The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• Scleral Lenses – Which Fit is Which?
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message February 2020

Dr. Wendy Gross

As the new SDCOS president, I am committed to making sure our society continues to be a strong presence at the local, state, and national levels.  I strongly encourage all of our members to get the most out of their membership and be as active as possible.  Our association with AOA, COA, and SDCOS allows us to be heard, create change, achieve goals, and ensure the future of our profession.  Making a conscious effort to highlight the benefits of SDCOS/COA membership to our colleagues as well is important to help our organization continue to grow and thrive.  Our organization is strengthened by our membership, and the more support we have, the stronger voice we have.

With that being said, I wanted to give you all a brief outline of some of the membership benefits you may not be aware of:

• Think About Your Eyes is an exclusive public information marketing campaign offered by the AOA and available to COA members at a reduced fee
• COA offers a free, continually-growing library of in-depth fact sheets addressing a wide variety of scope of practice and practice operation topics
• The Member Media Center (MMC) through the COA website offers content for members to use in their newsletters and social media sites to help inform the public about important eye issues
• COA has a Member Resource Center in which there are dedicated COA staff members who are available to answer common practice-related questions- from the steps to take to get on a health plan’s medical panel, to employment and workers’ compensation issues
• Eyelearn is an online learning resource exclusively offered to AOA members that includes COPE approved continuing education webinars, journal articles, and practice management resources
• Business and Career Success webinars are offered by AOA with topics including medical records and coding, HIPAA updates, PQRS, malpractice, etc.
• COA provides constant updates on various topics with Government Affairs Weekly emails, California Optometry (the official publication of the COA), COA Member News monthly newsletter, AOA’s daily First Look and weekly AOA Focus e-newsletters, and the monthly AOA Focus magazine.
• Discounts on continuing education events including Monterey Symposium, OptoWest, and AOA’s Optometry’s Meeting
• Opportunities for free continuing education through articles in California Optometry as well as further CE online through CE@HomeOnline
• Great deals as COA members from Vision West buying group. Insurance programs and exclusive discounts for members on professional liability, workers’ comp, cyber liability, etc
• To ensure state and federal compliance with labor laws, COA provides discounted subscriptions for mandatory posters
• As a COA member, there is an opportunity to enroll staff as AOA and COA Paraoptometric Members at no charge to aid in enhancing the skills and productivity of your staff
• AOAExcel’s Medical Record and Coding Services AskTheCodingExperts@ExcelOD.com allows you to consult a billing expert for questions on anything from procedure and diagnosis codes, changes in Medicare coding policies, ICD-10 and more
• As an AOA and COA member you are listed on each website under the Find An Eye Doc search portals to assist the public in finding you
• Optometry’s Career Center through AOA provides services to find a practice to join, or to start and grow a practice
• The Legal Service Resources Program provides members up to one-half hour (30 minutes) of telephone and research work per month with an attorney at no cost

---

---

Retina Corner The Effect of Anti-VEGF Injections on Geographic Atrophy

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

Happy February everyone, I hope that you are all having a wonderful start to 2020. This past year was challenging for us at RCSD as we watched Paul Tornambe valiantly fight a disease that he eventually succumbed to. Paul was a hero to me, and will be forever missed. I appreciate everyone who has reached out with condolences. More than anything, I love hearing the stories people have shared. Thank you. This month I wanted to discuss a topic that makes me think of Paul. He often commented to me that we are in a unique position as physicians to help patients, but to be careful as our treatment options are often double-edged swords, and that there are few conditions that we cannot make worse with our well-intentioned intervention. One of those conditions is macular degeneration.

We are all aware of the two types of AMD, dry and wet, and we all know that wet has outstanding treatment options with better drugs on the horizon. We have also discussed in these articles the less common form of advanced AMD, geographic atrophy (GA), where the macular RPE slowly dies and leads to an irreversible loss of central vision. Unfortunately, some patients have both wet AMD and GA. In general they do well as long as the GA spares the fovea, but the GA progresses with no current treatment options, and foveal involvement is inevitable given enough time. Moreover, while the data is conflicting, there is concern that the anti-VEGF injections used to treat wet AMD will actually exacerbate GA. If this is true, we as retina surgeons must be careful to treat patients conservatively with just enough injections to maintain patients’ vision, and must also select the treatment options that have the lowest potential for harm. For anti-VEGF injections in wet AMD, we have several “brands” to choose from, aflibercept (Eylea, Regeneron), ranibizumab (Lucentis, Genentech), brolucizumab (Beovu, Novartis), and bevacizumab (Avastin, Genentech).

In a recent publication in Ophthalmology, Gilles and associates compared aflibercept and ranibizumab in terms of atrophy development. This was a well-designed, randomized, phase 4 trial. They enrolled nearly 300 patients, assigned them to either ranibizumab or aflibercept, and compared change in the size of geographic atrophy at baseline to month 24 for the two groups. Both groups received the same number of injections, about 9.5 per year. The change in area of geographic atrophy was similar between the groups, with no significant differences in either the growth of GA, or the proportion of patients with GA. These results are reassuring, and give confidence to choose the best anti-VEGF injection for wet AMD patients based on other criteria, but I will certainly continue to watch this topic as additional data comes to light.

Thanks again for reading. Please don’t ever hesitate to contact me.
Best wishes, and until next time,
Nik

Nikolas London, MD, FACS
415-341-5456 (cell)
nik.london@gmail.com

---

---

Eye See written by Dr. Byron Y. Newman PLACEBOS: TRICK OR TREATMENT

A placebo has been defined as a substance or procedure …that is objectively without specific activity for the condition being treated,” according to Wikipedia.

The idea of the placebo (Latin for “I shall please”) originated with H.K. Beecher, who evaluated 15 clinical trials concerned with different diseases and found that 35% of 1,082 patients were satisfactorily relieved by a placebo alone. In effect, any pharmacological substance administered by any means can act as a placebo including pills, creams, inhalants and injections. In eye care occasionally plano lenses have been used as a placebo with the patient finding great relief In fact, sometimes even the doctor can be called a placebo as is evidenced by the following: “A study found that patient recovery can be increased by words that suggest the patient would be better in a few days…rather than negative words such as I’m not sure that the treatment I am about to give you will have an effect.

It has been reported lately that placebos are getting more effective, and drug makers are desperate to know why. According to an article by Steve Silberman, there are “fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmacological industry. It’s not only trials of new drugs, that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac are faltering in more recent follow-up tests.”

Fabrizio Benedetti, at the University of Turin, who became interested in placebos in the mid ’90s, states in an article, “The placebo effect was considered little more than a nuisance. Drug companies, physicians, and clinicians were not interested in understanding its mechanisms. They were concerned only with figuring out whether their drugs worked better.” Benedetti used the phrase “Placebo Response,” instead of “Placebo Effect.”

“By definition,” he says, “inert pills have no effect. But, under the right conditions they can act as a catalyst for the body’s endogenous health care system.

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

---

Scleral Lenses – Which Fit is Which?

If you’re trying to expand your practice to fitting scleral lenses you have probably started to investigate your options. Have you noticed that a lot of the scleral lens advertisements claim they are easy fit, simple fit, or even one fit? If they are so easy, then why are you so confused?

Probably what makes the scleral fit process seem more complicated than corneal lenses is because the lens covers a complex terrain of ocular curves. Think fitting a pair of dress pants versus a pair of gym shorts. The trick is to focus on fitting the dominant fitting parameter. In the case of a pair of pants, you start with the waist. Once the waist is fit, the other parameters such as inseam length can be more easily adjusted with the help of your tailor.

For scleral lenses, the dominant parameter is the apical clearance. Get that right and the rest of the fit can be adjusted with the help of your lens consultant. So how do we get to that point? Back to the dress pants analogy. Based on experience you know to select the pair with a waist measurement as close as possible to your waist size. With scleral lenses however, it seems each manufacturer uses a different measurement for selecting the initial fit lens from the fitting set. Some use base curve, some use sagittal depth, or some even use peripheral toricity. No matter which you use to make your initial lens selection, your fit evaluation will start with the apical clearance. Now there are debates regarding the amount of apical clearance to achieve based things like oxygen permeability versus lens stability but in the end it seems a value of 200 microns seems the most desirable. Once you put the lens on the patient, you can expect the lens to settle about 100 microns in the first 30 minutes and another 50 microns after 4 hours. So make sure to account for that.

If the apical clearance isn’t correct with the initial lens, you’ll switch to another lens using the fitting set instructions as a guide until you achieve the desired clearance. There you have it. You completed the hard part by getting the right apical clearance. The rest of the fitting process amounts to making measurements that will allow your lens consultant to make adjustments to the lens. Just like the tailor that adjusts your dress pants, your lens consultant needs measurements to make adjustments.

VISIONARY has created a fitting check list for recording your observations and measurements. Fill out this form, send it to Visionary and we can design the lens for you. Maybe it is easy.

---

---

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

February 13, 2020, 5-HOUR CE – Contact Lenses

Speaker: Dr. Maria Walker

Topic: Keratoconus and Myopia ManagementContact Lenses

See 2020 CE schedule

All 2020 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

CLASSIFIED ADVERTISEMENT

FOR SALE:  6 Eye Design display cabinets, 2 jewel cases and 2 dispensing tables for sale.  Condition is like new, asking $3500/obo for the entire package. Contact: Douglas Osborne, OD at villageidoc@gmail.com or 760.458.7934.  Photos available on request. (02/20)

Retinal Camera for sale. Good condition Topcon TRCNW3 with the table included. $950.00. Call Dr. Grazian 619-562-5220 (02/20)

 

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

Monarch School Screening

• Monday February 24th: Screening
• Tuesday/Wednesday March 10-11th: We need optometrists to help for a full or a half day on Monday!!

Contact Dr. Bob Meisel for more information at rmeisel47@gmail.com ; www.monarchschools.org

---

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.

---

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

Upcoming Events

• February 13, 2020: 2 hr CE
• February 21-22, 2020: Annual Meeting of the COA House of Delegates

• Click here for most recent SDCOS Board Meeting Minutes
• Click here for the 2020 CE schedule!
• Click here for COA membership benefits!

---

Welcome, new members!!

• Dr. Solbee Joanne Kim

Please update your information on www.eyehelp.org