The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Tech Corner
• Eye See
• Addressing Digital Eye Fatigue with Biofinity Energys™
• NaturalVue® Multifocal – Ideal for Patients over 40 Frustrated with Current Vision
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• Upcoming Events

President’s Message August 2018

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Retina Corner Highlights From The 2018 American Society of Retina Specialists Meeting

By Nikolas J.S. London, MD FACS
Director of Clinical Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla

The 36th annual American Society of Retina Specialists meeting just concluded after a wonderful week of events in beautiful Vancouver, Canada. Our group had the privilege of attending and participating in the meeting – both Dr. Anne Hanneken and I presented original research, I participated in an investigator meeting for an exciting new investigational drug for geographic atrophy associated with macular degeneration (now enrolling!), and together Dr. Hanneken and I conducted an educational dinner meeting on OCT angiography. It was a busy week with a lot of fascinating new information, so for this and possibly the next few articles I would like to summarize some of the most interesting data. Some of these data are from studies we participated in and may even have involved your patients.

While we have excellent drugs currently available to treat exudative macular degeneration, there is still a need for improved durability and visual outcomes. One possibly contender for this is brolucizumab. The HAWK and HARRIER studies examined the efficacy of this tiny 26 kilodaltin antiVEGF molecule, in neovascular age-related macular degeneration (AMD). Given the size of the molecule, the same dose volume provides 11-22 times the molar equivalent of current drugs (Lucentis, ranibizumab and Eylea, aflibercept). In the HAWK and HARRIER studies brolucizumab was compared to Eylea, and had a significantly better effect on eliminating fluid – the main factor we consider when deciding if and when to treat patients. Interesting, the drug also was able to be given every 12 weeks in 50% of patients with non-inferior visual acuity outcomes compared to Eylea. There were no new safety concerns. The drug is currently in the hands of the FDA and may be available sometime next year.

On another note, early results another antiVEGF medication, abicipar, were announced in a press release from Allergan. Similar to brolucizumab, abicipar is touted to have a potential 3-month durability. Indeed, in the phase III trials, 91% of patients were able to maintain their vision on a q12 week injection cycle. Moreover, patients in the abicipar group required substantially fewer injections to achieve the same visual result compared to ranibizumab (Lucentis). On the down side, the drug was associated with a fairly substantial incidence of intraocular inflammation – about 15% of patients treated with abicipar. This goes to show you how high the bar has been set with current anti-VEGF drugs and how unlikely we are to see such a paradigm shift as we did back in 2005 with the pivotal Lucentis studies.

On the final day of the conference as a late breaking presentation Genentech presented the results of their LADDER study which looked at a port-delivery system for ranibizumab. This is a tiny, surgically-implanted reservoir that promises extended deliver of antiVEGF medications for AMD patients, compared to the nearly monthly injections that patients currently require. In the data presented, nearly 80% of patients were able to go 6 months or longer before requiring a refill of the reservoir. This is potentially a game changer and I am excted to see the official data.

Well, there is more to come. The meeting was excellent and I am excited to share more of the presentations, including our own talk on OCT angiography and a novel AMD treatment algorithm.

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!

SECURE, SMART OFFICE HAS ACQUIRED GSWS
By Dave Tuckman from Golden State Web Solutions, Inc. (www.GSWS.com)

We have exciting news to share from camp GSWS this month. With so many of you becoming close friends, associates and clients over the past few years, this just seemed like the best way to notify everyone. My new position is Director of Engineering and I will be around long time. The principals of SSO both come from the intelligence community and are awesome to work with. I am excited beyond words. The formal announcement is below, and please reach out if you have any questions and/or would like additional information.

FORMAL PRESS RELEASE Secure Smart Office (SSO); a leading provider of security-centric IT services and solutions, today announced they have completed the acquisition of GSWS; a well-respected, stalwart, IT service and cyber security provider that has been strongly supporting clients in the San Diego region for 25 years.

All GSWS services, personnel and resources are part of the acquisition; bringing additional services, expertise and manpower to SSO. GSWS Senior leadership will join SSO’s senior leadership team and will remain on-board as part of the long-term organizational strategy. All business, individuals and services will unify and operate under the SSO brand/service identity.

During the acquisition process GSWS personnel will integrate onto the SSO team, and changes will be fully and carefully managed. We don’t anticipate any immediate changes for all of our clients. The transition will take place over the next several months to ensure a smooth process with minimal impact for everyone involved. We will begin reaching out to each client individually, to discuss and answer any questions you may have. During the transition period, GSWS President Dave Tuckman will retain his old email address and will continue to be directly available at dave@GSWS.com or by phone at 619-905-4468. Reach out any time, and he looks forward to speaking with each of you. As we move through the transition period and beyond, Dave can be reached at his new email address of dave@ssowow.com which will serve as his permanent contact point.

HIGHLIGHTS OF THE ACQUISITION:

• Two top local technology providers combine for strengthened and expanded services and capabilities portfolio.
• Decades of knowledge, experience, reputations and relationships in the Information Security and Information Technology sector combine to provide a full suite of Cybersecurity, Compliance, Managed IT, Hosting and Web Development services.

Rusty Sailors, SSO CEO, commented:
“We’re simply delighted to announce today’s acquisition of GSWS, Inc. This is a dove-tail fit with SSO and not only enhances and strengthens our current products and services, but also expands the security-based offerings for our clients. We have strong strategic plans for our combined organization and remain committed to delivering innovative products, excellent support, and strong secured IT expertise to our customers.”

Dave Tuckman, GSWS President and Founder, commented: “Rusty, Sam and I agreed immediately in philosophy and culture. We discussed the risks facing small and medium size organizations. The more we spoke, the more I realized this was something I wanted to be a part of. I couldn’t be more grateful, appreciative and excited working with this team, to improve the security of our communities and clients’ digital environment.”

ABOUT SECURE, SMART OFFICE
https://ssowow.com
Secure Smart Office is founded on the principles of making your office a place you can come home to – a place you and your staff want to be for 8 hours a day. Make 1/3 of your day better with SSO.

Based on the strong principles of solid cyber security, and stable, modern IT solutions, everything SSO does and every client offering is based on security integrated from the ground up. People feel safe when they know they’re secure and feeling safe helps people stay more motivated to come to work. Secure Smart Office provides secured IT services but also designs, secures, and integrates smart controls for your office. Imagine being able to control sound, temperature, lighting, blinds, ionization and oxygen in the air all with the control of your voice or other smart controls – and do so securely. Imagine an office where your staff is more productive, your retention rate is higher, and your clients are more likely to stay with your company. The future of the secure smart office is here and you can realize the office you want, and need, today with SSO.

ABOUT GSWS
https://gsws.com
Golden State Web Solutions, Inc. (GSWS) opened in 1994 as a start-up, internet technology company, offering websites, email, servers and hosting. Fast forward to today; providing cybersecurity and compliance solutions is our primary focus. This simply means if you are our client, our primary focus is on what is most critical to you. This can be security centered, compliance related and/or just the overall way your organization is using technology to improve processes. With our knowledge, skills, certifications and our level of service, clients are ensured solid technical, administrative and management security and compliance solutions for their organization.

Questions/Thoughts?

Reach out. You can reach Dave directly at (619-905-4468) or dave@GSWS.com.

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Eye See written by Dr. Byron Y. Newman UBIQUINONE, THE EVERYWHERE NUTRIENT

Ubiquinone is another name for CoQ10 because it is literally everywhere, in every cell in the human body. If you visit the vitamin and supplement aisle in any drug or grocery store, you’ll most likely find an entire space filled with CoQ10 products. When you search for “CoQ10” on the internet you’ll get nearly seven million results. And if you read about nutrients for heart function support, CoQ10 is sure to be featured. There’s no doubt about it: people are talking about CoQ10 benefits in a number of different spaces.

What is CoQ10?

  Coenzyme Q10 (CoQ10) is a fat-soluble, vitamin-like compound produced naturally in your body. Found in nearly every cell in the body, CoQ10 is concentrated in organs that require the most energy — such as the heart, liver, muscles and kidneys. CoQ10 is concentrated in these organs because it is essential to the process of producing cellular energy from the food you eat.

Biopsies performed on patients with various cardiac diseases demonstrate a deficiency of the enzyme in 50% to 75% of patients studied. It reduces angina and increases treadmill exercise tolerance, while it also benefits those with muscular dystrophies and neurogenic atrophies.

It is found in beef and eggs, both high in cholesterol and saturated fats. It occurs in lesser quantities in spinach, grains, beans and specific oils.

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

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Addressing Digital Eye Fatigue with Biofinity Energys™

Digital device use has increased dramatically in recent years and it affects all segments of the population.  Facebook now boasts over 2 billion users, and it is estimated that 1 billion hours of YouTube content is watched each day.  Overall, 95 percent1 of Americans spend 2 or more hours every day on digital devices.  And CNN recently reported that even children under 9 years of age spend an average of more than 2 hours per day on screens2. As digital device use increases, so do complaints of digital eye fatigue, characterized by eye tiredness and dryness.

CooperVision’s Biofinity® family of products continues to grow so you can meet the needs of more of your patients. As the latest innovation for sphere wearers, Biofinity Energys™ is the lens designed to help your patients shift focus between on-screen and offscreen activities. It includes Aquaform® Technology found in world-renowned Biofinity® lenses and Digital Zone Optics® lens design—combining to help patients with eye tiredness and dryness.

Accommodative Burden

Accommodative burden is an important source of digital eye fatigue.  Sustained focus on close-up digital devices strains the eye’s accommodative system. In experimental imaging of the ciliary muscle during accommodation using Visante OCT3, it was observed that while accommodating on a near image at 20 cm, ciliary muscle anterior length thickness increased 23% and maximum thickness increased 34%.  Sustained accommodation during digital device use can overwork ciliary muscles and lead to digital eye fatigue.

In Biofinity Energys™, multiple front-surface aspheric curves distribute power evenly to simulate positive power across the entire optic zone, so wearers can change focus from on-screen to off-screen and back with less effort. This eases accommodative burden and may help reduce ciliary stress4.

Comfort

Discomfort due to digital device use is often related to dryness. Digital device users blink less frequently while looking at a screen, resulting in changes to the tear film. Aquaform® Technology found in Biofinity Energys™ lenses helps with the dryness associated with digital eye fatigue. Aquaform® Technology creates an optimized balance of high oxygen permeability, good water content and optimum modulus providing increased breathability and moisture.

Patients may not realize that their eye symptoms could be related to digital device use and therefore may not bring it up at their exam.  Be sure to start the conversation: ask about symptoms of eye tiredness and dryness as well as overall screen time so that you don’t miss the opportunity to upgrade your patients to the lens designed to address their symptoms.

Talk to your CooperVision rep about how to upgrade your existing sphere wearers to Biofinity Energys for improved all day comfort on their digital devices.  And visit the Biofinity Energys product page for more information at https://coopervision.com/only-biofinity-energys.

1. The Vision Council. Hindsight is 20/20: Protect Your Eyes from Digital Devices
2. J. Howard. Kids under 9 spend more than 2 hours a day on screens, report shows. October 19, 2017. https://www.cnn.com/2017/10/19/health/children-smartphone-tablet-use-report/index.html
3. OCT imagery courtesy of Drs. Pete Kollbaum and Viswa Ramasubramanian, Indiana University, USA
4. Prospective, multi-center (9 sites), subject-masked, bilateral wear, cross-over, non-dispensing study comparing the difference of the change in AMF frequency measured by the Accommodative Function Analyzer instrument (AFA). Based on a statistically significant difference of the mean change of Accommodative Microfluctuations and when compared to Biofinity® sphere after reading on an iPhone for 20 minutes held at a distance of 25 cm

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NaturalVue® Multifocal – Ideal for Patients over 40 Frustrated with Current Vision

Have your patients ever been frustrated when they tell you they must wear readers with their contact lenses?  They may have even asked you, “What’s the point?”

Turns out, most people wearing contact lenses today (about 85% according to research[i]) experience some level of compromise with their contact lenses, especially when moving from near to far distances.  For example, they can read their computer screen, but may have difficulty reading street signs, or vice versa.

The challenge of achieving good vision at any distance is of special interest to those over 40 – some 142 million people – who have  presbyopia[ii].

THE SCIENCE OF Natural Vision

Visioneering Technologies, Inc. (VTI) is the maker of a revolutionary new contact lens called NaturalVue® (etafilcon A) Multifocal 1 Day Contact Lenses developed by the team of contact lens industry veterans.

This lens, created by an optometrist who is an optical engineer and former aerospace engineer, works with the brain to help the eyes better focus when and where they need to.

Through Neurofocus Optics® Technology, which harnesses the power of the brain3, NaturalVue Multifocal contact lenses offer improved vision at all distances4

Inspired by advanced camera optics, the design channels light for clear distance vision through the lens center while significantly increasing depth of focus. Neurofocus Optics technology allows the brain to “autocorrect” what you see, helping you to see more clearly at any distance. 

Preferred for Today’s Vision Correction

NaturalVue Multifocal provides outstanding vision at every distance, every day.  In fact, people with presbyopia found that NaturalVue Multifocal 1 Day contact lenses provided better vision for everyday activities and better overall performance than their habitual correction4.

In fact, people rated NaturalVue higher than their habitual vision correction in every aspect of everyday situations tested4:

Furthermore, in a clinical study, people with presbyopia expressed a strong preference for NaturalVue Multifocal 1 Day contact lenses over other corrective options4.

[i] VTI Data on file, 2013

[ii] US Census Bureau

3 VTI Data on File, Patents Awarded – Multifocal ophthalmic lens with induced aperture. Patent numbers available on VTIvision.com

For more information, please contact your local VTI, Inc. rep:

Carol Baez at 714-290-9725 / Cbaez@vtivision.com.

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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 Event Sponsors

June 10th, 5 Hr – Retina Symposium

August 12th, 5 Hr – Contact Lenses
Speaker: Stephanie L. Woo, O.D., F.A.A.O., F.S.L.S.

Course Title: Amniotic membranes and their uses in optometry.

Course Highlights: This course highlights the use of biologic corneal bandages to help the patient and the practitioner alike. Amniotic membrane history, safety, and production is discussed. Come learn how many patient candidates you see on a daily basis who could benefit from amniotic membranes. We review this amazing technology in great detail, including insertion, removal, and follow up care.  Tips and troubleshooting of amniotic membranes are reviewed. Billing and coding of the device is outlined. Several case reports are presented.

Course Title: Billing and Coding for Specialty Contact Lenses.

Course Highlights: Appropriate billing and coding for specialty lenses is essential for the success of any specialty contact lens clinic. Correct diagnosis codes, CPT codes and V codes are critical to proper reimbursement. Knowing when and how to bill specialty lenses to medical insurance versus vision insurance is also important to distinguish.  Come learn the billing and coding essentials for specialty lenses and discover how you can help patients and generate revenue!

Course Title: Scleral lenses for regular and irregular corneas.

Course Highlights: This course reviews the current scleral lens applications for regular and irregular corneas. The differences between scleral lenses and corneal gas permeable lenses is addressed. Ten categories of patients is defined and good scleral lens candidates are identified. Benefits of scleral lenses is highlighted. Customization of scleral lenses including notching, diameter changes, front surface toricity, and toric haptics is presented in detail. Presentation of scleral lenses to the patient is discussed. The fitting process and follow up care is reviewed.

Speaker Handout

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.

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Classifieds

Fill In OD Needed: Private sublease practice inside Target Optical Santee. Dates needed are September 20, 22, 23, 25. Likely more days available for the right match. Brand new office, light patient flow, automated equipment, EHR. Please email CV to drkellykeane@gmail.com if interested. (09/18)

As part of the “I See My Future” project, Southwestern College is seeking a Special Project Curriculum Developer/Instructor with experience in the field of Optometry (retired or practicing).  The goal of the program is to educate/train 50 students in the eyecare field.  The scope of the project involves developing a 75-hour curriculum that trains program participants for careers in ophthalmic technology.  The course is to begin November 5, 2018, and conclude by April 26, 2019. Instruction is to be provided to two cohorts of 25 students each in two locations-one on the east and one on the west side of Chula Vista-one in the morning and one in the evening.  This project was made possible by a grant to the South County Economic Development Council.  Project compensation and more details can be obtained by contacting John Pack, O.D. at jpackod@yahoo.com  (619) 806-1282  Deadline for application is August 10, 2018. (09/18)

Practice for sale –long-established practice in La Mesa–time to retire–will work part-time if the buyer wants–owner interested in an immediate sale–price is right–don’t miss this opportunity to own your own practice for very small investment. 619 743-1442 email drlevy@pacbell.net (8/18)

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 1-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 (08/18)

Donations Needed. The Lions Optometric Vision Clinic is in need of equipment for donation.  Lensometer, autorefractor, etc. Please contact Enrique at (619) 298-5273. (08/18)

Part-time or fill-in doctor. Sublease optometry practice located inside a Lenscrafters. Pre-testing, contact lens training, and billing performed by technicians. Patients are scheduled every twenty minutes with contact lens checks, dilations, and follow-ups scheduled on the hour. Part-time position available for Saturday-Monday with occasional additional day’s available if desired. Saturdays will be a double doctor day and Sundays will be the same per diem rate with fewer work hours. Doctor hours are from 10:15 AM – 7:00 PM on weekdays, 10:15 AM – 6:00 PM on Saturdays, and 11:15 AM – 5:00 PM on Sundays. Salary: $400.00 /day with an additional bonus depending on the number of patients seen and OPTOS taken per day. Please e-mail resume or CV to kvinhtam@yahoo.com  (08/18)

We have a fill-in O.D. position working Thursday, June 14, 21, 28 from 9-1 and Saturday mornings starting June 2 from 9-1 for an undetermined length of time.  It is in Mira Mesa right off the 805. If you are interested in any or all of the times please email Scott at svoc@sbcglobal.net (08/18)

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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

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Volunteer Corner

Monarch School Screening

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

Welcome, New Members!

• Allen Chung
• Chantelle Davis
• Christina Issa
• Megan Lopez
• Richard Ly
• Amanjot Mashiana
• Kimberly Michel
• Ashley Tang
• Valerie Tran
• Harrison Yang
• Stephanie Yarnell
• Mark Yeghiazarian

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

Upcoming Events

• August 12th- 5 hour CE: Contact Lenses