the importance of membership within our society so that SDCOS may continue to grow and thrive!

With that being said, I wanted to give you all a brief outline of some of the membership benefits that you may not be aware of:

• AOA and COA are constantly fighting legislative battles to protect our profession. These include initiatives to improve our reimbursements and prevent cuts in reimbursement, allow ODs to be included in certain federal incentive programs, prevent discrimination of ODs on insurance panels, and most recently to expand our scope of practice.
• COA offers a free, continually-growing library of in-depth fact sheets addressing a wide variety of scope of practice and practice operation topics.
• The Member Media Center (MMC) through the COA website offers content for members to use in their newsletters and social media sites to help inform the public about important eye issues.
• COA has a Member Resource Center in which there are dedicated COA staff members who are available to answer common practice-related questions- from the steps to take to get on a health plan’s medical panel, to employment and workers’ compensation issues.
• Eyelearn is an online benefit exclusively offered to AOA members that is comprised of an easy-to-use centralized online learning resource with access to journal articles, webinars, practice management resources, etc.
• Business and Career Success webinars are offered by AOA with topics including medical records and coding, HIPAA updates, PQRS, malpractice, etc.
• COA provides constant updates on various topics with Government Affairs Weekly emails, California Optometry (the official publication of the COA), COA Member News monthly newsletter, AOA’s daily First Look and weekly AOA Focus e-newsletters, and the monthly AOA Focus magazine.
• Discounts on continuing education events including Monterey Symposium, OptoWest, and AOA’s Optometry’s Meeting.
• Opportunities for free continuing education (6 hours annually) through articles in California Optometry as well as further CE online through CE@HomeOnline
• Great deals as COA members from Vision West buying group, Mercer Insurance, Warren G. Bender Insurance, IC System debt collection, Heartland Payment Systems merchant card processing and payroll services, and Constant Contact email marketing.
• To ensure state and federal compliance with labor laws, COA provides discounted subscriptions for mandatory posters.
• As a COA member there is an opportunity to enroll staff as AOA and COA Paraoptometric Members at no charge to aid in enhancing the skills and productivity of your staff.
• AOAExcel’s Medical Record and Coding Services allows you to consult an expert with questions regarding accurate choices for procedure and diagnosis codes, changes in Medicare coding policies, ICD-10 preparation and conversion, and participation in PQRS through AskTheCodingExperts@ExcelOD.com
• As an AOA and COA member you are listed on each website under the Find An Eye Doc search portals to assist the public in finding an you.
• Optometry’s Career Center through AOA provides a great placement service for opportunities throughout the lifecycle of a practice.
• COA Members have access to a social media consultant who can offer advice, training, and resources to build and maintain your social network.
• The Legal Service Resources Program provides members up to one-half hour (30 minutes) of telephone and research work per month with an attorney at no cost. The program offers services that will assist members in areas of the law related the practice of optometry including Licensure, Business Taxes, Regulatory and Contract Issues to name a few.

Please utilize these tools that are provided to us with our membership fees. We have a lot of great opportunities as members that we need to take full advantage of. Not only are we protecting our profession by being a member of AOA, COA, and SDCOS, but we also have so many resources available to allow ourselves to succeed on a daily basis!

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Retina Corner Love Hurts: Bilateral Central Vision Loss in a Romantic Middle-aged Man

By Nikolas London, MD, FACS

I hope everyone is doing well and had a wonderful winter holiday. I think this will be published closer to Valentine’s Day so, Happy Valentine’s Day! In that vein, I thought it would be interesting to review a case that is potentially the product of romance. This is a patient of the esteemed Matt Langford, who seems to have his fair share of very interesting cases.

The patient is a 47 year-old man with no past ocular history who presented to my Coronado office with a several month history of blurred vision in both eyes that had progressively worsened over the previous several months. In particular, he described small, hazy spots in his central vision with difficulty reading.  He denied any associated ocular symptoms, including photophobia, pain, redness, new floaters, or photopsia. He denied any systemic complaints and felt he was in very good health, exercising regularly. He denied any family history of eye disease. His social history was remarkable for marital stress and recent divorce, but he denied excessive drinking or tobacco use. His only medication was testosterone injections for “overall health.”

On examination, best-corrected visual acuity was 20/60 in both eyes. Intraocular pressure and anterior segment examination was normal. Posterior segment examination revealed blunted foveal reflexes with subtle yellow spots in the fovea bilaterally (Figures 1A and B). Fluorescein angiography was unremarkable bilaterally. Spectral domain optical coherence tomography (SDOCT) was remarkable for loss of foveal detail OU, including prominent disruption of the ellipsoid zone and other outer retinal layers (Figures 2A and B).

What’s your diagnosis?

The differential diagnosis in this case includes other causes of bilateral foveal damage with yellow discoloration. This includes solar retinopathy, medication toxicity, atypical central serous chorioretinopathy (CSCR), adult-onset vitelliform dystrophy, and chorioretinitis. In our patient, it is appropriate to consider whether the testosterone injections are related and potentially exacerbating an underlying CSCR. The OCT images are also very suggestive of solar retinopathy, although he denied any history of sungazing or possible laser injury.

Additional Case History:

On further questioning, the patient admitted to recent use of  “poppers” while partying with friends in San Diego. He noted using poppers shortly prior to the onset of the vision loss. I recommended complete cessation of any popper use. I also advised using oral lutein, which has shown potential benefit in recovering vision.

Discussion:

“Poppers” is a term referring to recreational drugs of the alkyl nitrite family. They are often used to induce brief periods of euphoria and can also serve as an aphrodisiac and myorelaxant. Poppers are fairly common in the gay club scene. In 2006, the active ingredient in most popper brands, isobutyl nitrite, was reported to be a Class II carcinogen. This led to many brands switching their active ingredient to isopropyl nitrite. Since that time, several case of poppers maculopathy have been reported in the literature.

A consistent clinical picture has been described. Patients typically present similar to our case with painless blurred vision, as well as possible central scotomas, metamorphospia, and photopsia. Visual acuity is often mildly affected. Examination typically reveals bilateral, small foveal yellow spots. The only imaging abnormality is seen on OCT, including disruption of the foveal cone outer segments and the photoreceptor inner segment/outer segment junction (aka. ellipsoid zone).

The mechanism by which poppers cause foveal damage is not fully understood. The most likely etiology is from nitric oxide (NO). Alkyl nitrites are volatile NO donors, and nitric oxide is a known cause of photoreceptor toxicity. Nitric oxide also decreases the threshold for phototoxicity, possibly explain the strong resemblance between poppers maculopathy and solar retinopathy. The natural history of poppers maculopathy is somewhat variable. Patients often recover vision following cessation of the drug, however there is often some permanent deficit.

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)

Figure. Poppers maculopathy. Color fundus photos and corresponding spectral-domain OCT scans of the right (A, C) and left (B, D) eyes of a patient with poppers maculopathy. Note the bilateral small, foveal vitelliform lesions in the color photos. In C and D, note the loss of detail of the foveal architecture, particularly the outer retinal layers.

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

WHAT IS A REVERSE IMAGE SEARCH, AND WHY THIS MAY BECOME YOUR NEW GOOD FRIEND

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

We use search engines all the time to help us find different information we seek. We type in keywords and/or phrases to help describe what we are looking for, and the search engine responds with the most relevant info it has on the requested topic. Imagine just how lost both you and the search engine would be if you didn’t have (or know) what keywords and/or phrases to use?

What if the only thing you had available was a picture? That’s what a reverse image search is. Instead of providing text words, you upload an image (or provide the website link the image is featured on) into the search engine and it replies with what information it has in relation to the image. Rather than describe this in more detail, it’s best to just experience how it works in action. Google (https://images.google.com – click the camera icon to left of search) and TinEye (https://www.tineye.com) are probably the 2 most popular ones to check out.

One of the more common uses for this feature is trying to track down the history or origin of the photo itself, but its benefits can extend much further. The more creative you can be, the more valuable this resource becomes. To help get your ideas flowing, here’s a few examples how it can be beneficial:

• You can search/see if your logo, headshot or your products are being used on other websites
• Perhaps you have a piece of furniture, product or unique item you want to learn more about
• Perhaps a person you met on social media or dating site you want additional information about
• Perhaps there’s a business, property, location or vacation spot you want to learn more about
• Perhaps you are doing a background check on a perspective new employee, intern or tenant

The list of ideas are the limit of your needs and imagination. But hopefully this helps get you started down this path and this resource serves you well.

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

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Eye See written by Dr. Byron Y. Newman The Mental Health of Teens

Teenagers live in  what most of us think of as a “happy-care-free life”.

Unfortunately, such is not the case, and the pressures we may not see severely affect them.

Just take a look at the statistics:

• 800,000 American teenagers suffer from depression.
• Another 500,000 require attention for suicide attempts.

This is according to a study some years ago by officials at Columbia University and reported in The Nation’s Health.

Suicide is the 3rd cause of death among teenagers, and the second cause of death among college age youths, as reported by the National Mental Health Assn.

What can be done about it, you ask?

An initiative known as “Positive Action for Teen Health” based on the research done at Columbia University will provide screening for mental health risks so that American teenagers at risk can be selected out for help.  And there is a program called “Teen Screen” that has been working on this.

Teenage mental illness also has consequences later in life—research from sociologist Ronald Kessler at Harvard Medical School has revealed that more than half of all cases of adult mental illness begin during the teenage years. “Five out of 10 of the leading causes of disability worldwide are significant mental illnesses, and the number one overall cause of disability in the United States is depression,” notes Eric Caine, co-director of the Center for the Study of Prevention of Suicide at the University of Rochester, who is not associated with TeenScreen. “If you start to look at their economic impact, the World Bank, which is not exactly a soft-hearted group, found major mental disorders have a huge impact far exceeding infectious diseases and a number of cancers, but there’s an inordinate lack of attention toward them.”   It is estimated that 10% of all teenagers have mental disorders, and over a million of them are taking Ritalin routinely.

TeenScreen is a nationally-recognized program developed by Columbia University to identify risk factors associated with depression, anxiety, suicide, body image, trauma and alcohol and substance abuse in youth.   It is now managed by Stanford University.    In Marin County, CA, TeenScreen is offered through Family Service Agency of Marin, a division of Buckelew Programs. Their mental health professionals conduct voluntary screenings in local schools. The program has been growing each year and just expanded to middle schools in addition to high schools.

David Shaffer, MD, Chief of Child and Adolescent Psychiatry, who was involved with the research at Columbia University, was quoted as saying, “It is now possible to find young people with serious mental health problems, many who are suffering silently and don’t know that what they are experiencing isn’t normal.”

As an aside, I once asked a mental health worker, “Just what is good mental health?”

She answered, “I don’t know how to describe it really, but I know when it isn’t there.”

Let us hope that those working on this through various groups can help more teenagers who don’t realize that good mental health just isn’t there.

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DIGITAL EYE LAB a division of ABB OPTICAL GROUP

Fabricating innovative products using cutting-edge laboratory equipment and technology

A fully automated optical lab dedicated for freeform, digital lens fabrication, DIGITAL EYE LAB (DEL), continually invests in technology, equipment, staff and training to deliver the finest, cutting-edge lens designs and top quality service.

DEL fabricates single vision and progressive digital lens designs from Shamir and Seiko as well as its own proprietary products – the Digital Master Series and Digital 5.0 Lens Series. Additionally, DEL is a Unity-enabled optical laboratory accepting VSP orders and fabricating Unity lenses and coatings in-house.

AR coatings produced in-house include Shamir Glacier plus, Unity performance coatings and DEL’s proprietary portfolio of premium AR coatings including CLARIS HD, CLARIS HD PLUS and CLARIS bluDEFENSE.

The recently launched bluDEFENSE Comfort Portfolio is an innovative collection of the lab’s bluDEFENSE products offering flexible solutions for digital eye strain discomfort. Included in the Comfort Portfolio are CLARIS bluDEFENSE AR and the new bluDEFENSE Lens Materials. bluDEFENSE AR reduces scatter and glare while reflecting harmful blue light and UV. The Lens Materials are available in four different materials – polycarbonate, 1.60, 1.67 and 1.74 – and can be used in almost any lens design.

EZCONNECT is the revolutionary service designed by DEL for ordering a complete frame and lens package. With EZCONNECT customers can order eyewear, lenses and fabrication all at once while eliminating the need to send frames to the lab. This convenient process significantly shortens turn-around times and helps ECPs better manage their frame inventories.

Take a look inside the lab with DEL’s new video, which will take you right on to the lab floor and highlight everything from the products DEL fabricates to the efficient new equipment that was installed during a recent expansion. Visit DigitalEyeLab.com to view the video from the home page.

DEL has been named as one of Vision Monday’s Top Independent Labs the past four years and is proud to support the San Diego County Optometric Society’s independent eye care professionals with eyewear that is truly personalized for their patients’ needs and lifestyles. To learn more or get started, visit DigitalEyeLab.com or contact your DEL Eyewear Specialist or ABB OPTICAL GROUP Account Manager, today!

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For over 20 years Gordon Schanzlin New Vision Institute has been a part of the San Diego community.  The doctors at GSNVI-TLC have proudly partnered with the Optometric community for all of these years.  AT GSNVI-TLC we offer advanced technology and, more importantly, a vast amount of clinical experience, services and specialties to assist you in the care of your valued patients.  Over the years our doctors have pioneered advancements in refractive surgery and continue to pursue excellence in all facets of our patient care.  Here are some highlights of what GSNVI-TLC can provide for you and your patients.

• GNSVI-TLC is pleased to have participated in the development of topography driven LASIK and the results post market in our clinic have been excellent.
• Full array of advanced intraocular lens options for cataract and refractive lens patients based on the lifestyle and needs of each individual patient.
• The doctors of GSNVI-TLC contributed data to assist with the Randelman paper, and were the first practice to embrace the Belin Ambrosio software in San Diego – Dr. Schanzlin lectured on the subject following its release.
• GSNVI-TLC participated in the Avedro cross linking study that led to its approval and offer a full spectrum of treatments for Keratoconus including cross linking (utilizing the FDA approved Avedro system)  Intacs, and DALK.
• Blepharoplasty performed by an ophthalmologist to ensure proper eyelid positioning for optimal ocular comfort and vision.
• Partnering with TLC has opened up the ability for you and your patients to participate in the Lifetime Commitment program – highlights the importance of annual eye health checkups.
• Glaucoma Management.
• Corneal disease and management.
• Investigators for clinical trials for presbyopia options (Refocus, Presbia, Acufocus, Revision Optics).
• Early adapters to All Laser LASIK in 2003.
• ICL surgery for non-laser candidates.
• Compassionate, caring and certified staff.

Our Doctors

• Michael Gordon, M.D.
• David Schanzlin, M.D.
• Alison Gordon, M.D.
• Bavand Youssefzadeh, D.O.
• David Geffen, O.D.
• Brittany McMurren, O.D.

We are dedicated to assisting you and your patients.  Our doctors and staff are happy to answer any questions you may have!

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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 Featured Annual Sponsors

February 26, 2017 5-hour CE

Topic: 4th Annual Refractive Surgery Updates

Speakers:

• Dr. Allison Gordon
• Dr. Michael Gordon
• Dr. Gayle Howard
• Dr. Angela Nahl
• Dr. Mihir Parikh
• Dr. David Schanzlin
• Dr. Bavand Youssefzadeh

Topics:

• Topo-guided LASIK
• New refractive surgery procedures
• Pearls & Pitfalls of treating glaucoma pre vs post cataract & refractive surgeries
• Corneal Collagen Crosslinking
• Advances in LASIK
• Determining Candidacy for Refractive Surgery
• Amniotic membrane use for corneal surface issues
• Advances in PRK
• Multifocal IOL Update
• RLE and/or Corneal Inlays
• ICL Update
• New refractive surgery procedures

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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

PT and FT Optometrist Positions We are looking for a part-time general optometrist with 3 years’ experience or residency training to include working Saturdays to join our busy Carlsbad, CA group practice. This position needs to be filled by mid-February. We are also looking for a full time optometrist with either 3 years’ experience or residency training in vision therapy and rehabilitation for neurological disorders.  Our office offers full scope optometric care including hard fitting contacts and medical care, vision therapy for special needs populations, visual rehabilitation for patients with stroke and brain injury, and we have all the latest in diagnostic equipment and a great staff of 22 employees. Please email your CV, references and salary requirements to drdaniel@drsofoptometry.com (03/17)

FT / PT / or Fill in Optometrist Looking for Full or Part time OD to work at moderately busy practice(s) Flexible schedule, convenient hours, great environment and staff In addition to providing high quality and comprehensive eye care the ideal candidate with have strong work ethic, great personality, professional chair-side manner, high energy, motivated, and possess a can-do attitude to deliver exceptional patient care. Please email your CV, references and salary requirements to keane.kmp@gmail.com (03/17)

For Sale Well maintained Retina camera.  Zeiss Stratus OCT (Needs a new bulb) You are welcome to come in and take a look and try out both. Best offer accepted. Located in San Diego if interested, please call or text 760-402-6518 or email dr2020eye@yahoo.com (03/17)

Office in Southern SD County, looking for fill-in OD coverage for any of the following dates: Feb 28th-Mar 12th (Mon through Sat). Nice and helpful staff will pretest for you. Friendly patients with light-moderate work load. Located in beautiful shopping center with stores and restaurants.  All shifts include 1hr lunch. Potential part time position possible based on future office needs, if interested. Please send CV/resume to ethan.diep.od@gmail.com or for more info (02/17)

Optometrist Part-time and Fill-in San Diego and Oceanside We desire a motivated, professional, energetic and caring Optometrist to be part the team in our office. We provide care to all ages emphasizing, vision, wellness, medical, contact lenses and glasses.  Our team is available to pre-test and to assist you.  Please submit your resume to 1010eyedoc@gmail.com or call 760-757-8771 the office manager Brandea (02/17)

Fill in OD needed in the week of Feb 20th.  We are happy to take any days that you are available, other than Thursdays. Please contact dr2020eye@yahoo.com (02/17)

Seeking permanent Associate Optometrist 4-5 days a week in our private practice in Poway.  Enjoy a comfortable pace with our all-digital equipment.  Staff performs pre-testing, including retinal photos.  Please email resumes/questions to MichelleKingOD@gmail.com (02/17)

Coastal Skin & Eye Institute is looking for an energetic, personable family optometrist to help grow a new business model.  Come join our team of Dermatologists and associates as we provide premium personalized skin and vision care to the Carmel Valley area.  We are looking for applicants who are eager to spend time with patients and explain their eye care options and needs.  We will have in house optical and a team of dermatologists providing both general derm and skin cancer care to cosmetic treatments.   We are here to serve the active Southern California lifestyle. Additional information. 1) Full or Part time, 2) CA .TLG Optometry licensed, 3) Comfortable with EHR, 4) Referral Ophthalmologist available, 5) Comfortable with fitting toric and multifocal contact lenses in soft and RGP materials and 6) Full scope of practice. Lease contact: michellecrosby@gmail.com (02/17)

Practice for Sale Busy part time practice in classic stand-alone professional building in East County for sale. Established in 1987, long time patient base, perfect for part time practice, semi-retired or Southern California golfer. lmgro@aol.com or 619-665-0981 (02/17)

FOR SALE Busy, thirty-five year practice in La Mesa, near I-8, in a single story professional building with excellent visibility The office is 2600 sq. feet (expandable), three lanes, two special testing rooms, large optical, and roomy, central clerical area. A finance service has already packaged the loan information to help with financing, the doctor is willing to carry part of the loan and work part time as needed for easy transition and patient retention. The staff is excellent and very efficient. Contact: drvidal@2020lamesa.com (03/17)

Dr. John Fitzpatrick, 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.

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Volunteer Corner

Monarch School Screening

Next Screening: Friday 24th March 08:00 – 1:00pm –we need 3 more doctors to help!!!
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!

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Welcome, new members!!

• Pamela Hoo
• Jena Jung
• Craig Liu
• Jennifer Lo
• Cathleen Yuen

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Upcoming Events

• February 10th-11th: COA’s Annual House of Delegates Meeting, San Fransisco
• February 26th: 5 Hour CE: “4th Annual Refractive Surgery Updates”