The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• GSNVI-TLC is pleased to be offering Advanced Technology for your patients
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message April 2017

Legislation is an important part of how we, as optometrists, are able to practice to the full scope of our training while increasing access to patients who benefit from our clinical expertise. As with previous years, COA has put together an agenda outlining which bills it supports and how we, as primary eye care providers, can engage with our local legislatures to let them know what we need from them in order to improve eye care for the citizens of our great state! Below I want to emphasize a few bills in this year’s legislature that the San Diego County Optometric Society would like you to be aware of, and hopefully, participate in the legislative process.

AB 1110 (Burke)

AB 1110 gives every child the opportunity to have a comprehensive eye exam needed to succeed and ensure clear vision for life. The bill requires each child to have a comprehensive eye exam upon school enrollment. It also respects parental choice by imposing no “opt-out” penalties to parents who choose to forgo their child’s right to an eye exam. Most eye exams and glasses for children come at no cost to families. Under the Affordable Care Act, eye exams and glasses are covered for children. AB 1110 helps parents utilize this benefit and understand that eye exams play an important role in their children’s overall health. Current school screening requirements check for distance and near visual acuities along with a color vision screening and a gross external evaluation of the eyes for obvious eye turns and physical defects. By requiring a comprehensive eye exam by an eye care provider, we will be able to screen for subtle defects that can have a profound effect on a child’s ability to learn (remember that 80% of learning is visual)! Eye tracking, convergence, accommodation, and depth perception screening, along with a comprehensive medical evaluation for eye disease, will be required for all students entering school. Currently, the bill is set for hearing in the Assembly Education Committee on April 5. The bill has garnered support from both Republicans and Democrats. Many Assembly Members from San Diego (Todd Gloria, Rocky Chavez, Shirley Weber) are on the Education Committee and I encourage all of you to reach out to your representative in support of AB 1110.

AB 1092 (Cooley)

At the request of VSP, Assembly Member Ken Cooley has introduced AB 1092, a bill that would restore Medi-Cal coverage of one pair of eyeglasses provided every two years to an individual 21 years of age or older. This bill is co-authored by Senators Jim Nielsen, Toni Atkins and Jeff Stone and Assembly Member Evan Low. This bill is set for hearing April 4 in the Assembly Health Committee.

AB 443 (Salas)

After last year’s stunning defeat of SB 622, COA has decided the overhaul its entire scope of practice legislation. Assembly Member Rudy Salas has introduced AB 443, a spot bill that will ultimately be amended to expand the scope of practice of optometry. Assembly Member Salas is the chair of the Assembly Business and Professions Committee, the committee through which scope of practice legislation must move.  COA is pleased Assembly Member Salas wants to pursue this legislation and looks forward to working with him to craft legislation that will expand access to health care for millions of Californians. Currently the bill is still being written.

Finally, I just wanted to review COA’s Legislative Day for 2017. In years past, April has traditionally been the time that we, as an organization, descend upon the state legislature in Sacramento to educate our representative about how optometrists can provide greater care for our fellow citizens. This year, COA has decided to change the plan and focus more on legislatures in their local districts. Personally, I think this is a wonderful idea that will save costs and allow more local doctors to meet with the Assembly Members in their home districts. While the previous Legislative Days have been a great experience in traveling to the capitol and understanding how the legislative process works, this time COA plans on focusing on educating Assembly members who vote against the interests of optometrists and the patients that we serve. No current dates have been set in San Diego County but rest assured that COA is currently in the process of organizing meetings with our local representatives. Be on the look-out for more information to come!

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Retina Corner OCT Angiography

By Nikolas London, MD, FACS

I remember back about a decade ago when spectral-domain optical coherence tomography (SD-OCT) was first being introduced to the market. The images were gorgeous – significantly higher resolution that the preceding technology, time-domain OCT. However, pretty images alone were not enough to convince a doc to fork over $70,000 for a new machine. I remember very well hearing discussion about the potential utility of the machine and, in particular, whether it added enough information to affect clinical decision making for our patients. At the time we were really using OCT for black-and-white assessments: is there cystoid edema or not in an AMD patient, is a macular hole present or not, is there vitreomacular traction or not. These questions could easily be answered with the older technology. Well, this is a perfect example of one of my favorite Yogi Berra-esque sayings “you don’t know what you don’t know.” Over the next few years as we used SDOCT we realized it’s potential. People started describing subtle yet important findings that would never have been possible before. This reminds me of the current emergence of OCT angiography. Practices will be reluctant to make a large investment into a new technology with uncertain clinical benefit. I thought this would make an interesting topic for this month as you are sure to hear more about OCTA in the months to come and may even be visited by an eager salesman.

First a quick step back. As a fast, non-invasive, and richly-informative imaging modality, optical coherence tomography (OCT) has revolutionized the diagnosis and management of macular diseases. Since OCT’s introduction in the early 1990s, improvements in hardware and software have dramatically improved scanning speeds and axial resolution. With these technological advances, new clinical applications such as OCT angiography (OCTA) have developed. Currently there are two companies with FDA-approved devices capable of OCTA, the Optovue Angiovue (Optovue, Inc, Fremont, CA), and the Zeiss AngioPlex.

OCTA is a novel imaging modality that allows clinicians to visualize retinal microvasculature in exquisite detail in a variety of pathologies such as diabetic retinopathy, retinal vascular occlusions, and dry and exudative AMD. The fundamental idea of OCTA is that in a static eye, the only motion detected is that from erythrocytes (ie. Brownian Motion). With high numbers of OCT B-scans taken rapidly at the same position, a decorrelation signal can be obtained and presented as bright pixels – white is assigned to movement and black to non-movement. These bright pixels, when viewed en face, form an image of the retinal vasculature, which can closely resemble the look of a fluorescein angiogram in which active vasculature appears white and non-active areas are black. Software manipulations can display different vascular levels in different colors. The scan is collected in about 5 seconds and without any injected dye. The end result is a “block” of retinal vasculature that the physician can scroll through to determine the level of a vascular finding.

For all of its benefits OCTA is intriguing, but it does have some drawbacks. As OCTA only demonstrates movement, it is unable to represent “leakage,” “staining,” or “pooling” of dye, which are important features on a fluorescein angiogram (FA). It is also not a dynamic test, and cannot evaluate blood flow. The tests may be a bit more difficult for patients as blinking or any head movement could obscure the results.

Regardless of these issues, I am confident that with time OCTA will soon become a mainstay in retina. We don’t know what we don’t know, and as we gain that knowledge, as we describe new clinical findings, important disease features and variants, and find that we can follow vascular diseases more appropriately and tailor care better for our individual patients, that ten years from now we will wonder how we ever practiced without this technology.

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!

WHAT TO DO IF YOU ARE VICTIM OF IDENTITY THEFT By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com) Last month we discussed data breaches and how we can best prepare ourselves, were it to happen. Hopefully for many of us, we can be aware, and manage to keep ourselves secure. For those that aren’t as fortunate, and do become the victim of a breach, this article is for you. The recommendations were originally written by Symantec, and we’ve provided a list of some additional resources to help, if you find yourself in such a position. At same time, please don’t be shy, and share this with anyone you may know that has been impacted by just such an incident.

1. IDENTIFY AFFECTED ACCOUNTS AND CLOSE THEM IMMEDIATELY In a best-case scenario, you will be able to shut-down or change any credit card, bank or other online service accounts before they can be leveraged by the thief. Err on the side of safety: a little more trouble taken up front to freeze or change accounts can save much more effort later disputing fraudulent purchases by a cybercriminal. While you have your financial institution on the phone or access to them in-person, use this time to discuss any impact this might have on your account and the steps you would need to take if the account was compromised during the attack (i.e. How can you dispute the charges? Can you recover the stolen funds?).

1. SETUP FRAUD ALERT WITH THE 3 NATIONAL COSUMER REPORTING (Equifax, Experian, TransUnion). Contacting just one of the 3 companies will set up the alert for all of them. The fraud alert will tell creditors to contact you directly before making any changes to existing accounts to trying to open up new ones. This is an essential step to control the amount of damage an identity thief can do with your stolen information. This step also allows you to order your credit reports from each of the agencies for free.

1. FILE A POLICE REPORT Ideally this would be done in the area where the crime took place. While this may or may not provide the police enough information to bring the criminal to justice, you can use a copy of the police report or the report number as evidence with your creditors in case they ask for proof. You may never need it, but it may make all the difference later.

1. CONTACT GOVENRMENT AGENCIES If your driver’s license or social security number have been stolen, you will need to contact the Department of Motor Vehicles and the Social Security Association respectively. Additionally, you should report your identity theft to the Federal Trade Commission whom maintains an identity theft database used by law enforcement agencies for investigations.

1. WATCH YOUR CREDIT REPORTS CLOSELY Keeping a sharp eye on your accounts from all three credit reporting agencies is essential as information may not be the same across all three. Some of the credit reporting agencies offer all-in-one reports or just-in-time alerting services for a fee. Depending on the level of potential impact and your concern, it may be worth the quick turn-around time and easy viewing to pay for these additional services. Remember that it may take some time before all of the fraudulent activity to appear on your credit reports.

1. LOOK FOR SIGNS OF IDENTITY THEFT It’s natural to have your guard up after having your identity stolen. During this time, be on the lookout for odd things in the mail, including credit cards you did not request and bills that you normally receive which have gone missing. Being contacted by vendors regarding accounts you are unaware of, or even worse, by debt collectors for purchases someone else made, are clear signs of lingering identity theft problems.

1. HAVE (AND KNOW) WHO YOUR TECHNOLOGY RESOURCE IS

In same way it’s best to know who your mechanic is before the car breaks down, it’s the same with technology. We now have enough technology in our daily lives, that it only makes sense to have a resource that can assist when you have questions and/or find yourself in a rough spot. It doesn’t need to be an official IT services company, it can easily be a family member or friend. If you have no friends or family, I will be your friend (my contact info is below). The important thing is that you know who to contact BEFORE something happens. This step alone can save a lot of time and grief.

ONLINE RESOURCES   Identity Theft Resource Center http://www.idtheftcenter.org Local, non-profit resource for assisting individuals that become victims of identity theft and/or other cyber-crimes.   FTC Identity Theft https://www.identitytheft.gov The federal government’s one-stop resource for identity theft victims. Site provides streamlined checklists and sample letters to guide you through the recovery process.

National Cyber Security Alliance https://staysafeonline.org/stay-safe-online/protect-your-personal-information/id-theft-and-fraud  If you’re the victim of cybercrime, you need to know what to do and respond quickly. This website is an excellent resource of additional information.

FBI INTERNET CRIME COMPLAINT CENTER (IC3) https://www.ic3.gov/complaint/default.aspx/ IC3 provides the public with a reliable and convenient reporting mechanism to submit information to the Federal Bureau of Investigation concerning suspected Internet-facilitated criminal activity and to develop effective alliances with law enforcement and industry partners.

If you have any questions and/or would like additional information, you can reach Dave directly at (619-905-4468) or email dave@GSWS.com.

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GSNVI-TLC is pleased to be offering Advanced Technology for your patients:

Corneal cross-linking (CXL) is a newly approved FDA in-office procedure that strengthens the cornea. Cross-linking works when riboflavin (vitamin B2) is placed onto the cornea and then exposed to ultra violet light. The light causes the riboflavin to fluoresce, leading to the formation of bonds between collagen. We have seen a marked increase in the use of corneal collagen cross-linking as a treatment strategy for progressive keratoconus. At Gordon Schanzlin New Vision Institute-TLC we perform Epithelium-off CXL.  In this procedure, the thin outer layer (epithelium) of the cornea is removed to allow the liquid riboflavin to more easily penetrate the corneal tissue. There are no relative age contraindications but the FDA approved CXL limits its use to the age of 14 and above. There are some relative exclusions including corneal thickness of less than 400 microns, prior herpetic infection, concurrent infection, and severe corneal scarring.  GSNVI-TLC participated in the Avedro crosslinking study and approval of Avedro’s cross-linking system was based on the results of clinical trials that showed the Photrexa/KXL System halted and produced a mild reversal of the bulging of the cornea in patients with progressive keratoconus three to 12 months after the procedure. Patients who received a sham treatment for comparison purposes had a worsening of their keratoconus over the same period.  Crosslinking is the break through treatment we needed in halting the progression of keratoconus and now we are able to provide that to our patients.

Recently, the Symfony intraocular lens has become available as an excellent option for refractive lens exchange and cataract surgery patients who want to be as glasses independent as possible. This IOL is the only presbyopia-correcting IOL that provides an “extended range of vision.” The unique design of the IOL results in a pattern of light diffraction that causes an elongated focal point, thus giving excellent distance vision as well as a range of intermediate/near vision. In order to set realistic expectations, we advise the patient that they may possibly still need reading glasses for fine print or in low light situations. In addition, the design of the IOL results in contrast enhancement for the patient. The IOL comes in a toric version as well for patients with astigmatism. In contrast to multifocal IOLs, this IOL does not have the same incidence of glare and halos (although we counsel patients that this is still a possible side effect). The multifocal IOLs split the light into 2 distinct focal points rather than a continuous range of vision. The other option for presbyopia correcting IOLs is the accommodative (Crystalens). The results with this IOL can be variable depending on how well it flexes once in the eye. The results of the FDA trials for the Symfony were excellent with a clinically significant increase in the range of vision and high patient satisfaction with few complaints of significant side effects. At GSNVI-TLC, we have had great outcomes with this IOL and highly recommend it.

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Eye See written by Dr. Byron Y. Newman Fidgeting and Embarrassing Conditions

Jiggling can help you lose weight.

A recent study showed that those restless joggles, twitches, and trips back and forth to the water cooler or other places, may play a significant role in weight control.

The article in the Knight-Ridder newspaper a few years back, pointed out that this non-exercise activity that some call fidgeting, burns up on average 328 calories per day.

“The little things we do minute by minute and day by day, really do add up,” stated Michael D Jensen who led the study with Mayo Clinic Colleagues.

Embarrassing medical discussions

I once had a young woman in my office who refused ophthalmoscopy on the grounds that looking into her eyes would be too embarrassing.    Some years ago I ran across an article in American Family Physician that listed the top ten medical conditions that are too embarrassing for many people to even discuss.

Here is the list:

10. Menopause
9. Birth control and sex, especially teenagers.
8. Alcohol and drug abuse.
7. Eating disorders.
6. Emotional problems, such as depression.
5. Incontinence
4. Prostate problems
3. Physical and sexual abuse.
2. Sexually transmitted diseases.

1. The most embarrassing condition:  Impotence.

But, now we need to know the answers to some of these things when the condition affects the eyes.

Don’t you find that people are even reluctant to discuss their smoking or drinking habits?  On the other hand I rarely found that teenagers and young women are reluctant to say that they use birth control pills.

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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

MAY 18, 2017 2 Hour

Speaker: Dr. Pewitt

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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

FOR SALE: Topcon IS-80 ophthalmic stand. In good working condition. Includes the slit lamp, keratometer, chair, and overhead lamp. Does not include the phoropter. If you have any questions, would like pictures, or would like to come by the office to take a look, feel free to email me at andrewfasciani@gmail.com (05/17)

Part-time, Full-time Optometrist needed for maternity coverage starting July 10th through October 22nd.  Busy private office located on the 32nd street Naval Base.  Great staff that performs all pre-testing.  New grads welcome. Please email resume and availability to drcas2009@gmail.com (04/17)

San Diego North County practice for sale. 1100sqft. 1 lane expandable to 2  150k plus draw area, Annual Gross: $240,000 Ave Last 3 years on 16-21 OD hrs/week.  68K, plus inventory . willing to assist with financing: This office is a good satellite office.  It has great potential for the right person  eyelb395@gmail.com (05/17)

OD wanted 1 day a week to start, Tuesdays Rancho Penasquitos area. Contact Dr Ring at: eye3231@gmail.com (05/17)

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:odjobs@sdcos.org to put your name on the list.

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Volunteer Corner

Monarch School Screening

Next Exams: Thursday and Friday April 13th and 14th 08:30 – 3:00pm: WE NEED 1-2 MORE DOCTORS ON THE 13th!
Contact Dr. Bob Meisel for more information at rmeisel@netscape.net ; www.monarchschools.org

Lion’s Optometric Vision Clinic

ATTENTION LOVC VOLUNTEER DOCTORS
FREE 5-hour CE for SDCOS Members (maximum of 2 CE’s per year)
$70 CE for Non-Members choice (maximum of 2 CE’s per year)

VOLUNTEER DOCTORS needed for flexible shifts throughout the year. 9-1:00 pm. Monday -Friday 1805 Upas St San Diego, CA 92103
Can’t volunteer at the clinic? See patients in your office. Call 619-298-5273.

DONATE GLASSES
Please bring to a CE meeting or contact the society office at 619-663-8439 for arrangements to pick up.

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

First Place Winner, Aditya Guru Second Place Winner, Savanna House’s Experiment Second Place Winner, Savanna House View of Part of the Exhibit Hall

SCIENCE FAIR WINNERS CHOSEN BY OPTOMETRISTS

Three winners and an honorable mention were selected by the San Diego County Optometric Society public awareness team at the 63rd annual Greater San Diego Science and Engineering Fair (www.gsdsef.com) held on March 15th in Balboa Park.

Aditya Guru was selected as the first place winner with his experiment displayed at the event as Project #219 entitled:  “Identification of Novel Ciliary Protein mutations causing Retinal Degeneration.”    Aditya, an 11th grade student at La Jolla Pines High School was entered in the Senior Medicine and Health Sciences Section for the fair with Ms Julia Newman as his adviser.   The quality of his research led to his award.

The second place winner was awarded to Savanna House, an 8th grade student at St. John School, with project #563 titled:  Does the Human Eye Think?  Savanna’s adviser with Ms Gena Heins.    The project and the title were cleverly presented.

Michael Houk, a 7th grade student at Rhoads School had project #562, with his study on The Effects of motion on Unintentional Blindness taking 3rd place in the society contest.  Michael’s school adviser was Ms Roxanne Hunker.

With over 1,000 entries in the Balboa Park Activity Center covering every imaginable subject from light to medicine, insects to farm animals, and from Chemistry to computers, it was an amazing display of experiments created by young minds.    The society also offered an Honorable Mention prize to Megan Fuson, whose project was #950: “Does Soccer Headgear Prevent Concussions?” Which captured the attention of the society judges.    The three Doctors of Optometry making up the judging team for the Optometric Society were:  Byron Y. Newman, OD, Jack Anthony, OD and Robert Meisel, OD, chair of the Public Awareness Division of the Society.

• Click here for most recent SDCOS Board Meeting Minutes
• Click here for the new 2017 CE schedule!

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Welcome, new members!!

• Dena Shahani
• Lisa Kamino

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Upcoming Events

• April 8th: UCSD Health Fair
• April 13-14th: Monarch School Exams
• May 18th: 2 Hour CE
• June 11th: 5 Hour CE
• July 23rd: Annual SDCOS Golf Tournament