The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• Focus: What EVERYONE Could Benefit from Personally and Professionally
• Corneal Collagen Cross Linking (CXL) for Keratoconus
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• New Members
• Upcoming Events

President’s Message November 2017

As fast as 2017 arrived, it’s now coming to an end. For me personally, it seems like it was just yesterday that I nervously held my first board meeting followed by my first time hosting a CE lecture. Throughout my time on the executive board, I’ve learned and grown a lot, both personally and professionally. Working my way up the society has taught me valuable skills such as leadership, resource management, and public speaking, among others. I now feel better prepared to serve my patients and community than I did as a fresh faced graduate just a few years ago. And none of this would have happened without the support of you, the members. Everyone I have encountered throughout my years in the society has been nothing short of supportive and insightful on how to thrive as a new doctor navigating our profession. For that, I say “Thank You.”

One of the biggest achievements I am proud to be a part of this year is the passage of AB 443. In conjunction with the COA, San Diego ODs were instrumental in getting the votes needed to pass this important piece of legislation. The crown jewel of this bill is getting the right to control our own drug formulary. Now, whenever a new medication is available to treat an eye-related condition that is in our scope, we no longer have to return to the California general assembly to ask permission to use that medication: Our state board will be able to regulate what fellow ODs can and cannot prescribe. This will help reduce health care costs by cutting down on unnecessary referrals while at the same time providing better eye care to the nearly 40 million residents of California! Likewise, AB 443 will also allow ODs to perform corneal foreign body removals with a needle, check blood sugar on diabetic or suspected diabetic patients, and perform skin testing for allergies, among other things. Again, thank you to all of you who participated in our local legislation day last month to help secure this big win on behalf of Optometry.

I also want to acknowledge the 2017 SDCOS Board Members. Each of these volunteers has played an instrumental role in the success of our society this year. Without each and every one of these doctors, we would not be able to hold all of the events that SDCOS is so proud to offer to our members and the community. To Drs. Allison Pierce, Michael Morgan, Robert Grazian, Michelle Biaggi, Eric White, Dick Skay, Dave Sherman, Andrew Fasciani, Paul Lavin, Nickolet Boermans, Lucia Millet, Susan Cervantes, Bob Meisel, John Fitzpatrick, Erin Swift, and Byron Newman: “Thank You” for volunteering so much of your time and energy throughout the years to the society. Likewise, I want to acknowledge our trustees for 2017: Drs. Dana Gampal, David Ardakani, Wendy Gross, David Wong, Patty Cheng, and Mickey Kling have all stepped up to continue to make our society one of the best in the nation. To everyone I have named: You have all done such an amazing job this year and I am so proud to be able to work with you. I appreciate everything that you do for the society and all of the hard work you put in to ensure the advancement of our great profession! Last but not least, I want to recognize everything Nancy-Jo Sinkiewicz does for SDCOS. She is the true president of the society, answering your questions, organizing our CE, and keeping the whole society functioning on a day-to-day basis.  On behalf of myself and all the presidents before me, “Thank You” NJ for all of your hard work!

But now is the time for celebration, not nostalgia! I would like everyone to join me at our Holiday Party this year. It will be held at the Admiral Kidd Banquet Center in Downtown San Diego on Saturday December 9th. Cocktails will begin at 6:00 pm, followed by dinner at 7:00 pm. Thanks to generous sponsorships from VSP, VisionWest, and WestPac Financial, ticket prices are only $25 dollars and include dinner, drinks, DJ, and dancing all night! Quantities are limited, so be sure to register today. I want to see everybody out on the dance floor, saying “Goodbye” to 2017 in style!

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Retina Corner Vitreoretinal Surgery Using a 3D System and Heads-up Display.

By Nikolas London, MD, FACS

As we approach the holiday season, it seems like a perfectly good time to reflect on our toys. I’m not talking about the buckets of legos or mountains of stuffed animals my boys have, but OUR toys – our laser-equipped imaging systems that deliver near-cellular level scans of the retina, cornea and anterior chamber, our cameras that provide 200-degree views of the back of the eye, our slit-lamp microscopes and ophthalmoscopes that enable gorgeous views of the eye and it’s tissues. If there’s one thing we can all agree on about our field, it’s that we have cool toys. This month I wanted to tell you about a new technology (toy) that we just acquired at Scripps Memorial Hospital – a 3D head’s up system for vitreoretinal surgery. One of the first in San Diego and a technology that could have a dramatic impact on how we do surgery. Before I forget, I would like to invite anyone who is interested to join me in the operating room to watch a case using the system.

The NGENUITY 3D system for vitreoretinal surgery (Alcon, Fort Worth, Texas), consists of a 4,000-pixel display with an ultrafast, high-definition digital camera that allows for high-resolution, three-dimensional viewing in the operating room. The HD camera is integrated into the surgical microscope, and the surgeon and all staff wear polarized, 3D glasses while viewing the screen. The experience is immersive. It is difficult to describe, but the level of detail when peeling epiretinal membranes off the macula is astonishing and beautiful. Beyond beauty, however, it is important to consider how this technology might impact outcomes.

Figure 1. NGENUITY System including the 55-inch 4K OLED screen and the HD camera mounted on the microscope.

The most obvious benefit is the potential for an enhanced view while performing surgery. A basic premise for successful surgery is to maintain an optimized view, a capability that often defines the difference between experienced and young surgeons. Although the advanced optics of current surgical microscopes provide a clear view, digitalization may provide enhanced surgical visualization as it has for photography and other fields. NGENUITY 3D augments depth perception, which is particularly helpful during macular surgery and difficult diabetic dissections where axial identification of fine planes is paramount. The NGENUITY 3D camera can also digitally amplify the recorded signal to reduce endoillumination while maintaining sufficient visualization. Decreased endoillumination during macular cases may reduce the risk for photoxicity and also minimizes glare during the fluid-air exchange.

Figure 2. View of the retina while performing small-gauge vitrectomy on the NGENUITY screen.

Another clear potential benefit is surgeon ergonomics. An American Academy of Ophthalmology survey noted high prevalence of neck, upper- and lower-extremity pain in 52 percent of surveyed physicians. Operating with NGENUITY has allowed a more ergonomic posture during surgery, resulting in noticeably less back pain and fatigue at the end of longer operating days. While I currently don’t suffer from any back pain, I certainly embrace any advances to minimize the potential for this. The biggest relative benefit is likely to the surgical assistant, technician, students, and other members of the surgical team who don’t get the beautiful view that the surgeon sees through the operating microscope. Everyone in the room wearing the 3D glasses sees the same amazing image. This has clear benefits for the surgical assistant, but also improves engagement of the rest of the team and provides a wonderful educational opportunity. Also in the vein of education, the system records 4K video that can be edited in 2D or 3D. I am hopeful to share 3D surgical videos at one of my upcoming lectures with you.

And last but not least, NGENUITY 3D has the ability to project information such as surgical settings and information as well as preoperative imaging such as optical coherence tomography scans and fluorescein angiograms on the display screen during any portion of the operation. The company is also planning to integrate intraoperative OCT that will show a real-time OCT image of the retina to help with surgical dissections and manipulation. This creates a digital platform to enable multimodal surgeon interaction.

As I told the Alcon representative today, the technology is not perfect, but it is certainly exciting. It reminds me a bit of the iPhone when it came out 10 years ago. Clearly the technology had room for improvement, but it wowed us when it arrive changed the game in its field. I am excited to see how the NGENUITY system will develop over the next 10 years.

Again please feel free to contact me if you are interested in observing a surgery using the NGENUITY system. 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!

THE BIGGEST CYBERSECURITY DISASTERS OF 2017 (SO FAR)

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

2017 has seen an inordinate number of cybersecurity meltdowns. And these aren’t just your standard corporate breaches, we’ve seen state-sponsored ransomware, leaks of spy tools from US intelligence agencies, and full-on campaign hacking. And that’s just the beginning. This article recaps and highlights some of 2017’s biggest cyber-incidents so far serve as a reminder of just how chaotic things have become.

• SHADOW BROKERS/NSA
  Shadow Brokers is a hacking group that reached notoriety in 2016, with claims they breached the spy tools of the elite NSA-linked operation known as the Equation Group. In April, they released a trove of NSA tools, including a Windows exploit known as EternalBlue. Eternal Blue below (see WannaCry & Petya below), as this was the catalyst to other events we’ve seen this year.
• WIKILEAKS CIA VAULT 7
  On March 7, WikiLeaks published a data trove containing 8,761 documents allegedly stolen from the CIA that contained extensive documentation of alleged spying operations and hacking tools. WikiLeaks claimed s that Vault 7 revealed “the majority of [the CIA] hacking arsenal including malware, viruses, trojans, weaponized ‘zero day’ exploits, malware remote control systems and associated documentation.”
• CLOUDBLEED
  Cloudflare offers performance and security services to about six million customer websites (including heavy hitters like Fitbit and OKCupid). In February, they announced that a bug in their platform caused leakage of potentially sensitive customer data. While the leaks were infrequent and only involved small snippets of data, they drew from an enormous pool of information.
• WANNACRY
  On May 12 a strain of ransomware called WannaCry spread around the world, walloping hundreds of thousands of targets, including public utilities and large corporations. This is the Malware outbrak that impacted over 10,000 organizations, 200,000 individuals, more than 150 countries within a 24 Hour Period. Same incident I covered when presenting at SDCOS earlier this year.
• PETYA/NOTPETYA/NYETYA/GOLDENEYE
  A month or so after WannaCry, another wave of ransomware hit targets worldwide. This malware, called Petya, NotPetya (among other names) was more advanced than WannaCry. While it infected networks in multiple countries, it is  suspected that the ransomware actually masked a targeted cyberattack against Ukraine. The ransomware hit Ukrainian infrastructure particularly hard, disrupting utilities like power companies, airports, public transit, and the central bank, just the latest in a series of cyber assaults against the country.
• 198 MILLION VOTER RECORDS EXPOSED
  On June 19, researcher Chris Vickery announced a discovery that would give even the most jaded security expert pause. He had discovered a publicly accessible database that contained personal information for 198 million US voters—possibly every American voter going back more than 10 years.
• EQUIFAX
  With 2 months left to go in the year, Equifax currently is our gold medal winner. From  initial mismanagement, to whom it’s impacted and what they have done post-incident has been a textbook example of how NOT to do things. Rather than rehash/relive those details, please check out last month’s SDCOS article on the topic: http://www.sdcos.org/newsletter/2017-10/#techcorner

Got questions or want help?
Please let us know if you have any questions. We’re here to help. 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 Munchausen Syndrome

Baron Munchausen was an 18th century German cavalry officer (1729-1797) whose tales of his incredible adventures in Russia became classics and were written up and published in 1785 in English.  His feats were so incredible, in fact, that to many they read like fiction and became synonymous with telling out and out lies.

In medical circles, Munchausen Syndrome is a psychological condition in which the person repeatedly seeks medical treatment for feigned or self-induced illnesses, all in an attempt to gain attention.    In cases of Munchausen “by proxy,” parents create illnesses in their own child.   It can be likened to hypochondria, and in optometry school we called it malingering. Probably many of us have heard untrue stories of their conditions that we could not verify.    According to an item in RN Magazine a few years ago, there are three forms of the disorder.

1. Dramatic medical complaints that suggest a major emergency.  In spite of many medical visits, and even surgeries, with many well-educated professionals remaining baffled.  These people have become familiar with medical terminology and routines and can be aggressive in demanding attention.
2. There are some who induce their illnesses by taking toxic substances, or even injecting themselves with something to be ill, or even create the appearance of being ill.
3. Munchausen by proxy, which can be a severe form of child abuse, where the parent(s) describe or elaborate symptoms or even in some cases cause their child to be ill.

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

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Focus: What EVERYONE Could Benefit from Personally and Professionally

By WestPac Wealth Partners

Think of the most recent day you had that lacked impact, progress or momentum. Now think of the last day that you had that WAS impactful. What was the difference? One word that stands out to me is Focus.

Your clients lack this (focus) physically, which is why they come to visit you for a prescription . And you? With the many hats you wear as a professional, partner, business owner, and, let’s be honest, a s a basic human being, how can you do it all?

The short answer? You can’t , at least not alone. Every day something has to be procrastinated or handed off to someone else to manage so you can focus on the critical or key components that make the greatest impact.

One area that is often overlooked, with your plate full, is protection. Proper protection for your health, home, car, business, income.

Most people know they need to insure their life, their car, and their home or condo. But they often overlook insuring their most important asset – their ability to earn an income. Your income is the primary source of funding for a lifetime of things, from basic necessities to the hopes and dreams you have for yourself and those you love. The $3 – 9 million or more you’ll likely earn over the course of your career is surely an asset worth insuring.

But what would happen if your income stopped because you were too sick or injured to work? Without a paycheck, how long could you pay your rent and utilities, buy groceries, make student loan payments, etc.? In all likelihood, your life would be thrown significantly off course.

Before you say this could never happen to you, consider the fact that 1 in 4 of today’s 20 – year – olds will become disabled before they retire. ¹ And if you’re thinking that most disabilities are the result of freak accidents, you’re in for a surprise. The vast majority of disabilities, about 90%, are caused by various forms of illness including cancer, mental disorders like anxiety and depression , muscle and back problems, and heart disease. ²

We have yet to meet with someone who had the answers to the questions mentioned above. This begs the question, do you want to continue to not focus on this area of your life and hope that nothing happens as you continue blindly navigating the world around you, or would you like a prescription that would give you clarity on where you currently stand and what needs to happen to get you where you want to be?

At WestPac we have several teams that offer just a bout any product you can think of, but what makes us different is our process. Give us a call today , or shoot us an email, for a quick no – pressure conversation to see if we can help you and if you are interested in learning more.

Vanessa Wood : 619.684.8624
vanessa_wood@thewp2.com

1 U.S. Social Security Administration Fact Sheet, October 2015
2 Council for Disability Awareness 2014 Long – Term Disability Claims Review.

Financial Representative of The Guardian Life Insurance Company of America® (Guardian), New York, NY. WestPac Wealth Partners, LLC is not an affiliate or subsidiary of Guardian. Insurance products offered through WestPac Wealth Partners and Insurance Services, a DBA of WestPac Wealth Partners , LLC. | CA Insurance License # 0J08256 | 2017 – 4507 5 Exp. 08/19

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CORNEAL COLLAGEN CROSS LINKING (CXL) FOR KERATOCONUS

By: Dr. Mihir “Max” Parikh

Keratoconus is a progressive eye disease that starts in the teen years or early 20’s. It can stem from the progression of “astigmatism” or intense eye rubbing. The progression is also frequently associated with patients not having good vision with spectacles or toric contact lenses and needing gas permeable contact lenses. The corneas of the eyes grow weak and thin and the natural dome shape of the cornea changes to a steep, irregular cone shape, causing blurred and distorted vision.  All patients, especially the younger ones, should get topographies with such symptoms.

Normal corneas have strong cross-links between their collagen fibers that allow them to maintain an oval shape. With keratoconus, there are fewer such cross-links, or “support beams”, which results in a weak cornea.

Corneal Collagen Cross Linking, or CXL, is a procedure that strengthens and stiffens the cornea, stopping further vision loss. In the procedure, the top layer of the cornea – known as the epithelium – is removed. Drops of riboflavin, Vitamin B2 in a yellow liquid form, are put in the eye every two minutes for half an hour. When the riboflavin has soaked through the entire cornea, the patient looks into a blue UV light, also for half an hour. The mixture of UV light, Riboflavin and oxygen creates a chemical reaction, creating links within the collagen of the cornea in the eye. At the end, a clear, non-prescription contact lens is placed on the eye to serve as a bandage contact lens for almost five days; this gives time for the epithelium to grow back.

While the procedure will not improve vision, it is meant to prevent the cornea from getting any worse. The younger a patient is when they get keratoconus, the faster it tends to progress. Parents want their kids to do well in life, and a permanent vision problem can be a tremendous psychological barrier. CXL can save people from a lifetime of visual hardship.  I recommend crosslinking to all patients with progressive keratoconus.  This has been my recommendation and treatment protocol for the past three years and anyone is invited to watch a procedure by contacting me at NVision.

https://www.nvisioncenters.com/procedures/corneal-cross-linking.html

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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

November 19th CE: 2 HR 

Topic: “Glaucoma Updates and Challenges”

Speaker: Dr. Gayle Howard

See 2017 and 2018 CE schedules.

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

Optometrist needed Private Practice setting with full scope practice for multiple day coverages in Clairemont and Encinitas. If interested please email Rambod.Esfandiari@gmail.com (01/18)

Practice for sale – Poway Great community – “City in the Country” atmosphere with award winning schools. Full Scope practice with a significant Vision Therapy net. Dr. wishes to have the practice continue to offer Therapy.  Will consider a doctor who has COVD Fellowship or the desire to obtain a fellowship in COVD. Dr. will provide exams and consulting services part-time to aid the transition and patient retention. Please submit Vitae/Resume to djaniuk@pacbell.net (01/18)

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  (11/17)

Full-time position available for an Associate Optometrist with a strong medical background Large group practice includes 3 Optometrists, 3 Ophthalmologists, full-sized optical, and state-of-the-art equipment in a brand new clinic in Downtown Chula Vista. Job duties include medical co-management of ocular pathology patients along with routine eye care. Requirements include prior residency or minimum 3-year experience in a medical eye care setting, current CA Licensure, and Professional Liability Insurance. Basic Spanish language skills preferred. Competitive Salary If interested please email a cover letter and CV to Olga Ramirez at castillejoseyeinstitute@hotmail.com (11/17)

Optometry Retail Space immediately available in Rancho San Diego Village. Fully built-out space is currently 920 SF with the ability to expand the square footage if desired. This popular family-oriented shopping center is anchored by a top-performing Smart & Final, 24 Hour Fitness, Dixieline, Little Sprouts Daycare & Starbucks and is located at Avocado Blvd and Campo Road in the Rancho San Diego submarket. The address is 3681 Avocado Blvd, La Mesa, 91941. Contact Beth Sargent at bsargent@flockeavoyer.com for more information. (11/17)

PRACTICE FOR SALE:  Long established optometry practice in La Mesa, CA Located in a very busy shopping center with easy freeway access—Draws patients from all over San Diego County–Doctor wishes to retire. Will also consider an associate position leading to planned Buy-Out   Contact drlevy@pacbell.net (11/17)

For Sale by Owner: Established optometry office in the heart of Mission Valley. Great location with a spacious and open floor plan. Has a fully equipped one exam lane and on-site edging lab with stock lenses. All furniture’s and display cases are custom made. Over 1,000 frames inventory. Asking $60k obo. Please Contact Tammy via email t11le@hotmail.com or call 760-670-6775 for more info Thank you!! (11/17)

Dr. John Fitzpatrick, the Society Optometrist Relations Liaison, offers a unique service to the San Diego Optometric community. Several lists are kept on file for doctors seeking the following, or any combination: • full-time work • part-time work • fill-in work • purchase a practice • sell a practice • partner in a practice. There is no charge for this service. To put your name on the list, please contact Dr. John Fitzpatrick at jpfod@aol.com

Volunteer Corner

Monarch School Screening

Next Monarch School Screening: Spring 2018

Contact Dr. Bob Meisel for more information at rmeisel@netscape.net ; www.monarchschools.org

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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. Please contact Dr. Bob Meisel if you are interested or have any further questions!

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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 off for Non-Members choice of 2 or 5 HR CE

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 the society office at 619-663-8439 or email sdcos@sdcos.org

SDCOS Announcements

• Click here for most recent SDCOS Board Meeting Minutes
• Click here for the 2017 CE schedule!
• Click here for the new 2018 CE schedule!

Welcome, new members!!

• Vi Phan
• Harrison Yang
• Karen Molina
• Vy Le

Upcoming Events

• November 16th: 2 Hour CE
• December 9th: SDCOS Annual Holiday Party