The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• CE Corner
• What Can A PEO Do For You?
• Classifieds
• Volunteer Corner
• SDCOS Announcements
• Upcoming Events

President’s Message April 2019

Robert Grazian, O.D.

Imagine to yourself a real-life important person: a real VIP. It’s up to you who this person is. For the sake of imagination, make it big. Could this VIP be someone on the world stage—perhaps a president, a king or queen? Perhaps a great entertainer, like Elvis, Sinatra, or Liberace? Perhaps the Pope, the wealthiest person alive, the top General of the Armed Forces, or our best Nobel Prize-winning scientist.

OK, now imagine this most important person, this real VIP, wants an eye examination because they are experiencing an unusual vision disturbance.

Could you perform their eye exam? Of course you could. Now decide what kind of an eye exam it would be. Well, that’s easy, just like everyone else’s. Or is that the truth? Would you give the most high-level eye exam in your capabilities? What about the time spent? How many minutes? Would you dilate? Would you perform binocular testing, phorias, compensating vergences, ocular photos, biomicroscopy, evaluate for dry eye, and perform perimetry? Would you take the time to test for computer distances and explain the benefits of computer glasses? What about sunglasses to protect the VIP’s eyes? Would you be able to perform the eye examination for this highly-important person at the level you’d like to? If not, why not?

And more importantly, why can’t everyone, everyone down to the last person you know, have the eye examination you just wanted to provide?

My point here is that we are better than we are. Our desire to provide the highest-quality eye care, consistent with our capabilities and knowledge, probably exceeds what we are currently providing. There are reasons for that, and those reasons start within ourselves.

In my own experience, I remember being frustrated with the care I provided my elderly patients early in my practice. I stopped prescribing them dietary supplements because their managed care plan openly discouraged it, and I didn’t want to be confrontational for fear of losing my panel position. Thankfully, eye vitamins are considered more of a standard of care these days, but it still bothers me how I compromised patient care for a time because I didn’t want to buck the system.

There is a concept in personality psychology called “locus of control”—individuals have either an external or internal locus of control. Those with an external locus of control tend to believe that outside forces, like luck or fate or the actions of others, are the driving factors in their lives. For example, someone with an external locus of control might say, “It’s the government’s fault,” or “You can’t fight city hall,” or “My college wasn’t prestigious enough,” or “It’s all about how much money you have.”  Those with an internal locus of control tend to believe they themselves are the masters of their destiny, and that their own effort and abilities are the reason for their successes. Someone with an internal locus of control might say, “I know it’s up to me,” or “I have to learn how to become more successful,” or “I am responsible for what happens in my practice,” or “I learn from my mistakes.”

Many studies have linked an internal locus of control to better work performance and higher career satisfaction.  Most psychologists agree overall that an internal locus of control is more preferable and more adaptive. Certainly, there are advantages to employing both outlooks, and there are instances when all control is definitively out of our hands. But because the internal type is more advantageous, we can all benefit from paying closer attention to where our personal locus of control is pointing. If it’s outward all the time, we can try to nudge it inward.

Think about how you want to practice optometry down to the very eye examinations you are providing to your VIP’s and loved ones. Think about being in control of your own career. Think about staying interested in your own career. We are better than we are.

With that none-too-subtle note, I will remind our members that COA Legislative Day is an event that I truly believe every California OD should experience, at least once in their lifetime! I’ve found it to be an empowering, positive experience for my own career, and well worth the effort. Consider making the trip to Sacramento to spend some quality time visiting with our elected officials and talking about the important optometric issues of the day. The COA makes this easy on us by providing a morning of personal coaching and individual talking points. We then take it from there, and make the day great. If you participated in Legislative Day this year, the Society says “Thank you.” If you missed it, there’s always next year. Hope to see you there!

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Retina Corner Elmiron Maculopathy

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

Happy Spring, everyone! This month will be quick, interesting, and to the point. A few months ago I wrote about a fascinating novel maculopathy linked to the drug Elmiron.

Just to recap, Elmiron is one of the only effective treatment options for the debilitating condition, interstitial cystitis (IC), which I liken to fibromyalgia of the bladder. It primarily affects women, and presents with vague bladder pain, urinary urgency and frequency, and painful intercourse. Honestly, it sounds awful. Elmiron is an oral drug that protects the epithelial lining of the bladder and minimizes symptoms in a substantial percentage of patients – for some, it is the only effective option. Recently, however, a report in Ophthalmology described a degenerative maculopathy that appears to be associated with chronic Elmiron use. The condition presents with central irregular pigment clumping with areas of adjacent RPE atrophy. In the report visual acuity appears to be fairly well preserved, with the main symptom being difficulty with night vision.

Last month I shared a case I had recently seen, and about a week later I had a second patient come with a nearly identical presentation and a 10-year history of Elmiron use. This didn’t strike me as a coincidence, so I scoured our patient records and discovered another five affected patients and possibly more (some imaging records are in our archives). I put the cases together and presented them at a recent meeting at UCLA. The patients all looked similar to the published case series, and nearly all had difficulty with dark adaptation. Moreover, as we are one of the rare Retina clinics with a dark adaptometer (Adaptdx, MacuLogix, Inc.) I was able to bring in three of the patients to document a clearly abnormal dark adaptation score. Dark adaptation may be the best indicator of disease severity, and I plan to follow this and macular microperimetry over time to monitor progression. While I cannot be certain that the maculopathy is due to the drug and not the IC, out of caution I advised all the patients to discontinue or minimize use of the drug. I am concerned that a toxicity will continue even after the drug is stopped, similar to what we see in plaquenil maculopathy.

It is not a coincidence that I found so many patients so quickly. Elmiron was developed in San Diego by a prominent local urologist, and we very likely have relatively large population of patients on the medication for ten or more years in the community. These patients are easily misdiagnosed as AMD or a pattern dystrophy, and I urge you all to look for potential patients. I would be happy to see them to screen for the maculopathy.

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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What Can A PEO Do For You?

Juggling too many HR tasks? Read how a PEO helped one HEA member.

Two years ago, Mark Sabre, OD, of Minneapolis, Minnesota, found himself between a rock and a hard place. The health insurance company his practice had been working with announced that it was eliminating its individual care plans. With his small practice that didn’t qualify as a group, that meant he had to go in search of a new carrier because all of his employees’ plans — including his and his wife’s — were being discontinued.

“We were in jeopardy of losing our coverage, and I was trying to determine how I could reasonably provide health care coverage for my team,” he says. That process involved hours on various websites, plugging in numbers and not knowing whether he was accurately assessing the needs of his staff. “I started reaching out to colleagues — other ODs as well as friends with small businesses,” he says.

He called his brothers, who were both successful business owners. “I learned they had been using a professional employer organization (PEO) for the previous 10 years to handle human resources (HR) matters and for access to benefits for their employees,” he says. He quizzed his brothers thoroughly and found that they used Insperity. So Dr. Sabre called.

A More Organized Approach

In talking with Insperity, he found that the company offered all of the individual services he might need under one umbrella: payroll and HR issues; government compliance assistance; workers’ compensation coverage and claim resolution; HR professionals experienced in training and development, writing manuals and handbooks, and investigations or mediation; and, most urgently for him, access to comprehensive and affordable benefits.

Insperity helped him gain access to affordable coverage for everyone in his practice — including himself — who wanted to elect health care coverage. The total price tag for covering the entire office was about the same amount as it would have cost him just to cover himself and his wife, he says. He also learned about additional services that Insperity could offer his practice. “The more I thought about it, the more it made sense to try to bring everything together under this PEO umbrella. It would simplify my life,” he says.

“With Insperity, I was part of a group that was capable of achieving more attractive terms. My employees are the beneficiaries of these programs that have been unique to larger companies and are almost unheard of in a seven-person office.”

Weight Off The Shoulders

The PEO has helped him in ways that he didn’t anticipate as well. “I had been working on updating the employee handbook, and I was drawing from two or three sources and trying to cobble something together. Insperity had me send what I had, and its team helped me put together a robust employee manual that makes sure I don’t miss any of the federal rules or state regulations that should be a part of it,” he says. It’s also good to know that he can have representatives available at a moment’s notice should there be hiring or firing issues. “If you have to call an employment law attorney to find out what steps have to be taken in an employee situation, that can be very costly. These issues are in the wheelhouse of a PEO,” he says.

“It’s worth a phone call,” he says. “Spend an hour meeting with a rep and look over the proposal the team puts together.”

This item is excerpted from the cover story in the Jan/Feb 2019 edition of HEA Solutions. You can read the whole story here.

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Eye See written by Dr. Byron Y. Newman HUMOR FOR HEALTHCARE PROVIDERS

While anecdotal evidence has long suggested that people “feel better” after a hearty laugh, it’s only been in the past 40 years that researchers have been investigating how humor and laughter yield specific health benefits. There’s even a company called “The Laughter Remedy,” a New Jersey Company that provides seminars on humor for health care providers.

It appears that most of the research has focused on the link between humor and the immune system, since humor (and the resulting laughter) increases immunoglobulin A (IgA) which protects against upper respiratory infections. Other studies show an increase in IgM and IgG, which do a number of good things in the immune system. Not only that, but some patients even get pain relief, with one study showing nearly three-quarters with neurological or musculoskeletal disorders agreeing with the statement “sometimes laughing works as well as a pill.”

Laughing increases endorphins, and is an excellent source of cardiac exercise, and for those with respiratory conditions it helps clear the lungs of residual air which can be replaced with oxygen-rich air.

There are many books on the subject, two of which I’ll mention here.

One is called, “Splashes of joy in the Cesspools of Life,” by Barbara Johnson, and the other is “The Laughter Prescription,” by Cal Samra.

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

May 16th, 2019, 2-HOUR CE -Glaucoma
Speaker: Dr. Gayle Howard

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.

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Classifieds

For Sale: Solo private practice continuously serving Solana Beach since 1977. Loyal patient base, many 3rd generation family members returning. Office noted for high-quality care and community service. Full scope optometry with high-end instruments and up to 3 full exam lanes. Attractive, well-designed office space with a large upscale dispensary, private pretest/contact lens area, finishing lab. Medical co-management and billing in place for years. The lease is under market until 09/22 with options to renew. The doctor is seeking retirement but is very flexible and would consider staying on part-time for patient retention. Please contact Mfoyleod@yahoo.com (04/19)

Optometry Practice for sale: in an upscale shopping center in Escondido, San Diego County. California. Solo Private Practice established since 1996. Please email basantis2004@yahoo.com for details/questions. Has a large patient base. Equipment is in excellent condition. A full scope Optometry Practice. Complete Sale or buy out option. (04/19)

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 (04/19)

Part-time associate optometrist needed for primary optometry office in Chula Vista, San Diego. The doctor will be working with excellent support staff including opticians and a technician who performs full workup including retinal photos. The office is equipped with the latest technology including RT-5100 Refractors, retinal camera, and auto-refractor and more. Come and join our great team! Please email CV or questions to emascareno@yahoo.com or call 619-254-0115. (05/19)

Full-Time OD Position: Seeking permanent Associate Optometrist for our private practices in San Diego.  Enjoy a comfortable pace with our all-digital equipment.  Staff performs full workup, including retinal photos and OCT.  Please email resumes/questions to MichelleKingOD@gmail.com (05/19)

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

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)

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)

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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

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

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Monarch School Screening

Next Monarch screening will be this Fall. Stay tuned for details!

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

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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.

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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!

• Dr. Thu Nguyen
• Dr. Alla Young

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

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

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Please update your information on www.eyehelp.org

 

Upcoming Events

• April 10th, 2019: Legislative Day in Sacramento