The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• Upcoming Events

President’s Message May 2017

We are a nation of Givers! As a whole, Americans have a long history of volunteering. In fact, as a part of our constitution, the ability to form voluntary associations has been a treasured aspect of American life since our nation’s founding. Even in our own back yard, roughly 25% of Californians volunteer their time and services to charitable causes! And we, as Optometrists, have a duty to engage in our community as a force for good. With our advanced specialized skills, we have the ability to make such a profound impact in the lives of people who need it the most. Today, I want to focus on two amazing volunteer opportunities we have available for society members.

First, I want to highlight our local charity of choice, the Lions Optometric Vision Clinic. The purpose of the Lions Optometric Vision Clinic (LOVC) is to provide quality eye care for individuals throughout San Diego County who are otherwise unable to obtain assistance through private insurance or other social service agencies. This includes low-income families, or those undergoing rehabilitation programs. The LOVC provides many vision and eye health services for the public, including comprehensive eye examinations, low-cost glasses, dilated retinal evaluations for diabetic patients, Optos retinal photography, vision therapy, and glaucoma screenings.

SDCOS has created an incentive program to those doctors who are able and willing to volunteer for a shift at the LOVC:

• Members who volunteer will receive a free 5-hour CE registration
• Non-members who volunteer will receive a $70 discount off registration for any CE event
• SDCOS will extend this discount up to twice per year per doctor

Additionally, the LOVC is willing to work around any scheduling needs that you may require.

• Patients are typically seen in the mornings from 9am-1pm, but LOVC would be happy to accommodate you in the afternoons if needed
• Patients can also be scheduled in your own offices if you cannot make it to the clinic
• LOVC can arrange for Saturday volunteering if you work Monday through Friday
• You can set your own schedule of how many patients you would be comfortable seeing during your time in the clinic, and you can request a certain age group (e.g. children)

The LOVC and SDCOS have had a very long and successful relationship together and SDCOS is committed to continuing to support the LOVC in any and every way possible. The eye examinations at LOVC are free of cost to those who qualify, but this is largely possible because of the doctors who are so gracious to volunteer their time to provide services to the patients in need. Currently, there is an extensive wait-time for those in need of an eye exam and optical services. SDCOS asks that you please consider donating any time that you may have to help this organization continue to serve a very needing and deserving group of people.

If you prefer to focus your attention internationally, SDCOS has also partnered with Optometry Giving Sight!

In 2003, the World Council of Optometry, the Brien Holden Vision Institute, and the International Agency for the Prevention of Blindness created Optometry Giving Sight, a charity to mobilize resources from the global Optometric community in order to eliminate refractive error blindness and low vision.  Their mission is threefold: dedicating their resources to train local eye care professionals, establish vision centers for sustainability, and deliver eye care and glasses.  Their vision is a world where avoidable blindness and vision loss due to a simple lack of eyeglasses is eliminated by utilizing access to quality vision and eye care services for those in need.

As a partnering doctor, you will have opportunities to hear from Optometry Giving Sight and how you and your practice can support their global initiative by making donations and/or raising funds.  Their “I Care & Share” program is a great way to support their project and also market your practice to patients who value a company which gives back to those in need.  Through this program, you can base your donation on a product or service, such as eyeglass sales.  For example, you could donate $2 for every pair of glasses you sell.  Through this ‘buy one – give one principle’ you are letting your patients know that you care and share!

These fundraising efforts support a range of high-impact, long-lasting programs in underserved communities around the world.  With your help, Optometry Giving Sight supports 35 projects in 27 countries.  They provide vital support to community education and advocacy activities to raise awareness of the importance of eye health and the role of the Optometrist as primary eye care providers.  To learn more about Optometry Giving Sight, please go to www.givingsight.org. For information on how you can help, please contact Eric Anderson at eric.anderson@givingsight.org.

Please let any of our board members know if you have any questions. The possibility for Optometrists to make a huge impact in our communities and beyond is limitless. I encourage all of you take advantage of these opportunities to help not just others, but ourselves as well!

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Retina Corner Blindness in Broward County, Florida

By Nikolas London, MD, FACS

Left eye of a patient with widespread retinal bleeding following an autologous stem cell injection.

The first and foremost rule in medicine is “non maleficence” – do no harm. This is something I remind myself of with every patient I see, considering the implications of the various tortures I inflict: putting a needle in an eye to inject a potentially harmful medication, bathing an eye in a caustic fluid (povidone iodine) prior to said injections, freezing the retina or burning it with a laser, peeling a 20 micron membrane off the surface of the macula, and filling an eye with a bubble of gas that could potentially expand and completely and permanently blind that eye. Of course I do all of these things on a near daily basis, as the alternatives are even worse. I do so with a full understanding of the possible risk, and a determination that the potential benefit outweighs that risk. I do this based on the available evidence, and avoid treatments that have insufficient evidence. We all do this. This is why stories like the one I would like to share with you below are so upsetting.

This is a story of three elderly women who were desperate for treatment for declining vision due to macular degeneration. In researching their options on the internet as many of our patients do these days, they discovered what sounded like an exciting opportunity to participate in a “clinical trial” on www.clinicaltrials.gov. This is website I sometimes recommend to my own patients that is meant to catalogue and provide transparency for all current and recent clinical trials on a particular disease. The trial they found described a potential new treatment option for macular degeneration using stem cells and after an initial inquiry the patients were evaluated at a local medical facility. They were not invited to participate in a clinical trial, but rather were invited to pay $5000 to have stem cells injected into their eyes to improve their AMD. At this point all patients had mild vision loss in the range of 20/70 to 20/200. All were still driving and living functional lives.

After an extensive consent process, the women underwent liposuction to remove abdominal adipose tissue. This was then treated with enzymes and centrifuged to isolate the cellular component. This was then further treated chemically. The treated cells were then suspended in plasma derived from their blood and injected into both eyes, on the same day, by a nurse practitioner. Within the next week they experienced vision loss and, in some cases, severe pain. They presented to the Bascom Palmer Eye Institute and were noted to have severe ocular damage, including widespread retinal hemorrhages, intractable ocular hypertension, vitreous hemorrhage, crystalline lens dislocation, and retinal detachment with scarring. All eyes were treated urgently, but all ended up legally blind with the best vision at 20/200 and one patient with no-light perception in both eyes. It was felt that the stem cells, blood component used for suspension, and inexperienced injection technique contributed to the issues.

This is a terrible situation that could have been avoided. Some of the red flags from a patient’s perspective were that they were asked to pay for the treatment, both eyes were treated with an experimental therapy on the same day, and the injections were performed not only by a non-Retinal specialist, but a non-ophthalmologist. The clinic should have clearly known better as well. It is not clear if they knew this or not, but injecting plasma and other blood products is one of the ways we can induce experimental retinal detachment and proliferative vitreoretinopathy in rodents. A fairly simple internet search would have revealed this. Worse yet if this was known and simply disregarded. Moreover, this “treatment” was clearly experimental with little to no evidence that it would be helpful. Injecting stem cells is not as simple as injecting them into the eye and expecting them to find exactly where to go, what type of tissue to regrow, and what connections to reform.

In a way, this reminds me of a scuba-diving trip I once took with my dad on the Red sea. Incredible place, but one day we found that a huge pile of trash had spilled from a passing ship and was littering the beach and shallow water. We were a bit apprehensive about swimming through the trash, but our dive master wasn’t phased and guided us to our destination. Once we waded by the trash, we spent hours exploring beautiful ocean reefs. As technology advances and once futuristic treatment options become possible for our patients, we will need to do our best to stay informed and to help them navigate the inevitable sea of trash that comes along with it.

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 IS A BEC (AKA CEO FRAUD) – AND HOW TO PROTECT YOURSELF.

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

We’ve spent the last couple month’s discussing different cyber-vulnerabilities, and how to best protect ourselves from bad things happening. This article sticks with that theme as well, but looks into a particularly nasty scam, that if successful, could produce some costly results. This scam is called a BEC (Business Email Compromise), or more commonly referred to as a CEO scam. Here’s a brief overview of how it works, so you can be safe if it looks like one is coming your way.

A BEC is a form of phishing attack where a cyber-criminal impersonates an executive (often the CEO), and attempts to get an employee, customer, or vendor to transfer funds or sensitive information to the phisher. Unlike traditional phishing attacks, which target a large number of individuals across a company, BEC attacks are highly focused. The cyber-criminals will scrape company info online, follow recent company news, and research employees on social media sites in order to make these email attacks look as convincing as possible. This high level of targeting helps these email scams to slip through spam filters and evade email whitelisting campaigns. It can also make it much, much harder for employees to recognize the email is not legitimate.

Victims are not limited to a certain business type: hackers are targeting organizations of all sizes and in all industries. Employees want make their boss happy and usually don’t refuse an order coming directly from possibly the most important person within their company. Employees usually feel obligated to comply with anything their CEO requests, and that is what cyber-criminals put their money on.

The sense of urgency is also critical for these scams to work. Since the recipient of the email feels like it’s an urgent matter and that he can’t reach his boss for a second approval of the transfer, the targeted employee will almost certainly fall for the BEC scam.

The FBI’s website provides an example case study here: https://www.fbi.gov/news/stories/business-e-mail-compromise. The example included a wire transfer for more than $737,000 to a bank in China.

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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Eye See written by Dr. Byron Y. Newman A Golfer’s Question

People seem to have lots of questions about eyes, and we’re supposed to be prepared to answer them all.

I’ve heard some strange ones, as we all have, and we all answer them differently, I’m sure.  Often people will tell me what their last doctor told them, and I’m positive some of them got the advice all twisted around.  I used to shudder a bit over what they think they were told.

But, here’s the golfer’s question that appeared in Golf Magazine some years ago, by Calvin Hsu of Weston, Florida.

How would you answer this one?

Question:  “Can you explain how to use awareness of eye-dominance to my advantage, and how to account for it in the set-up?”

Fortunately, there was an answer in the magazine by optometrist Craig L. Farnsworth.  (His credentials were included.  He was president of Sports Eye Enhancements, Inc. and consultant to many tour players.)

Dr. Farnsworth’s answer:  “First an explanation.  Your dominant eye gets information to the brain a little faster, and is responsible for your aim to a target.”

Then he described how to determine dominancy with a hole in a piece of paper, to look through to determine which eye was used, which he referred to as the aiming eye.  Then he talked about cross dominance, ie a right handed player with left eye dominance.

More of the answer from Dr. Farnsworth, “Cross dominant players sometime fight a reverse pivot.  If you are cross dominant try setting up with your dominant eye behind the ball by rotating your head toward the appropriate ear. ((Right ear, if right handed.)  People who are not cross dominant sometimes need to open their stance a little for both putting and a full swing, whereas cross dominant players usually do best with a square stance.  Also, it’s best to close your non-dominant eye when using spot alignment or the markings on your ball to aim.”

I doubt that I would have explained it exactly like this, would you?

Well, Dr. Farnsworth obviously knows a lot about golf, and he is the author of See it and Sink it: mastering putting through peak visual performance.  (HarperCollins, 1997)

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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!

Annual Event Sponsors Social Hour Sponsor

MAY 18, 2017 2 Hour

Speaker: Dawn Pewitt, OD FAAO
Topic: Update on Central Serous Chorio-retinopathy – VMA vs VMT (2 hours)
Handout: http://bit.ly/2p7AOZr

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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

Regency Eye Care is looking for Optometrists for our locations in El Cajon, Lemon Grove and Oceanside! We have full time positions available and offer competitive salaries, professional liability coverage, incentive programs, paid vacation and medical benefits. Please email odjobs@firstsightvision.net or call (909) 920-5008, EXT 2062, and ask for Jennifer Nelson. (05/17)

Optometrist Needed on Permanent Friday’s. Please email your CV to aooptometry@sbcglobal.net (05/17)

San Diego Optometry Practice For Sale.  Annual Gross $575,000.  Approximately $85,000 in inventory.  Established in 1991.  Located in busy strip center with high visibility.  Doctor is looking to semi-retire and happy to transition practice over to new owner.  Asking $325,000 plus inventory (negotiable).  Please contact Darrin M. Davenport at davenport@darrindavenport.com for full details. (05/17)

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 Screening: Fall 2017
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

Monarch School Spring Volunteer Update:

Group photo of 5 OD’s and 3 pre-optometry club students Dr. Skay performing retinoscopy on a Monarch student

Another semi-annual cycle of screening students and then arranging exams for those referred has ended at the Monarch School for the Homeless in the Barrio Logan area of San Diego. SDCOS ODs have been volunteering at the school for nearly the past decade and have recently been assisted by the VSP Mobile Clinic and their volunteer staff. All of the nearly 300 students are homeless or at risk of being homeless and one of the very few K-12 schools of its kind in the country.

Drs. Dick Skay. Jason Tu, Erin Swift and Marcelline Ciuffreda assisted Dr. Bob Meisel, coordinator for the Monarch program, with the first event on 24th of March. A total of 225 students and a handful of parents were screened and 57 were referred for refractive exams and possible eyewear. Three students from the UCSD pre-optometry club also helped the docs complete a battery of acuity, ophthalmoscopy, retinoscopy and near skills tests.

The VSP Mobile Clinic was driven to San Diego from Sacramento and provided the examination equipment, frames and a fabrication lab on board the specialty motor home. On the 13th and 14th of April, Drs. Stephanie Le and Eric White volunteered with Dr. Meisel to complete exams on 70 patients. Some parents and a few staff at the school as well as most of the 56 students examined were given eyewear on site, but a few with high cylindrical or spherical powers will need to wait for their Rxs to be fabricated and sent from the VSP lab to the school.

The program has closed the loop by determining which students need eyewear, then obtaining their glasses on site. In the past, VSP vouchers were given to those who failed the screening tests. Often the students would or could not get to a provider to obtain needed glasses and they would come to the next screening in 6 months needing the very same services. Now the great majority of students have their glasses dispensed within an hour and are very excited when they receive them.

The next screening and exam cycle will happen in September and October, after the new semester starts. Please consider volunteering as it is a heart-warming experience when these kids thank you for helping them!

 

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

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Upcoming Events

• July 23rd: Annual SDCOS Golf Tournament