San Diego County Optometric Society
The San Diego View
Inside this Issue:
- President’s Message
- Retina Corner
- Eye See
- CE Corner
- When treating meibomian gland (MGD) is critical
- Volunteer Corner
- SDCOS Announcements
Robert Grazian, O.D.
Immunizations and California Optometry
Are you interested in providing immunizations to your patients? With the passage of Assembly Bill 443 in 2017 and Senate Bill 762 in 2018, California law allows optometrists to become certified to perform three immunizations—influenza, herpes zoster virus, and pneumococcus—on adults eighteen years and older.
The training for immunization certification has three requirements:
1. Optometrists will need to complete an immunization training program that is endorsed by the federal Center for Disease Control and Prevention (CDC) or the Accreditation Council for Pharmacy Education that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.
2. Optometrists will need to maintain basic life support certification.
3. Optometrists will need to perform one hour of ongoing continuing education focused on immunizations and vaccines from an approved provider once every two years.
After successfully completing the immunization training, the OD applies for an immunization certificate on a board-approved form. This is where the paradox begins.
According to a notice circulated to practicing California OD’s from the California State Board of Optometry on May 10, 2019, the California State Board writes that, “At present, the Board is not accepting applications, course completion certificates or payments for the immunization certification. Immunization applications and payments sent to the Board will not be processed and will be returned to the licensee. The Board is not allowed to accept these until regulation implementing AB 443 becomes law (anticipated Spring of 2020).”
The notice concludes, “The final regulation, including the actual text and application form, will be made by the Office of Administrative Law (OAL), not the Board.”
The most common vaccination likely to be administered by California optometrists in the future is the influenza vaccine. Influenza (flu) vaccination is the primary way to prevent sickness and death caused by flu, and the CDC estimates that influenza was associated with more than 48.8 million illnesses, more than 22.7 million medical visits, 959,000 hospitalizations, and 79,400 deaths during the 2017-18 influenza season. This burden was higher than any season since the 2009 pandemic and serves as a reminder of how severe seasonal influenza can be. CDC estimates that from 2010-11 to 2017-18, influenza-associated deaths in the United States ranged from a low of 12,000 (during 2011-12) to a high of 79,400 (during 2017-18).
Among adults aged eighteen years and over, immunization coverage was 37.1% during 2017-18—6.2 percentage points lower than coverage during the 2016-17 season—with California adults having even less at 35.0%, according to the CDC website. Limited access to care is a factor in the low immunization coverage.
The 2018-19 statistics are yet to be published, and hopefully medical visits, hospitalizations, and deaths were less than the previous flu season. My question at this moment, and likely yours, is why bureaucratic obstacles are being announced by the California State Board of Optometry that prevent patient access to vital flu vaccines. California optometrists could be contributing during this year’s upcoming 2019-2020 flu season. Many OD’s have successfully completed their immunization courses, and they could be part of this season’s vaccination campaign. Instead, we are obliged to sit out and wait for OAL to write regulation. Senate Bill 762 contains some urgent wording that specifically states, “in order to protect the health and well-being of the public by allowing appropriately trained optometrists to administer immunizations, it is necessary for this act to take effect immediately.”
That being said, I recommend you, your family, and your staff each have an annual flu vaccine this month. In addition, consult the COA website for Immunization Certification Courses taught by optometry colleges at Western University of Health Sciences and SCCO at Marshall B. Ketchum University. Also on the COA website is a link for the next Pharmacy-based Immunization Delivery Course on November 2nd at UC San Diego, La Jolla.
Scleral Fixation for Dislocated Intraocular Lenses
By Nikolas J.S. London, MD FACS
Director of Clinical Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla
I hope everyone is doing well and having a wonderful October. This is one of my favorite times of the year – school is in full swing for my kids, the weather is cooling down and beautiful, the sun is setting early giving my family ample time for our outdoor movie nights, and there are fun holidays every month through the rest of the year. Not to mention Oktoberfestivals – nothing beats german beer, live music, and brats!
So, for this month I wanted to talk about some of the recently-developed advanced techniques for scleral fixation of IOLs. While IOL dislocation is relatively rare, affecting about 1% of patients following cataract surgery, patients typically need surgical intervention to refixate or replace the dislocated lens. Traditionally, the go-to approach was to remove the dislocated IOL and replace it with an anterior chamber IOL. This is a fine technique, but has several drawbacks and is cosmetically undesirable for many of anterior segment surgeons – nearly all prefer the IOL to be behind the iris “where it belongs.” Older techniques to accomplish this include iris fixation of IOLs, which can lead to a distorted iris and pigment dispersion, and scleral fixation with flaps and prolene suture, which can break years down the road and is a relatively complicated technique.
Fortunately, better techniques have been developed. For me there are two go-to techniques that cover all situations. For dislocated 1-piece IOLs or aphakic patients with no capsular support, I use a technique that involves 4-point scleral fixation of an Akreos AO60 IOL (Bauch and Lomb) with Gore-tex suture. This is a simple and elegant technique that suspends the IOL like a hammock using loops of the Gore-tex suture on either side of the eye (figure 1). The suture is nearly indestructible (think dental floss) and the IOL is extremely easy to center and avoid tilt on. Outcomes are excellent, and the surgery takes about 45 minutes under local anesthesia.
In eyes with a dislocated 3-piece IOL I use an even simpler technique – a slight modification of what is called the Yamane technique. In this trans-conjunctival technique, the haptics of the 3-piece IOL are externalized at 12 and 6, 2mm from the limbus (figure 2). The ends of the haptics are touched with a low-temp cautery to create a small “nail head” that will be larger than the sclerotomy used to externalize the haptics. The haptics are simply released after this and will easily fall under the conjunctiva, but will not pass through the sclerotomy. This 20-minute surgery gives excellent results with remarkably good refractive outcomes – a recent patient of mine is 20/20 uncorrected about a week after the surgery.
I would be happy to share videos of the above techniques if you would like to learn more. Until then, thanks again for reading. Please don’t ever hesitate to contact me.
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)
written by Dr. Byron Y. Newman
Some years ago when I was active in AOA activities, I attended a conference where during one session, everyone was asked to explain why they were willing to volunteer for various AOA activities. Members stood holding the microphone to the largely filled room, and explained often that they felt the profession did so much for them that they wanted to give back, and they felt that volunteering their time to the profession paid back for all the benefits they received. In fact, in most cases it was this in different words, for the most part.
When it was my turn, I told the story that when a person dies, the date of their birth and the date of their death was connected by a dash, and that dash represented everything they did between those two years. I added that I wanted the dash between my birth and death to mean something with all the wonderful deeds for my patients, my community, and to my profession.
Several people came up to me afterwards and told me that they liked my presentation about the dash, and that they had never heard it before.
I told them it was from a poem called, “The Dash,” and they could find it by Googleing it. Just type in The Dash and it will pop up with several places to click on. It’s a poem by Linda Ellis and copies are available for purchase, and recently a free copy became available if you joined their newsletter. But, you can read it on several of the sites.
It’s a very inspiring poem, and I recommend you click on it and read it yourself. It might bring a tear to your eye and it might explain your own purpose in life, and how important it is to have your DASH mean something.
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
October 17, 2019, 2-HOUR CE – Pediatrics, amblyopia, and strabismus
Speaker: Dr. Dashaini Retnasothie
Topic: Pediatric Eye Care: Refreshers and Updates
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.
Full-Time Optometrist – East County La Mesa Full-time position to start immediately, Some Saturday mornings and early evenings. A competitive salary, commensurate with experience with a full benefits package and potential productivity bonuses. This position requires the ability to perform routine eye exams, implement new technology- medical software, complete contact lens, and specialty lens exams and frame fitting. Please send CV to firstname.lastname@example.org (10/19)
Optometric Practice for Sale East County in the city of El Cajon 40+ years Optometry Practice for sale By Dr. Robert L. Evans and Dr. Marilyn A. Carter. Many long-time, loyal patients and excellent staff. Please call Dr. Evans at 619-444-9012 (El Cajon) Or 619-422-5361 (Chula Vista) Or 619-479-5070 (Home) (10/19)
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 email@example.com
Monarch School Screening
- Monarch School Screening, Monday September 30, 2019, 8:00am-3:00pm
- Monarch School Exams, Tuesday October 15 and Wed. October 16, 2019, 8:00am-3:00pm
Lion’s Optometric Vision Clinic
ALL DOCTORS WILL RECEIVE A FREE 5 HOUR CE FOR EVERY SHIFT FOR WHICH THEY VOLUNTEER
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 firstname.lastname@example.org
Volunteers Needed for Free Medical Outreach
Where: Mountain Empire High School
3305 Buckman Springs Rd. Pine Valley, Ca. 91962
When: October 20, 2019
Time: 8:30 am to 3:00 pm
We are looking for volunteers for upcoming Medical Outreach. This is the fifth year we are bringing this to Mountain Empire. We are in need of non-professional volunteers (No previous experience Necessary) and Professional Medical volunteers (Dentists, Optometrists, and Nurses). The event is being put on by the Tzu Chi Foundation and is free to all. If you can help out contact Mark Ostrander for details at email@example.com or (201) 890-3344. We will offer a free training for all non-professional volunteers.
- Click here for most recent SDCOS Board Meeting Minutes
- Click here for the 2019 CE schedule!
- Click here for COA membership benefits!
Welcome, new members!!
- Samira Alizadeh
- Terra Barnes
- Gillian Bentley
- Connor Caldwell
- Courtney Cape
- Emelline Chen
- Florena Culas
- Hannah DeMarino
- Ama Eisa
- Roula El-Moghrabi
- Kendall George
- Kevin Hoang
- Courtney Hongo
- Loan Huynh
- Vanessa Kashak
- Kimberly Le
- Theresa Luong
- Vivek Mallampalli
- Tania Mojtehedi
- Andreea Nastasoiu
- Kristine Park
- Jyoti Patel
- Ginny Schaffner
- Matt Schaffner
- Nina Song
- Erica Stokes
Please update your information on www.eyehelp.org
Phone: 619 663 8439
Fax: 800 643 8301