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
In order for optometrists to continue to provide the highest quality care and the most current practices, we must be up to date on the legislation that governs our profession. The COA and the San Diego County Optometric Society wanted to provide you a quick summary of current legislation that affects our world.
SB 1386 (Senator McGuire) This senate bill has been amended with placeholder language which will allow it to continue through the legislative process while the COA and State Board of Optometry work toward a compromise on changing the branch office rule. The State Board of Optometry is in favor of a full repeal of the Branch Office Law while the COA is in favor relaxing the rule but not eliminating it all together. Instead of a total repeal, the COA is debating the benefits of reducing the time an owner needs to be in a branch office from 50 percent to 10 percent of the time the office is open. The COA believes that it is important to require owners of an optometric practice to be more involved in a branch office than just financial interests. We also want to ensure that the new branch office regulation does not interfere with the professional judgments of Optometrists in chain store settings.
AB 2444 (Assembly Member Burke) This bill is to better educate families on the certain health opportunities and to increase access for children. This bill creates an informational sheet in school enrollment packets on the importance of good vision and eye health for children. The sheet will also include how to access eye and vision care that is covered by current Medi-Cal and private insurances. This bill also instructs the Department of Education to create a standardized follow-up process so that children with vision problems get all the care that they need. Furthermore, AB 2444 creates a pilot program aimed at early detection of eye and vision problems. We as optometrists know how this can drastically improve educational outcomes. The bill’s first hearing is on April 11, 2018 in Assembly Education Committee.
AB 1802 (Assembly Member Salas) is the placeholder bill to expand the optometric scope of practice. COA is planning negotiations with medicine to see if there are additional areas of agreement. This bill is likely to be heard on April 24.
AB 2789 (Assembly Member Wood) AB2789 will be amended to exempt eyeglasses and contacts lenses from a requirement for health care practitioners to issue all prescriptions electronically.
SB 1241 (Assembly Member Nguyen)This bill would give a tax credit for a physician, nurse practitioner, physician’s assistant, or dentist who is a volunteer for a nonprofit licensed health clinic located in California. The COA has received a commitment that the bill will be amended to make optometrists also eligible for the tax credit.
SB 1238 (Senator Roth) A bill that would require a provider that plans to destroy patient records to notify the patient at least 60 days before a patient’s records are destroyed. COA is concerned that this bill is an undue burden on optometrists and has joined other provider groups in questioning the need for this bill.
It is imperative that we as optometrists engage with our legislators so that our profession can continue to practice the highest quality of patient care. The COA and San Diego County Optometric Society will always keep our members updated on any legislative matters.
Retina Corner: 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
Happy Easter, everyone! I hope that all is well and that people are enjoying the wonderful temperatures. Spring has certainly arrived at the London house, with baseball in full effect for two of my boys.
Last month we discussed a bit of background and results on pneumatic vitreolysis. Just to recap, this is a relatively new office-based procedure where a gas bubble is injected into the vitreous cavity with the goal of mechanically separating the vitreous from the surface of the macula. This is indicated for cases of vitreomacular traction (VMT) as well as for macular holes with co-existing VMT. In cases of VMT, the success rate is surprisingly high, up to 84%, while avoiding the potential complications and significant cost of vitrectomy as well as avoiding the potential side effects of pharmacologic vitreolysis with ocriplasmin (Jetrea, Thrombogenics). As promised, this month I would like to review the steps of the procedure so that you could appropriately counsel patients you feel might benefit from the procedure. We will also review some of the potential complications and how to weigh the risk-benefit ratio relative to other treatment options.
The first consideration is finding good candidates for the procedure. In this case, we can borrow from the literature on Jetrea, which showed us that positive predictive factors included age less than 65 years, phakic lens status, a localized area of vitreous traction less than 1500 microns, and the absence of an epiretinal membrane. In cases of macular hole, ideal cases would have a thickness of less than 200 microns. Patients certainly do not need to meet all of these criteria, but the more they have, the more likely the procedure is to work. Once a good candidate is identified it is important to describe the procedure in detail as well as the other potential options and potential complications.
The first step in pneumatic vitreolysis is the anesthesize the eye to be treated. I typically this this with layers of anesthesia, including topical proparacaine followed by a cotton pledget soaked in 4% lidocaine against the injection site – typically superotemporal pars plana. Once the anesthesia has taken effect I will place a sterile lid speculum in the eye, apply betadine drops to disinfect the ocular surface, and perform an anterior chamber paracentesis to remove approximately the same volume of aqueous as the volume of gas I will be injecting, 0.3cc. Next, I fill a 1cc syringe with sterile, filtered, 100% perfluoropropane (C3F8) gas and express excess for a final volume of 0.3cc. The gas is then injected through the superotemporal pars plana. Finally, I ask the patient to perform about 20 head bobs (bending at the waist to bring the head to the level of the knees) to start the gas bubble moving. The IOP is checked, the retina is examined, and the eye is patched. The patient is then instructed to resume normal activities and to return for an exam in 1-2 days.
Complications, they are very important to review. The most pressing issue is that patients are unable to ascend to any elevation over 2000 ft as the bubble would expand and they could suffer a CRAO from ocular hypertension. Patients also should be told that they may have some irritation and subconjunctival hemorrhage that will resolve with time. The main risks include a 1-2% risk of retinal tear, which is why they need to be examined within a few days, as well as a 1 in 5,000 chance of endophthalmitis.
Patients tend to tolerate the procedure very well, and fortunately I have not yet had any complications. It is fairly quick and relatively painless, and it is nice to avoid a trip to the operative room. Honestly, it is one of those procedures that makes you wonder why you have not been doing it this way all along.
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
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DATA IS THE NEW OIL
By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)
This statement is generally attributed to Clive Humby back circa 2006. In its full form it reads:
“Data is the new oil. It’s valuable, but if unrefined it cannot really be used. It has to be changed into gas, plastic, chemicals, etc to create a valuable entity that drives profitable activity; so must data be broken down, analyzed for it to have value.”
My introduction was to the edited version of Data is the New Oil. It wasn’t until I did some research did I learn of the full statement. In full context it’s a pretty descriptive comparison. Initially I took the comparison in a more esoteric manner, thinking a bit more outside the box. This article shares those thoughts, what they have in common and arguably why data is the new oil.
- BOTH HAVE CHANGED OUR LIVES
Things changed fundamentally after each one of these came on the scene. Barring an apocalypse, there’s no going back to a time before we had oil or data to rely on.
- BOTH HAVE VALUE
Both a criminal and a security advisor will agree that oil and data have value. To measure their value to you, live without either (or both) for a week and let me know how it turns out for you.
- BOTH MOVE THINGS
Not only do oil and data have value themselves, they increase the value in products and services by improving distribution opportunities.
- BOTH CAN IMPROVE A SITUATION
Beyond adding value by moving things, oil and data can improve a situation in a variety of ways. Automation, improved efficiencies, collection and access to information, improved communication are all examples where oil and data add value to their environments.
- BOTH CAN DO DAMAGE IF NOT PROPERLY MANAGED
We’ve seen this happen too many times (think Equifax and Exxon as examples). When oil or data gets spilled in an uncontrollable manner, there are no winners. Proper management requires understanding, strategy and a plan should an incident occur. Without a proper management plan in place, it’s a recipe for disaster.
What are your thoughts?
Reach out. You can reach Dave directly at (619-905-4468) or email dave@GSWS.com.
written by Dr. Byron Y. Newman
NUTRITION TAKING CENTER STAGE
Just a few short years ago nutritional subjects at meetings of physicians were not well attended, according to an editorial by Jean Barilla in the Physicians Newsletter some years ago. But, at a meeting of The American Heart association in the late 90’s, held in New Orleans, Nutritional Therapy Courses were so crowded that many attendees had to sit on the floor.
The trend is certainly true in optometry as well. Some years ago (in the late 70’s) I personally presented a lecture on nutrition at an optometry conference and felt a cool reception from a small audience. I even had a co-speaker who was a nutritionist at UCLA with me. At the time, all I was trying to do was to have them bring up the subject with their patients, like asking if they took vitamins.
I found that most of my patients said, “Yes, I take vitamins.”
That showed me that the general public seemed to be ahead of the professions. Some said that they didn’t need to take vitamins since the family had well balanced meals. Even those who said, “no, I don’t take them, but I should,” showed concern for health. But, there were those who said, “I don’t believe in vitamins.”
As one learns more about nutrition, certainly the interest in it will grow.
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!
No CE in April!! Next month’s CE is May 17th, with Dr. Marc Bloomenstein
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.
Fill in OD needed multiple days in May (21st-30th). Location is a sublease Target Optical in Santee. Brand new location with great equipment, staff, and hours. Please email email@example.com with your availability or to find out more information. (05/18)
Private Optometry Practice for Sale in highly desirable Sorrento Valley area. Steady yearly Revenue with room to improve bottom line. Expand your practice. Current staff willing to stay or bring in your team. Reason for sale is owner retiring after 30+ years. Don’t miss out! Please email at firstname.lastname@example.org or call 619-861-3535 for more information. (05/18)
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)
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
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
- Bob Coppleman OD
- Floyd Lee OD
- Gene Sieben OD
- Floyd Wergeland MD
Welcome New Members
- John Dizon
- Edgardo Cintron
- Laheqa Suljuki
- Lauren Fiscale
- Ruby Bello
- Andrew Romeril
- Manel Lamouchi
- April 18th, 2018- COA Legislative Day in Sacramento
- May 17th, 2018- 2 Hr CE with Dr. Marc Bloomenstein
Phone: 619 663 8439
Fax: 800 643 8301