The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• CE Corner
• Respond to All Google Reviews. Your Wallet Will Thank You.
• The Usefulness of Power Mapping Multifocal Specialty Lenses
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• Upcoming Events

President’s Message March 2019

2019 California Optometric Association House of Delegates Report

The 2019 COA House of Delegates met for its annual meeting on March 1st and 2nd in San Francisco. Our Society had a great delegation of 16 participants who traveled by plane to the Marriott Hotel on the wide, placid Bay Shore, located conveniently near the airport. The COA HOD demonstrates to me how our independent profession of optometry can govern itself in a positive working fashion. There were several orders of business that took place at HOD, and some that I would like to share with our membership.

The State of the Association Address was given by Ranjeet Bajwa, O.D., COA President.  He spoke of the need to counteract online eye exams and online vision testing because of the risk they pose to consumers. COA is steadfast in their opposition to this opportunistic, disruptive technology, as it confuses the public and trivializes the importance of ocular disease detection, while giving at best an inaccurate prescription for our patients’ needs. He noted that online eye examinations eliminate the doctor-patient relationship. After that, Dr. Bajwa spoke of a new bill, AB1467, Salas and Low, which is about ODs using new procedures to treat glaucoma.

Three elected representatives were welcomed to speak at this year’s HOD. We were addressed by California Assembly member Kevin Mullin. He spoke of the importance of ODs in our state and our increasing responsibilities to improve patient access to care. We were then addressed by Assembly member Phil Ting and, later in the day, Assembly member David Chiu. He spoke of healthcare practitioner shortage and how we must expand access to care.  He stressed that our wonderful profession provides home-grown practitioners with cultural competency to best serve Californians.

We were also addressed by Barbara Horn, O.D., AOA President, who gave a relevant talk about AOA’s recent successes. She spoke of their progress in protecting us from adversaries who want to force optometrists to keep on file signed contracts for each patient as proof that we offered CL Rx’s at each visit. Studies show an average of $18K per office would be spent to implement this onerous mandate.  Dr. Horn then stressed the success of AOA’s “Think About Your Eyes” national advertising campaign which every COA member now has. Dr. Horn stated that “Think About Your Eyes” raises public awareness, having generated 2.3 million web portal visits and almost 4 million eye examinations since its inception. She also invited us to attend the AOA Congress this June 19-23rd, to take place in St Louis.

Two policy resolutions passed by the Delegates in the House included the following: First, the House voted to adopt the present ascending dues schedule that is currently in use. Second, the House voted to support the COA in a future endeavor to work, support, and interact with the California Board of Optometry. This is with the positive intention of improving the number of independent ODs serving on the State Board of Optometry.

Our Society received the “Website of the Year Award,” and we must thank our 2018 Webmaster Committee Chair, Dr. Susan Cervantes, for her leadership and creativity that resulted in the winning website. Congratulations and thanks to all who have also contributed to our website including: Dr. Stephanie Le, Dr. Lucia Millet, Dr. Nickolet Boermans, Nancy-Jo Sinkiewicz, and Steve Sicherman of EyeCarePro.

COA Optometrist of the Year was awarded to James R. Dallas, O.D. of Barstow, CA.

COA is introducing a new Strategic Plan and following there was a lively discussion with much input from the Delegates. The Strategic Plan divides a square onto four parts and focuses on Market, Services, Governance, and Operations. Each of these tenets are then contextualized and improved upon.

The floor adjourned temporarily, and called to order the Annual Meeting of the Public Vision League. Complaints leading to investigations that result in legal action are performed by the PVL. False advertising by an optical corporation and a bait-and-switch contact lens company were both discussed. The PVL and the COA would like to know of your encounters with eye patients that have been abused or harmed by any of the above, and/or missed diseases by online vision testing companies. In addition, if our Society members have questions about AB 684-Corporate Leasing-Protection for Doctors-Enforcement, contact the COA for a fact sheet or talk to the COA staff about your specific legal questions.

The contested election of COA Trustees resulted in our very own Dr. Erin Swift being elected to COA Trustee.  Congratulations Dr. Swift! In addition, our own SDCOS member, Dr. Amanda Dexter will continue her term as COA Trustee. Our society is fortunate to have dedicated members who aspire to the highest levels of COA leadership. Thank you to Amanda and Erin for your dedicated service to California optometry and for representing our Society in this exemplary manner at a high state level!

Dr. Jason Tu was elected to COA President-elect! Dr. Tu is our fellow member of SDCOS, and he is another reason why SDCOS is America’s finest optometric society. Congratulations, Jason, we are fortunate as a Society to have you representing us at the summit of the state level!

Our new COA President, Ronald G. Seger, O.D. of Mountain View, CA was installed and gave an address to the House. He talked of the consolidation of optometric business and measured reduction of self-employed optometrists, and how reduced self-employment has been linked to lack of freedom, lower career satisfaction, and decline of self-actualization. He stated that in the U.S., purchases by private equity groups have increased. He emphasized that the successful factor in optometric practice is the trust and strong professional relationships we share with our patients. Dr. Seger asks that each of us work to make optometry strong and patient care excellent.

The next COA event will be Legislative Day in Sacramento on April 10, 2019. I encourage our ODs to travel to our state capitol and join forces on Leg. Day, as there are many optometric issues of the day to discuss with our elected legislators. COA will teach us about the issues in the morning, supplying us with talking points regarding bills that could potentially threaten our profession, as well as bills that would allow us increased freedom of practice. Please let me know if you are interested in participating!

---

---

Retina Corner Gene Therapy

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

Hey everyone – I hope you are all doing well. Last month we talked about a novel pigmentary maculopathy that may be due to the Interstitial Cystitis medication, pentosan polysulfate sodium

(Elmiron). I described a patient recently sent to me by Earl Sandler and, very interestingly, I saw an extremely similar patient just a few weeks later. This may not be a coincidence. The drug was actually developed in collaboration with a local urologist, and there may be more patients in the San Diego area than anywhere else in the world. As such, I am contacting urologists and hope to collect as much information about this as possible. If anyone knows of any patients on the drug, particularly those on for over 10 years, please let me know and I will gladly screen them for the maculopathy.

For this month I wanted to talk about gene therapy for macular degeneration. After decades of discussion and promise, this is finally coming close to reality. This past weekend I attended a small meeting with the scientific team from Regenexbio, where we practiced injecting fluid into the subretinal space – mimicking the modality for delivering the investigational product, RGX-314. Very exciting.

About RGX-314

RGX-314 is being developed as a one-time subretinal treatment for wet AMD. It includes the NAV AAV8 vector encoding an antibody fragment which inhibits VEGF, similar to the drugs we inject into the eye for patients with choroidal neovascular membranes.

RGX314 was recently evaluated in a Phase I, multi-center, open-label, multiple-cohort, doseescalation study. The study enrolled 24 previously treated wet AMD subjects across four cohorts that were responsive to anti-VEGF therapy. The study was designed to evaluate four doses of RGX-314, and the primary purpose of the clinical study was to evaluate the safety and tolerability of the drug. Primary endpoints include safety and tolerability and secondary endpoints include ocular examinations, visual acuity, imaging (including spectral domain optical coherence tomography (SDOCT)) and the need for additional anti-VEGF therapy. Following completion of the primary study period, subjects will enter a follow-up period and will continue to be assessed until week 106 for long-term safety and durability of effect.

The drug was well-tolerated and showed dose-dependent protein expression levels, dose-dependent reductions in anti-vascular endothelial growth factor (anti-VEGF) injections, and maintenance of central retinal thickness and vision.

As the number of patients with wet macular degeneration continues to increase, it is wonderful and exciting to know that options are being developed to minimize the treatment burden. In addition to gene therapy, which may be a one-and-done treatment, we also are on the brink of having the port delivery system from Gennetech, with which only 20% of patients required a treatment more frequently than every 6 months in the phase 2 trial. The phase 3 trial for this is enrolling now, and the phase 2 study for the Regenexbio gene therapy system should start enrolling over the next 3-6 month. Either way, we have exciting options for patients hoping to minimize treatment burden. I would be happy to let you know if any of your patients might be a candidate.

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)

---

---

Respond to All Google Reviews. Your Wallet Will Thank You.

Google Reviews are the reviews that might actually persuade potential new patients searching for a local eye exam to choose you. Your Google reviews will be scrutinized, so it’s important to respond to them, good and bad.

Wait, I Should be Responding to Positive Reviews?

YES! There are two big reasons you SHOULD be responding to positive reviews:

1. Responding to reviews is good for your SEO
2. People like the feedback to THEIR feedback

Reviews count as engagement on your GoogleMyBusiness (GMB) listing. Responses further that engagement. A GMB listing that is active is more likely to show up prominently for relevant local searches. More online search exposure means more patients through the door. It’s as simple as that.

Responding to positive reviews extends the posters great patient experience into an out-of-office rapport of good feelings that will now last longer in the mind of your patient. That kind of public branding is priceless and sends the message to new potential patients that you care about delivering a great patient experience and take feedback seriously.

So How Should I Respond to a Nice Review?

Something like, “Thank you for your kind words”, or, “We appreciate your feedback” are great. Be genuine and gracious. Never any patient specifics.

Hungry, Hungry HIPAA’s: Responding to Reviews While Respecting Privacy

It can be very tempting to respond to a review, particularly a negative one, by directly countering the specifics. Avoid the urge! At EyeCarePro, we take a very conservative approach to HIPAA compliance. An audit, fine, or worse, a lawsuit, is simply never worth the risk. Never explicitly acknowledge that the poster is a patient, or that he or she received a specific treatment or exam. You can address concerns about patient care, insurance, timeliness, etc. but keep your replies general and not specific to the patient.

Responding to Negative Reviews

Bad reviews happen to everyone. No matter how fantastic your care is and no matter how warm and friendly your staff is. Don’t worry though, a few negative reviews amongst lots of great ones make your great reviews seem more believable.

Reply to negative reviews promptly. Chances are slim that the poster of the negative review will change their mind. But it doesn’t matter.

The main point of responses to negative reviews is to show other people that you care about and respond to patient concerns!

If you can get the issue resolved and the review retracted or changed that’s fantastic!. Ultimately, though, your response is there to show prospective new patients that you take patient concerns seriously.

Be Proactive: Ask for Reviews All the Time

The best way to counter negative reviews is to bury them in a deluge of positivity! You can protect your average and disprove the negative nancies with the positivity you generate. Always be asking for a nice review from happy patients! Current positive reviews will single your practice out as the one to choose, meaning more patients and more revenue.

Zvi Pardes is the Head of content marketing at EyeCarePro , which provides ECPs with educational content that helps them advance their practices through technology, management strategies and digital marketing. EyeCarePro serves both industry and practices and is the only company of its kind solely focused on the optometric space. Contact him atzvi@eyecarepro.net.

---

---

By the Visionary Contact Lens Team The Usefulness of Power Mapping Multifocal Specialty Lenses

Presbyopia is one of life’s big inconveniences and any relief comes with a warm welcome.  One of the challenges of a multifocal contact lens is to get the largest range of vision that satisfies the lifestyle of the wearer.   Given the big reward for successful multifocal vision you might find that more detailed knowledge of the lens power profile could be a useful diagnostic tool for modifying the design to suit your patient’s needs.

For single vision lenses the power varies radially with the target power contained consistently within the optic zone.  For multifocals, the power outside the optic zone is also important so it is valuable to understand how the power transitions from the central optic zone toward the lens periphery.  The transition depends on the nature of the design.  For example, power will transition much differently for an aspheric center distance lens versus a center near three curve lens.  The power profile can go a long way to explain why your patient can’t get the range of vision they desire.

For example, if your patient puts on the multifocal and is pleased with his/her vision, you can assume the distance power and add power fall in the visual zone of the lens necessary to meet their needs.  However, if your patient complains of having sharp distance vision but unable to focus on their computer monitor, a look at where the add power lies with respect to the center of the lens could reveal the center distance zone is too large and the add power is too far from the center of the lens.

At Visionary, we can perform a power map using the Rotlex Contest II.  The Contest II can report power across the surface of the lens within the selected radius of interest.  The Contest II power map is unlike a lensometer reading that reports the power at a single location. The Contest II uses the principle of Moire deflectometry to create a Moire fringe pattern on the surface of the lens that corresponds to the optical properties of the lens.  Once the power map is plotted it becomes a useful tool for evaluating the effectiveness of multiple powers.

To demonstrate the value of the mapping, Figures 1 – 3 show examples of multifocals and give insight to the kind of vision a patient might expect.

The first two figures are center distance multifocals.  Figure 1 has an aspheric back curve while the lens in Figure 2 is made with a three curve peripheral system.  In both cases the center distance power is achieved and consistent across the optic zone.  Also for both lenses, the desired add is achieved at the closer to the peripheral zone of the lens.  The difference between the two lenses is in the power transition zone which exists between center distance zone and the add power zone.  Manipulation of the transition zone may improve visual satisfaction by moving the desired add closer to the optic zone.

Figure 3 is a center near multifocal.  Again, knowing the location of the distance zone relative to the near zone can help with diagnosing visual satisfaction.

 

---

Eye See written by Dr. Byron Y. Newman THE STARBUCK SOLUTION

In an article from the Mayo Clinic, Donald Hensrud, MD wrote in answer to the question, “Does Coffee Offer Health Benefits?”

Dr. Hensrud answered, “Coffee has been around for a long time and blamed for many ills—from stunting growth to causing heart disease. But, newer research showed that it may actually have health benefits.”

He went on to discuss recent studies, one of which found no connection between coffee and an increased risk of heart disease or cancer, and another found an association between coffee consumption and decreased overall mortality.

He goes on to ask, “Why the apparent reversal in the thinking about coffee?”

He goes on to report that earlier studies didn’t always take into account known high-risk behaviors such as smoking and physical inactivity, which tended to be common in heavy coffee drinkers. He also pointed out that coffee has benefits including protecting against Parkinson’s disease, type 2 diabetes, and liver disease. Coffee also appears to improve cognitive function, he said, and it decreases the risk of depression.

The risks showed up in studies where unfiltered coffee in large amounts, such as boiled or espresso was associated with mild elevations of cholesterol.

He cautioned that adding sugar and cream to your coffee adds fat and calories, and in some cases up to hundreds of calories.

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

---

---

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

March 24, 2019, 5-HOUR CE – Ocular Disease/Glaucoma
Speaker: Dr. Dawn Pewitt, Handouts

 

See 2019 CE schedule

All 2019 CE meetings are located at the Handlery Hotel, 950 Hotel Circle North, San Diego, 92108.

2 Hour CE

• SDCOS Members: Free if reserved 4 days in advance*
• COA/AOA Members: $35
• Non-members: $130
• Registration 6:00 pm, lecture at 7 pm. Dinner included.

5 Hour CE

• SDCOS Members: $90 if reserved 4 days in advance*
• COA/AOA Members: $90*
• Non-members: $325
• Registration 7:00 am, lecture at 8 am. Breakfast included.

*Late registration and no-shows will result in an additional fee of $35 to cover the cost of food.*

Members need to make sure they sign out at the end of all CE meetings. Even though they receive a letter of Validation and COA is notified, if audited, the sign in and out sheet is the document that will be considered.

---

---

Classifieds

Practice for sale: North County Carlsbad “Upscale” Practice established in 1982. Great opportunity to buy a practice in a well-desired location with great visibility and walk-in traffic. Only two miles to the ocean! The owner is interested in an immediate sale or will consider a buy-in or possibly merge with another practice. I am looking to retire but will consider a part-time position to make the transition easier. Center is well established with Vons market and Movie theatres as anchors. Don’t miss this opportunity to own your dream practice! Email: bluesdoch@yahoo.com or call 760-310-8492 (03/19)

Optometry practice for sale in an upscale area of beautiful San Diego. This solo location practice has annual revenue of $524,000 and still has potential to grow. This approximate 1,200 square foot office was recently renovated. Equipment is in excellent condition and includes a Humphrey Visual Field and OCT Cirrus Photo 600. The full scope of practice includes adult and pediatric examinations, contacts, and specialty contact lenses, dry eye, ocular disease and a moderate population of glaucoma patients. Over 1,500 patients examined last year. Beautiful optical with a wide array of frame lines. EMR/EHR certified using Compulink software system. Complete Sale/Buy Out. This practice is set up for a turnkey transition. Please email CV or questions to drewhutten@gmail.com  (03/19)

Urban Optiks Optometry is currently interviewing for a personable optometrist to join our professional team on a part-time basis (1-2 days per week). Qualifications would include: Must be able to work Saturdays, ability to fill in on additional days as needed a plus, strong diagnostic skills & a passion for delivering patient-centered primary eye care, team-oriented & willingness to chip in wherever necessary, familiarity with Exam Writer and Topcon CV5000 preferred. There is a great opportunity for an associate doctor to eventually acquire a partnership in our practice. For a chance to join this exciting team, please send resume & cover letter, including why you think you’d be a great fit to kristy@uoosd.com  (03/19)

Optometrist needed inside Mission Valley Costco on Tuesdays. Please contact Robyn Slikker, O.D. at (619) 977-7703 Cell orrslikker@san.rr.com (03/19)

Optometry Position in private practice in Clairemont, San Diego for 1 day per week (Fridays) Apply to gsneag@yahoo.com  or call 858-560-5181 (03/19)

Optometrist Position: Private primary care practice in City Heights seeking Part-time OD 1-3 days/week beginning in April.  Please send CV & inquiries focusoptometrysd@gmail.com (03/19)

Equipment for sale: Zeiss Humphrey Matrix 800. Great condition! Asking $9,700. Contact andrew.romeril@gmail.com for more info. https://med-shop.zeiss.com/Ophthalmology/Glaucoma/Perimetry/Humphrey-Matrix-800-zid266002-1136-161?tracking=tc-homepage-featuredProducts (04/19)

Optometrist Position:  Busy, full-scope optometry practice in beautiful Carlsbad is looking for an amazing optometrist to join our awesome team starting in April 2019!  This will be a full-time position with benefits (32 hrs/week), and includes some evening hours as well as 3 Saturdays per month (9am-2pm).   If you are interested in this position, please send a CV and cover letter to kwitmeyer@carlsbad-optometry.net  (04/19)

Maternity Leave Coverage Needed: Optometrist needed in Santee for Tuesdays & Fridays for the months of June, July, August & September. Daily pay plus bonus structure available. Will be opening another location at the end of the year so this could turn in to a full-time opportunity if desired. Please send CV drkellykeane@gmail.com (04/19)

Optometrist Position: Primary Care optometry practice seeking a part-time optometrist for 2-3 days a week in a private practice located in Mira Mesa. Please send CV or interest to tonydpham@hotmail.com or call (714) 454–7400 (04/19)

---

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

ALL DOCTORS WILL RECEIVE A FREE 5 HOUR CE FOR EVERY SHIFT FOR WHICH THEY VOLUNTEER

---

Monarch School Screening

Monarch Screening: Monday February 25th
Monarch Exams with VSP Mobile Clinic: March 11-12th.

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

---

Lion’s Optometric Vision Clinic

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.

---

DONATE GLASSES
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 sdcos@sdcos.org

SDCOS Announcements

Welcome, New Members!

• Anita Koo, O.D.

A Note from Dr. Robert Meisel

The past several years I have served on the SDCOS board of Directors as the Public Awareness Chairman. You’re thinking what is that?  The mission is to make sure the public knows what optometry is and what it can do. This is accomplished by the society members that volunteer for events held throughout the year.

I coordinate the various county public health fairs, school screenings and Stand-Down programs for Veterans and anywhere else we can pass the word about eye health and eye care.

Monarch School: Located in the Barrio Logan area, Monarch is a public K-12 school exclusively for students who are homeless, at risk of being homeless, or impacted by homelessness. Screening and follow-up exams for the students who need eyewear are done semi-annually. The next opportunity to volunteer is with the VSP Mobile Clinic on March 11-12, 2019.

UC San Diego American Medical Student Association (AMSA) 10th Annual Health Fair: The purpose is to educate the underserved and low-income families of San Diego about health-awareness and disease prevention related issues. Volunteers are asked to pass out brochures regarding eye health and vision information on behalf of the SDCOS. Saturday, April 13, 2019.

San Diego Veterans Stand-Down: An intervention program dedicated to “Leave No One Behind” supporting more than 800 homeless veterans and their families. Volunteers provide eye exams, eye health and vision information for veterans and their families. The San Diego Stand-down is on June 28-30, 2019.

The Lions Optometric Vision Clinic (LOVC): An independent clinic founded by members of the SDCOS. The LOVC provides vision care to individuals in the community that could not otherwise afford adequate care. It has been the tireless effort and dedication of volunteers from the SDCOS that have made this a successful project. Volunteering can be anytime you are available; even one day a month would help so many in need. If volunteering at the clinic is not an option you can see patients at your office. If you are interested please contact the LOVC (619) 298-5273, Monday – Friday 9:00 until 1:00 pm.

These are only some of the volunteer opportunities available for SDCOS members. Please contact me if you feel moved to make a difference in the lives of students and adults in San Diego County. rmeisel@netscape.net  or (c) 619-818-3031

---

• Click here for most recent SDCOS Board Meeting Minutes
• Click here for the 2019 CE schedule!
• Click here for COA membership benefits!

---

Please update your information on www.eyehelp.org

 

Upcoming Events

• February 21st, 2019: 2 hour CE, “Ocular Disease”
• March 24th, 2019: 5 hour CE: Ocular Disease
• April 10th, 2019: Legislative Day in Sacramento