San Diego County Optometric Society
The San Diego View
Inside this Issue:
- President’s Message
- Retina Corner
- Tech Corner
- Eye See
- CE Corner
- Volunteer Corner
- SDCOS Announcements
- Upcoming Events
The month of March is near and dear to our hearts because it happens to be “Save Your Vision Month”. “Save Your Vision” was started by members of the AOA in 1927 as a week long campaign. It has evolved over the years into “Save Your Vision Month”, thanks to a vote at the 2005 House of Delegates. The AOA continues to sponsor this campaign and we as doctors can do our part by educating our patients and encouraging them to spread the word as well.
A more recent campaign, “Think About Your Eyes” was designed by the AOA to educate the general public through TV ads and radio, about the importance of eye care and vision health. This campaign reached more than 150 million Americans and resulted in more than 1.18 million eye exams in 2017 nationwide, the most successful campaign to date. At our COA House of Delegates meeting this past month, California pledged to become an active participant in this campaign. Chaired by Dr. Steven A. Loomis and with California’s help and our added resources, we will propel this campaign to even greater heights in 2018. There are resources for doctors on the AOA website regarding both “Think About Your Eyes” and “Save Your Vision Month”. By educating our patients and increasing public awareness to vision problems and eye health, we continue to demonstrate that Optometrists are vital primary eye care providers.
Courtesy of the AOA, here are some basic tips to educate our patients on some important eye health and vision issues in the workplace. These are strategies to help patients get through a work day by minimizing eye strain and other side effects of Computer Vision Syndrome.
- The 20-20-20 rule: Every 20 minutes on the computer, take a 20 second break and look at something at least 20 feet away.
- Keep a distance: The AOA recommends sitting 20-28 inches away from your computer screen. Keep your head and torso in an upright posture and with back support.
View from a different angle: Ideally, the center of the computer screen should be 15 to 20 degrees below eye level to be most comfortable.
- Decrease glare: Anti-reflective coatings and different computer screen tints are effective methods of reducing glare on our screens, as well as overhead lighting placement.
- Blink often: Blinking frequently will help minimize dryness that results from computer use.
Pneumatic Vitreolysis for Management of Symptomatic Focal Vitreomacular Traction
By Nikolas London, MD, FACS
Director of Clinical Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla
Vitreoretinal interface disorders refer to a spectrum of interactions between the posterior hyaloid and the underlying retinal surface, ranging from benign attachment to substantial vitreomacular traction (VMT) with lifting of the fovea and potentially macular hole formation. For reasons not fully understood, affected eyes have an abnormally strong adhesion between the hyaloid and inner retinal surface. As the traction increases, metamorphopsia may develop and if a macular hole develops patients will develop a central scotoma and vision loss.
Conventional management options for VMT with or without a small macular hole include observation, intraocular injection of ocriplasmin, and vitrectomy. Symptomatic patients can be observed for several months for traction release – this is seen in about a third of patients. Patients can also be encouraged to perform activities that might help with traction release such as exercise. I once saw a case presentation from an Italian retina surgeon who resolved the traction by suggesting a passionate activity that I will leave up to your imagination. Persistent disease, however, often mandates treatment. Vitrectomy is an extremely effective option with nearly a 100% likelihood of resolving the traction and over a 95% likelihood of closing a macular hole, but is expensive, time-consuming, and carries risks including endophthalmitis, cataract formation, and retinal detachment. Vitrectomy is typically reserved for more persistent VMT cases with vision loss or prominent symptoms.
Ocriplasmin is an injectable drug that was released in 2012 for VMT with or without macular holes. It works as a proteolytic that dissolves the laminin and fibronectin glue that binds the vitreous to the retina. The MIVI-TRUST Trial showed successful release of VMT in 26.5% of the treated eyes compared to 10.1% of the placebo eyes. The success rate was increased to 40% for eyes without an epiretinal membrane, and to 60% for small macular holes of <250 microns. Up to 80% success rates were noted in younger, phakic, patients with a small area of adhesion, and small macular holes. However, several potential side effects were noted, including transient visual loss, persistent dyschromatopsia, electroretinographic changes, subluxation of the crystalline lens related to zonulolysis, and disturbance or dehiscence of the ellipsoid layer documented by ocular coherence tomography (OCT). While these are likely rare and transient, along with the $4,000 cost of the drug and limited efficacy, these side effects have greatly limited the use of ocriplasmin.
Popularized more recently, perhaps the best initial treatment option for VMT following observation is pneumatic retinopexy. This technique was first introduced by Clement Chan and involves the injection of a small quantity of expansile gas into the vitreous with the goal of mechanically separating the vitreous from the retina. A 1995 pilot study reported VMT release in 96% of the treated eyes and closure of 57% of small stage-2 macular holes. In 2001 and 2006, Costa et al and also Jorge et al reported 100% VMT release and closure of 83% of stage-2 macular holes in a small series of eyes. In 2007, Mori et al reported VMT release and closure of stage-2 macular holes after injection gas followed by 3 to 5 days of face-down positioning. They were successful in inducing VMT release in 95% of their case series (19 of 20 eyes), and closure 50% of the of stage-2 macular holes. For the subset of eyes with VA better than 20/40 and size of macular holes of less than 200 microns, the success of macular hole closure was 100%. It appears that longer acting gas bubbles are significantly more effective. Recently, Steinle et al. reported a success rate of 84% with C3F8 gas (a 2-month bubble) compared to 56% with SF6 gas (2 weeks), and 48% with ocriplasmin in release of VMT. Given the low cost and convenience of gas injection as well as a low rate of adverse events reported in prior retrospective studies, pneumatic vitreolysis may serve as an alternative to the much more costly treatment with ocriplasmin or vitrectomy for managing VMT.
I have adopted this technique and have performed over a dozen procedures over the past few months with VMT release in 100% so far (knock on wood) with no side effects. Next month I will discuss the basics of this technique, potential adverse events, as well as what patients can expect following the procedure.
Thanks again for reading. Please don’t hesitate to contact me with any questions.
Best wishes, and until next time,
Nikolas London, MD
Retina Consultants San Diego, Poway, La Jolla, and Coronado
firstname.lastname@example.org (personal email)
email@example.com (RCSD email)
Got Tech questions? We’ve got Answers!
GDPR – WHAT IS IT AND HOW DOES IT AFFECT YOU?
By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)
GDPR (General Data Protection Regulation) is an EU regulation that goes into effect on May 25, 2018. It replaces a 22 year old regulation (the DPD – Data Protection Directive), designed to update and enable EU citizens with better control over their personal data. Data is defined as “any information relating to an identified or identifiable natural person”. This includes everything from medical information down to the cookies a website collects. It is complex and far-reaching legislation that touches organizations in numerous ways and at all levels.
Even if your practice is based in the United States, the EU’s new regulations may affect you. Verify if any of your patients or clients are of EU citizenry. If any are, this regulation impacts you. Here is a summary overview of an EU citizen’s rights under the GDPR.
- UNIFORM REGULATIONS AND CITIZEN RIGHTS ACROSS THE EU
For the first time, EU citizens will have a single data privacy and security regulation standard regulation across all 27 countries. We can expect to start seeing some of the EU standards being applied in the US shortly after the GDPR goes into effect.
- DATA PRIVACY RIGHTS ARE GLOBAL
The EU citizen data rights are not limited to the borders of the EU They follow and stay with the citizen globally. For example: if a citizen in France posts something (or sees something about them posted by someone else) on Facebook, it doesn’t matter that Facebook is not an EU, they are expected to accommodate the rights of the citizen, or face a fine. This is where US businesses face exposure.
- THE RIGHT TO BE INFORMED
An EU citizen has the right to be informed about anything that happens with their personal data. They have the right to access, modify and even remove content from a certain organization. In the event of a breach, the citizen has the right to be notified within 72 hours of the incident.
- THE RIGHT TO EXCLUSION
From the beginning, the citizens first right as an EU citizen, is refusal of participation in any capacity. It is unlikely many will stay completely off the grid (no bank activity, official employment, phone, etc.) but they do possess the right.
- THE RIGHT TO ERASURE (THE RIGHT TO BE FORGOTTEN)
Another important right is the right of erasure (or the right to be forgotten). An individual has the right to request the deletion or removal of their personal data. This right is not absolute, as there are circumstances when data will not be erased at the request of the individual. For example, if the personal data is used to comply with a legal obligation, or for public health purposes, for scientific research or for the exercise or defense of legal claims, then the right to erasure can be denied for the individual.
- RIGHTS RELATED TO AUTOMATED DECISION MAKING AND PROFILING
This right is practically a safeguard against a potentially damaging decision that might be taken without human intervention. If the automated decision is based upon explicit consent, or is authorized by law, then this right no longer applies. The GDPR defines profiling as any form of automated processing intended to evaluate personal aspects of an individual, such as their performance at work, their health, personal preferences, economic situation, location and more. If you do resort to profiling, you must be sure several safeguards are in place. For example, make sure you are using appropriate mathematical and/or statistical procedures, secure personal data, create measures that enable inaccuracies to be corrected and minimize the risk of errors. However, automated processing must never be applied for the data of a child.
Here’s a list of several websites with additional information:
- https://en.wikipedia.org/wiki/General_Data_Protection_Regulation (Wikipedia overview)
- https://encryption.eset.com/us/gdpr-compliance (Info and online compliance check)
- https://eugdpr.com (overview of GDPR)
- https://gdpr-info.eu (complete online draft of GDPR)
This may sound like a lot, and in ways it is. We can help your practice navigate through requirements like this. To speak with a human, contact Dave Tuckman directly at 619-905-4468 or dave@GSWS.com.
written by Dr. Byron Y. Newman
DROWSINESS WHILE DRIVING
Falling asleep at the wheel has become a major public health problem since it was discovered that there are more accidents caused by drowsy drivers than by drunk drivers.
Some researchers have suggested that it’s because drivers start trips while they are still tired or deprived of sleep.
Most optometrists know that poor visual skills at a distance can cause sleepiness as well, just as poor visual skills at near can cause sleepiness while reading. So, poor visual skills combined with fatigue before starting off is a recipe for disaster.
Meanwhile the French auto maker Renault, which also makes trucks in Europe and owns Mack Trucks in the U.S., said that it is developing a warning system to keep truck drivers from falling asleep while driving. A small camera mounted on the dashboard monitors the driver’s blinking patterns to determine if the driver dozes off at which time the alarm (a flash or alarm sound) would go off.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
We are committed to helping you fulfill your CE requirements through our local meeting with the support of our sponsors!
Featured Annual Sponsors
March 11th, 2018- 5 hours
Speaker: Dr. Pinakin Davey
See 2018 CE schedule.
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.
Seeking part-time Optometrist to work in the months of July, August, September and October 2018 during my maternity leave. Our office is equipped with an EHR system, Marco digital refraction, and a retinal camera. We are an independent office, located inside Target in Del Sur, San Diego. Applicants will enjoy full scope optometry, in a fun and relaxed environment with friendly and knowledgeable staff. High energy, good personality, and professional bedside manners are required, as to deliver high-quality patient care. Hours: Sun 10-5, Tues 10-6, Thurs & Fri 11-7:30 and Sat 9-6 Requirements: Optometry degree, valid CA OD license and proof of malpractice insurance. Training will be provided, if needed for any of the equipment in office Salary negotiable Also, looking for a fill-in doctor for: Thursday 3/22, Friday 3/23, Saturday 3/24, Sunday 3/25 Thursday 5/24, Friday 5/25, Saturday 5/26, Sunday 5/27 Please email at DSOptometry@gmail.com if interested in any of these days and send your salary requirements. (03/18)
FT/PT/ Fill-in needed San Diego Central. Please call 610 585 9888 or email firstname.lastname@example.org (03/18)
Office Space Available Great for second location or New Grads: Beautiful space for optometrist or ophthalmologist, built in custom cabinetry, granite, Italian tile throughout. Located on a very busy street with 40,000 cars passing by a day. Location is in City Heights, close to freeways 805, 8, 15, and 94. It is a 10-minute drive to downtown San Diego with a huge demand for eye care in this area. Over 50 schools within a 5-mile radius. Existing practice has been sold and moving, space is available for a new doctor to begin a practice here in a location that already has been known as an eye clinic. Contact 858 504 2020, email email@example.com (03/18)
Optometrist needed for a part-time or full-time position at a busy well-established general ophthalmology private practice in San Diego, California. Job responsibilities include (but are not limited to): Patient work-ups, Refractions, Contact-Lens Fittings, Specialty Contact-Lens Fittings, Diabetic Exams, Glaucoma Care, LASIK pre-ops, and Cataract Evaluations. Leading candidates will have strong organizational skills, the desire to work in a team-based work environment, and understand the importance of responsibilities when caring for our patient’s eye health and quality of vision. Requirements: Current CA license, current Liability Insurance. Please submit cover letter and CV to firstname.lastname@example.org (03/18)
For Sale: 5 frame display units with lower cabinets, approx. 100 frames each. Available in about 2 months. Will send photos to those interested. $150 each. Send contact information to email@example.com (04/18)
Centervue DRS Retinal for Sale – Less than 2 years old and in excellent condition. Includes the table with electronic height adjustment. Purchased brand new for $16K. Looking to sell for $12K. If interested please email: firstname.lastname@example.org (03/18)
OD fill-in needed North County March 26 – April 26. Monday –Thursday with 4th day optional. Please email CV to email@example.com (03/18)
Expanding Optometry business: 3 positions available 1-Ophthalmic laboratory technician who is experienced in edging lenses. 2-Optometrist for part-time or fill-in work. 3-Amazing eye doctor assistant (will train the right person) We desire a person that wants to deliver the highest quality eye care to our patients. Dispense, obtain test results, consult with doctors, consult with assistants, opticians, and technicians, and maintain patient communique and good staff relationships are important. Our candidate must work well with office staff and patients, have a history of professionals noting that you can show up on time, work your scheduled hours, negotiate conflicts, be honest, have the confidence to perform difficult assignments, support and build confidence in others, have a positive sense of yourself and others, use creative problem-solving techniques, be self-reliant, people-orientated, enthusiastic, hard-working. Please contact us 760-757-8771 at Oceanside or 619-425-9001for San Diego at firstname.lastname@example.org by sending your resume, and/or professional CV by e-mail for a possible interview. (03/18)
Private Optometry Practice for Sale in northern San Diego County. Stellar revenue per square foot. This newly remodeled established practice is unique in southern California as there are few competitors in the area, and it has strong anchors in the community. No capital improvements are required. Due to the owners’ plans to leave the San Diego area for family reasons, we are offering this busy and highly profitable practice for a fantastic price. Please contact email@example.com or 619-559-4509. Thank you. (03/18)
Give the gift of sight! Have you ever thought about volunteering your time and talent to help those less fortunate in developing countries? I work with a nonprofit, volunteer organization dedicated to the delivery of professional medical, surgical, and educational vision health care services—free-of-charge—to medically underserved populations in places such as Latin and South America. We offer medical, surgical and optical services, including cataract removal with intraocular lens insertion, strabismus repair, pterygium removal and various oculoplastic procedures for tumors, birth defects, and trauma. In addition, medical conditions such as glaucoma and infections are diagnosed and treated. Many hundreds of people are refracted on every trip, and eyeglass measurements are taken and glasses fitted for the refractive errors. The teaching of local professionals often takes place. We are in need of optometrists, ophthalmologists, opticians, anesthesiologists, nurses, and scrub technicians for upcoming trips. Would you consider volunteering with VHI in any of the following places? Villa Nueva, Guatemala La Entrada, Honduras Riobamba, Ecuador Kibosho-Umbwe, Tanzania Piura, Peru If you would like to learn more, please send me an email with your contact information. There is no obligation! If you know of a colleague who may be interested, please pass on the invitation. We are always in need of volunteers! Debprince2020@gmail.com (04/18)
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 firstname.lastname@example.org
Monarch School Screening
Exams: Monday/Tuesday March 12th/13th (we need one doctor for each day)
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!
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.
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 the society office at 619-663-8439 or email email@example.com
- March 11th: 5 Hour CE – Glaucoma
- April 18th, 2018- COA Legislative Day in Sacramento
Phone: 619 663 8439
Fax: 800 643 8301