San Diego County Optometric Society
The San Diego View
Inside this Issue:
Robert Grazian, O.D.
As optometrists, we know better than anyone that quality of life is deeply connected to having normal, comfortable vision. Once empowered with clear eyesight, our patients can go about life with confidence—they can study for finals without battling headaches; contribute at a work meeting without straining their eyes; go on a hike and notice every leaf, flower, and bird. The use of eyeglasses may seem basic to us, but to our patients, it can be life changing.
One of the most personally gratifying aspects of our profession is how we’ve been specially educated to provide a valuable service to anyone who needs it. When a person—no matter their age or socio-economic status—has a vision difficulty, they can confidently go to an optometrist and receive the care they need.
By volunteering our time, we can provide the public with a high level of community service. SDCOS members have a fully-equipped, fully-staffed optometric clinic available to us through our local charity of choice, the Lions Optometric Vision Clinic (LOVC).
The LOVC’s mission is to provide eye care for individuals throughout San Diego County who are otherwise unable to obtain it through private insurance or other social service agencies. By volunteering at the LOVC, you can deliver many vision and eye health services to the public, including comprehensive eye examinations, low-cost eyeglasses, dilated retinal evaluations for diabetic patients, Optos retinal photography, vision therapy, and glaucoma screenings.
SDCOS members have volunteered at LOVC for many years, and in our long and successful relationship we’ve helped them in their charter of providing eye care for persons in need throughout San Diego County. The eye examinations at LOVC are free of cost to those who qualify, but this is only possible because of the doctors who are so generous to volunteer their time and skills. At this time, there is a waiting list of patients seeking optometric care because there is an undersupply of participating volunteer doctors.
LOVC volunteer scheduling is half a day, from 9am – 12:30pm, Monday through Friday.
This allows plenty of time for the volunteering doctor to see a half-day schedule of patients at LOVC and not miss a full day of personal work. LOVC is also very accommodating to doctors who want to work at different paces, and will make the experience as comfortable as possible. New OD volunteers are valued as well as veteran doctors, and LOVC only needs two or more days’ notice from a volunteering OD.
I’d like to encourage all our members to consider volunteering any time you may have, to help LOVC continue to serve a very needing and deserving group of people in our community. Doing so provides a truly life-changing service for our fellow San Diegans.
Please call LOVC directly to schedule yourself by contacting the Lions Optometric Vision Clinic at 619-298-5273. The clinic is located at 1805 Upas Street, San Diego. For more information from a colleague, contact Dr. David Wong, SDCOS Liaison to LOVC, or ask any SDCOS Board member.
Metamorphopsia Following Retinal Detachment Repair
By Nikolas J.S. London, MD FACS
Director of Clinical Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla
Amazingly, we are well into spring and on the way to summer. Each year seems to pass faster and faster, doesn’t it? I hope that everyone is enjoying the beautiful weather and planning some wonderful summer vacations. For me, I’ve got a few camping trips planned for our new Airstream with my wife and three boys – Sequoia National Park coming up soon and Yosemite at the end of the summer. We can’t wait!
For this month I wanted to talk a bit about something that can be frustrating following successful repair of macula-involving retinal detachments, visual distortion. Fortunately, this is relatively rare, but when it does happen, patients can be quite symptomatic with metamorphopsia and even binocular diplopia. The main reason for this is that the retina is very much like a thin, living wallpaper lining the back wall of the eye – it is simply held in place by a light adhesion and negative pressure between the retina and RPE. When a retinal tear allows liquid vitreous into the subretinal space, these mechanisms are disrupted and the “wallpaper” falls off the wall. While we are able to reattach the retina with very high success rates, this is a gross process, and the exact position of the tissue is likely different than prior to the detachment. We call this “retinal shift,” and this is more common in cases with very large retinal tears, in cases with substantial residual subretinal fluid, and in cases where the patient was unable to strictly follow the postoperative positioning requirement.
Sometime the cause of retinal shift is obvious, with clear micro- and macro folds in the tissue visible on exam. During my fellowship one of my attendings had a remarkable case with a huge retinal fold that coursed directly through the macula. While the retina was attached, the patient’s vision was terrible, and the surgeon actually took the patient back to the operating room and redetached the retina in order to flatten out the fold. On the other hand, most small folds, termed “microfolds” that are visible as thin hypopigmented lines on exam, and as small hyper-reflective dots in the outer retina on OCT, often resolve spontaneously over several months. Other times there is retinal shift that is only visible with fundus autofluorescence – you can see hyper autofluorescent lines that indicate where blood vessels previously lied.
Retinal shift is not fully unavoidable, but can be minimized with proper operative techniques. Positioning is critical. As there is commonly a small amount of residual subretinal fluid following surgical repair, patients should be advised to position for a short time with the tear in the most gravity-dependent position. This is counter-intuitive as we typically require the patient to position in the exact opposite way, but this can allow a few hours for residual fluid to egress in the appropriate direction. Face-down positioning is also a way to use the bubble to tamponade the macula and push fluid elsewhere. Finally, during surgery the use of the heavy liquid, perfluorocarbon, can push subretinal fluid back out through the retinal break and minimize residual fluid. Despite our best efforts, however, some patients will still suffer from this. For these patients I will reassure them that the retina looks very healthy overall and that over 50% of the time the symptoms will significantly improve or resolve with time. It can be difficult, but I tell them to be patient and don’t give up hope for at least 12-24 months. I have wonderful memories of affected patients coming in a year later with a big smile on their face that things have gone back to normal.
Thanks again for reading. Please don’t hesitate to contact me with any questions.
Best wishes, and until next time,
Nikolas London, MD
Retina Consultants San Diego, Poway, La Jolla, and Coronado
firstname.lastname@example.org (personal email)
email@example.com (RCSD email)
Restorative and Protective Compound for the Macular Pigment, Overall Retinal Health and Lowering the Risk of Vision Loss
Supplementation with the three macular carotenoids along with full-spectrum antioxidant therapy can restore the macular pigment, improve overall retinal health and reduce the risk of vision loss due to age-related macular degeneration (AMD) and other eye diseases. More than 100 peer-reviewed articles have been published supporting the benefits of the comprehensive range of specific ingredients contained in the highly effective Lumega-Z formula.
Macular Carotenoids: The Building Blocks of the Macular Pigment
More than forty different carotenoids are found in the human body, but only three of these carotenoids — lutein, zeaxanthin and meso-zeaxanthin — are concentrated in the eye. These three carotenoids accumulate in the center of the eye, directly in front of the macular region, and are known collectively as the protective macular pigment. Research shows that these pigments make up only 20 to 30% of the carotenoids in human blood serum, but 90% of the carotenoids in the human retina. This extremely high retinal concentration suggests a specific uptake and storage mechanism for lutein, zeaxanthin and meso-zeaxanthin in the retina and emphasizes their essential role in retinal function. Research shows that all three of these carotenoids play a critical role in the UV protection and reduction of oxidative free radicals.
Lumega-Z: Replacing What Age Has Taken
Lumega-Z is the only ocular health medical food that offers all three macular carotenoids in conjunction with a full powerful spectrum of anti-inflammatory and antioxidants. Lumega-Z is also delivered with a separate bottle of Omega-3 soft gels, which are important in the outer segment for fighting oxidative free radicals.
Lumega-Z Patient Success / Case Study from Dr. Aaron Lech
Sherry came to see me in 2011, grappling with changes to her vision caused by a progressive thinning and degeneration of her macula. I employed a series of therapies, and visual aids to protect this vibrant woman’s vision and her livelihood. You see Sherry, a professionally trained musician, operated a successful business training aspiring musicians. Shuttering her business, her life’s work, was increasing becoming reality.
After 3 years Sherry was forced to make the decision to close her business. In addition, Sherry had to give up a favorite pastime, one we all take for granted, reading a book. …fast forward to August of 2016… Bolstered by early success I had seen with a limited set of patients, I suggested Lumega-Z to Sherry. Similar to other patients, Cirrus OCT en face analysis seemed to indicate an improvement of sub-RPE illumination.
In November of 2016, Sherry sent my family a note from Hawaii. It read, “Thanks for allowing me to see Hawaii”.
In early December, Sherry popped in for a surprise visit. You couldn’t mistake the smile on her face. She said, “I have to tell you something, for the first time in 2 years, I read a book last night. Whatever you are doing is working.” In early January 2017, Sherry re-opened her business. She also pilfered all of my business cards since her friends and students were asking what had changed.
To learn more about Lumega-Z go to www.guardionhealth.com
What can VSP® Ventures do for an evolving practice?
As you may have heard, in March VSP Global® announced the launch of VSP Ventures, a new business unit designed to provide a care-focused choice for doctors looking to transition their practices. VSP Ventures is acquiring practices from doctors looking to retire or doctors that desire to remain in practice to fully focus on patient care.
Doctors have been asking VSP to create a doctor-centric alternative to private equity—one that truly centers on the importance of comprehensive care. It’s critical for VSP to ensure this evolving landscape serves both our members and VSP network doctors in mutually beneficial ways.
If you’re interested in learning more, please reach out to our team directly at VSPVentures@vspglobal.com.
Connect with a Colleague
Contact your local State Professional Representatives (SPRs) to get a fellow doctor’s perspective on what you’re hearing, or to learn more about VSP policies or feedback on programs.
Ankur Kalra, OD practicing in Chula Vista, CA, and Eric White, OD practicing in San Diego, CA are your local SPRs connected with VSP Global. They are available to listen, respond and facilitate information sharing with VSP.
Contact them today!
Ankur (A.K.) Kalra, OD
Eric White, OD
written by Dr. Byron Y. Newman
MASLOW’S HIERARCHY OF NEEDS
I’m sure you heard about this somewhere in your education, since Maslow and his Hierarchy of Needs (proposed in the 1950s) have become a big part of Psychology. Should optometrists be aware of it? Well, let’s take a look at it a bit and see.
This all started recently when I was doing my family’s genealogy, and found that my great grandmother’s maiden name was Maslow. Probably not related, but in searching I ran across the more modern Maslow and his psychological work.
Suppose you’re drowning, and someone comes to the edge of the pool where you’re struggling, and says he’s got a great deal on a new Cadillac that you could buy for under $5,000. I’m sure that would mean nothing to you until you were back on dry land and feeling back to normal.
Maslow considered physiological needs as most important as all the other needs become secondary until these needs are met.
Thus, the first and most important needs are biological requirements for human survival: Air, food, drink, shelter, clothing, warmth, and sleep.
If these needs aren’t satisfied, the human body cannot function optimally. Next comes safety (which I thought should be first, but far be it from me to judge the order he has chosen.) We need protection from the elements, security, order, law, stability, freedom from fear. Do the homeless worry about these things? Perhaps that’s why they don’t participate in other activities.
Because, next is love and belongingness. After physiological and safety needs have been filled, the third level of human needs is social and involves feelings of belongingness. Examples include friendships, intimacy, trust and acceptance, receiving and giving affection and love, Affiliating and being part of a group (Family, friends, work.)
Next are esteem needs: Esteem for oneself, (dignity, achievement, mastery, independence. A second part of this is the desire for reputation, or respect from others (ie status, prestige.)
Now you’re ready for the top tier, Self Actualization needs: realizing self-fulfillment, seeking personal growth with a desire “to become everything one is capable of becoming. This is where volunteering comes in, as well.
It is important to note that Maslow’s 5 step model has been expanded to include cognitive and aesthetic needs. And later, transcendence needs.
Each of us reading this know where we fit in, and can identify where most of our patients fit in, as well.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
We are committed to helping you fulfill your CE requirements through our local meeting with the support of our sponsors!
Featured Annual Sponsors
May 16th, 2019, 2-HOUR CE -Glaucoma
Speaker: Dr. Gayle Howard
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.
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: firstname.lastname@example.org or call 760-310-8492 (05/19)
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 (05/19)
Part-Time Associate Optometrist Position Available: Urban Optiks Optometry is seeking an awesome OD to join our beautiful high-end boutique practice 2-3 days per week. This is a great opportunity for an associate doctor to eventually acquire a full-time partnership in our practice. For a chance to join our exciting team, please send resume & cover letter, including why you think you’d be a great fit to email@example.com (05/19)
Optometrist needed inside Mission Valley Costco on Tuesdays. Please contact Robyn Slikker, O.D. at (619) 977-7703 Cell or firstname.lastname@example.org (05/19)
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 email@example.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 Opening Part-time North County. Saturday 10 am to 3 pm, potential Wednesday 9 am to 6 pm. interested candidates please send resume to firstname.lastname@example.org or call 760-930-9696. (05/19)
For sale 140 optical job trays, misc. colors; 28 Sterilite 7 quart containers with lids for optical cases $150. Please email email@example.com (06/19)
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 firstname.lastname@example.org
ALL DOCTORS WILL RECEIVE A FREE 5 HOUR CE FOR EVERY SHIFT FOR WHICH THEY VOLUNTEER
Monarch School Screening
Next Monarch screening will be this Fall. Stay tuned for details!
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.
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
- 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
Phone: 619 663 8439
Fax: 800 643 8301