The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• Shamir Blue Zero™
• Money Management
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message August 2017

August is National Eye Exam Month, and it’s no coincidence that it comes right at the beginning of back to school season! The value of good eyesight cannot be underestimated. A 2010 national survey of adults commissioned by Lighthouse International showed that of all the five human senses, the ability to see was overwhelmingly the most important. In fact, 82 percent of people surveyed feared the loss of sight, compared to the loss of hearing (8%), smell (3%), touch (2%), or taste (2%). A 2005 national survey of adults co-sponsored by the National Eye Institute and the Lions Club International Foundation found that when asked to think about certain conditions that would affect their everyday living, 71 percent of people surveyed rated the loss of eyesight as a 10 on a scale of 1 to 10—with 10 indicating the greatest impact. Maintaining good eye health through proper vision care is essential for overall health and well-being.

The school setting provides a public health environment for vision screening children, which, in turn, can serve as a platform for Optometrists to communicate about eye conditions with patients and their families. Many difficulties in school can stem from a learning-related vision problem.  Experts estimate 80% of what a child learns in school is presented visually, and visual problems are often erroneously diagnosed as laziness, learning disabilities, or even severe attention issues. The most prevalent vision-related childhood conditions are simple refractive errors, followed by amblyopia, strabismus, and binocular/accommodative issues. Many parents incorrectly assume when their child passes a school vision screening, there is no vision problem.  While school nurses provide an invaluable service by screening children at the beginning of the school year, there is no substitute for a comprehensive eye exam by an Optometrist. They are not aware that a child who can see 20/20 can still have difficulty with their vision.  In fact, Prevent Blindness® reports that one in four children has an undiagnosed vision problem. In most of these cases, a simple pair of glasses could help provide these children with the clear and comfortable vision they need to learn effectively.

On the other hand, more than 38 million adult Americans suffer from eye diseases and more than 10 million adult Americans have an undiagnosed eye problems or conditions. The most common vision impairments among adults aged 19-40 are caused by simple refractive errors with nearly early 90% of those who use a computer at least three hours a day suffering from vision problems associated with computer eye strain. For adults aged 40 and older, most vision impairments are caused by eye diseases. Many of the most common eye diseases, including diabetic retinopathy, glaucoma, cataracts, and age-related macular degeneration, typically do not have early warning signs but can have devastating consequences for our patients. Macular degeneration is the leading cause of vision loss and blindness among Americans age 65 and older, affecting 2 million Americans. Glaucoma affects more than three million Americans, but only half are aware they have the disease because the symptoms are so subtle. Diabetes is the third leading cause of blindness in the United States but the leading cause of vision impairment in patients under 50.

While these statistics are no revelation to eye care practitioners, most of our patients are not thinking about these things when they come in for a routine eye exam, or when they decide to skip their visit this year because their glasses seem okay. With the advent of disruptive technologies that offer to bypass the whole medical exam and write a questionable eyeglass prescription by pressing a few buttons on a smart phone app, it is now more important than ever to educate our patients on the importance of their annual eye exam!

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Retina Corner Micropulse Laser – Snake Oil or Holy Grail?

By Nikolas London, MD, FACS

Over the past few months our clinic has started treating select patients with micropulse laser, and I thought this month would be a good opportunity to review what exactly micropulse laser is, at least to the best of my ability given the relatively little information we have regarding its mechanism of action, utility, and indications. One of my Retina colleagues recently commented to me that micropulse is not only completely harmless, but a therapeutic option for literally every retinal condition. While hard to believe, I am trying to keep an open mind.

Standard laser, or photocoagulation, works by directing an intense beam of collimated light toward pigmented tissue. At the dermatologist, this is melanin in the skin, and for us it is melanin in the RPE and choroid. This light energy is quickly converted to heat, and at standard levels produces immediately visible white retinal burns that represent localized tissue destruction. We use this therapeutically to create a barricade around retinal breaks, and to destroy certain retinal lesions. Micropulse (aka subthreshold) laser, on the other hand uses extremely short bursts of laser, where the tissue is only exposed to laser power for 5% of the laser’s pulse – if the laser pulse is 200 milliseconds (ms), the power is active for only 10ms. As a result there is no visible retinal burn and, at least theoretically, no tissue damage. The tissue is stressed but not destroyed, and natural repair mechanisms are purportedly upregulated. One of these mechanisms may be the activation of heat shock proteins, which have manifold functions improving cell survival and function in response to acute stressors.

Despite being around for several decades, micropulse has gained only minimal traction in Retina. Part of this has to do with a lack of high-quality randomized, controlled clinical trials comparing its efficacy to other treatment options, and part has to do with the spotlight-stealing advances we have seen for wet macular degeneration, diabetic macular edema, retinal vascular occlusions, macular hole repair, and retinal detachment repair, not to mention the futuristic arena of retinal implants, stem cells, and gene therapy. Maybe the time has come to revisit micropulse.

While I’m not convinced micropulse laser is an option for EVERY retinal condition, we do have evidence it is effective for diabetic macular edema (for which it is FDA-approved), central serous retinopathy, and it likely reduces the conversion rate of dry to wet AMD. For now, however, we are starting with sicker eyes where there is severe and “permanent” damage. Until we are convinced we are not putting healthier eyes at risk, we are starting with patients who are desperate for some improvement and who have no other options. We have treated patients with center-involving geographic atrophy as well patients with scotomata from prior surgery, retinal detachment, closed macular hole, or macular toxicity. It is too early to tell what effect the treatment is having, but we have seen a few already with striking improvement in macular function. One particular patient of Dr. Tornambe’s, a patient who had suffered from pericentral distortion for years related to prior macular surgery literally came to his follow-up appointment in tears he was so happy with the improvement. A reaction like that is hard to dismiss.

Again, I plan to keep an open mind regarding this. While I am certainly skeptical, I sure would love to have another way to help patients see better, particularly those who have lost hope.

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!

IF HIPAA’S GIVING YOU THE BLUES, WE’VE GOT SOME GOOD NEWS!

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

GSWS provides HIPAA audit and compliance related services. When we speak with folks about HIPAA, many claim it is a 4 letter word (despite it’s having 5 characters). My 9 year old says it sounds like HIPPO and he thinks that’s funny. I think there’s an argument where each of those is correct, but at the end of the day – folks are just trying to understand what it really means and how it affects them/their practice.

For this months article, we’ve included some of the more common questions we get asked on this topic. Please give a look we hope this helps answer some questions you may have.

WHAT IS HIPAA? HIPAA (Health Insurance Portability and Accountability Act), sets the standard for protecting sensitive patient data. Any company that deals with protected health information (ePHI) must ensure that all the required physical, network, and process security measures are in place and followed. Initially passed in 1996, updated by a law called HITECH in 2009 and in 2013, (under the larger “Omnibus” rule) rolled the requirements of all 3 legislation into 1 act. For the sake of sanity, HIPAA, HITECH, and the Omnibus Rule all refer to the same concept: The HIPAA regulations.

WHO DOES HIPAA AFFECT? In short, everyone. Medical practitioners are responsible for managing client data within HIPAA’s compliance regulations. Patients affected with how their ePHI/PII is classified and it’s levels of privacy.

WHAT IS EVERYTHING REQUIRED TO BE HIPAA COMPLIANT?  The HIPAA framework includes 18 standards and a total of 36 implementation specifications that detail the framework for compliance. To see a complete list of standards and regulations, please visit the HIPAA Security Regulations and Standards Section of this document.

THOSE REQUIREMENTS CONFUSE ME, WHAT ARE MY OPTIONS?  Most common for medical practices is to hire a consultant (like us) to navigate them through the process. It can be tricky, and the penalties can be expensive, so it’s not something to be taken lightly. Upon completion, your practice will have a complete HIPAA reference manual, fully updated with all the information required from an audit. In English, we’ll be giving you exactly what a potential HHS HIPAA auditor will be looking for.

SO I HIRE YOU FOR AN AUDIT AND THIS ALL GOES AWAY? Nice thought, but no. Compliance with the HIPAA Security Regulation is an on-going process with periodic reviews and evaluations required. Best practice is for a consistent reviews. Reviews can be based on calendar (i.e. every 6, 12 months) or when there is a significant change to the organization (individuals leave, new hires, changes in technology, etc.). Additionally, part of the HIPAA framework adoption process states someone be identified as the designate HIPAA Security Officer for the practice. This can be an employee within the organization, or by a 3rd party (like us). Part of the overall process will define what makes best sense for the specific organization.

FINE, WHAT DO I DO NEXT?  We can help. Give us a call at 619-825-4797 or email us at info@GSWS.com. First thing we are going to do, is simply get together and discuss how the process works. There is no pressure, requirement to sign up or any cost for an initial consultation.

Please be aware, we did scale back the amount of questions included to control the length oif this article. To see the whole article, please visit here: https://gsws.com/security/hipaa/

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Eye See written by Dr. Byron Y. Newman ACNE SUFFERERS ARE DEPRESSED BUT THE FUTURE IS BRIGHT

Teenagers for generations have been plagued with acne, those red pimples that mar the faces of millions of boys and girls.  According to The British Journal several years ago, even mild to moderate acne can lead to severe depression.  They go on to say that compared to the population as a whole, acne sufferers were far more likely to say they had contemplated suicide. Parents and professionals need to look for behavioral signs such as difficulty in school getting worse.  Psychiatrists point out that in comparison, only about 2 to 3% of people have even thought about suicide.

But, new evidence reported in the London Telegraph by writer Henry Bodkin last Fall points out that spotty teenagers may have the last laugh over their peers with perfect skin. Research found that those who suffer from acne are likely to live longer.  Their cells have a built-in protection against aging, which is likely to make them look better in later life, a study has found.

By the time she reaches middle age, the spotty girl who could never find a boyfriend could be attracting envious glances from her older peers.

Experts had already noted that signs of aging such as wrinkles and thinning skin often appear much later in people who have experienced acne.  Acne sufferers appear to age more slowly than in those who have not experienced any acne in their lifetime.

Now, scientists believe they may have discovered why.

A study of white blood cells taken from individuals affected by spots showed they had longer protective caps on the ends of their chromosomes. Called telomeres, the caps can be compared with the plastic tips that stop shoe laces becoming frayed.

Check out Dr. Newman’s website, www.thehumorfactory.com!!!

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Shamir Blue Zero™

Shamir Blue Zero™ is a new state of the art, nearly clear lens, that absorbs HEV blue light.  This revolutionary lens provides a protective solution for most Shamir Freeform® designs, making it idea for everyday progressive, single vision and work solutions.

Overexposure to HEV light can lead to tired eyes, dry eyes, eye strain, insufficient visual contrast and headaches. At worst, it increases the risk of macular degeneration and retinal disease and we are constantly exposing ourselves to this harmful blue light. Not only are we exposed when we are outdoors in the sun, we are also exposed indoors with artificial light and digital device usage around the clock.  With continual exposure throughout the day most people experience a hard time falling asleep and daily fatigue.

Shamir understood the need to provide patients a protective solution.  Just as importantly, they wanted an opportunity to provide eye care practitioners a high level of protection to patients.  The new state-of-the-art, nearly clear lens, was developed in response to this growing demand of need protection from potentially harmful light falling within the 415-455nm range of the light spectrum.

Shamir Blue Zero™ is currently available in 1.67 and Trivex.

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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   Featured Event Sponsors

Click here to access the outlines from June’s Retina Symposium

August 13th: 5 HR CE

Topics:

• “Cornea Cornucopia – The Basics of Uveitis” (Walter O. Whitley, OD, MBA FAAO)
• “Childhood Glaucoma – New drugs, new concepts and controversies in glaucoma” (Pinakin Gunvant Davey, PhD, OD, FAAO)

 

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.

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Classifieds

For Sale by Owner: Established optometry office in Mission Valley, Spacious and open floor plan, 1,320 square ft., fully equipped one exam lane and on-site edging lab with stock lenses. All furnitures and display cases are custom made. Over 1,000 frames inventory. Asking $149k obo Please email t11le@hotmail.com or call 760-670-6775 for more info Thank you!! Looking for part-time OD.  (08/17)

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. (08/17)

ODO Eye Care is a private practice in La Jolla looking for a friendly and warm associate optometrist. We are looking for someone temporary for 1-2 days a week to begin soon until the end of September. However, for the right candidate, we would like them to stay on as an associate for 1-2 days a week afterwards. Competitive per diem. New grads are welcome! Please email CV or questions to olivia@odoeyecare.com (08/17)

No More Shoulder Pain!!!  For Sale: Marco TRS 5100 Digital Refractor.  Purchased in 2011 for $16,350.  Excellent condition.  Willing to sacrifice at $8,500.  Includes the M & S Chart system that syncs with the phoropter.  ALSO: Marco Chair and Stand (older) $2,000.  email:  elizchristensen@gmail.com (08/17)

OD needed in El Cajon Saturday (10-06) Sunday (11-05) Monday (10-07) with available future dates and vacation relief dates available. $400 per diem with additional bonuses available. Please email kvintam@yahoo.com with any questions and CV if interested. (07/17)

Volunteer Corner

Monarch School Screening

Next Screening: Fall 2017
Contact Dr. Bob Meisel for more information at rmeisel@netscape.net ; www.monarchschools.org

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Volunteer opportunities with Tzu Chi Foundation:

• October 22nd in Mountain Empire

Please contact Dr. Bob Meisel for more information

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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)

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Flying Samaritan Optometry Clinic – Tecate, Mexico

The SDSU Flying Samaritans are asking for any optometrists that would be willing to volunteer on Saturdays and accompany other volunteers to their optometry clinic in Tecate, Mexico.  It is not necessary to be fluent in Spanish, a translator can be provided. The clinic is located about 40 miles southeast of SDSU. Their goal is to provide free eye exams, glasses, and access to other free medical benefits to the underserved communities of Baja California. They are looking for volunteers for the following dates: August 19th, September 23rd, October 21st. Please contact Dr. Bob Meisel if you are interested or have any further questions!

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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.

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

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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!

Welcome, new members!!

• Brianna Kebo
• Edward Tran
• Sherry Liu
• Sloan Rajadhyksha
• Alexandra Scovill
• Adam Tayman
• Sandra Harpster

Upcoming Events

• August 13th: 5 hr CE
• September 21st: 2 hr CE
• October 7th: SDCOS Legislative Advocacy Day
• October 19th: 2 hr CE