The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message March 2020

Dr. Wendy Gross

On February 21st and 22nd, the 2020 COA House of Delegates met for its annual meeting in Los Angeles, California and our society showed strong representation.  I am proud to announce that our society won the award for 2019 “Society of The Year”!  We must thank our past president, Dr. Robert Grazian, and the 2019 SDCOS board for their dedication, leadership, and creativity in helping to set our society apart from the rest.

Our society is also very well represented on the COA board this year, and THREE of our members were sworn in as COA executive board members.  Our new COA President, Dr. Jason Tu, a long-time member and past-president of SDCOS, was officially installed and gave a wonderful address to the House.  We know he will do a great job!  Dr. Amanda Dexter, our current SDCOS board member and past-president of SDCOS, was also elected as Secretary/Treasurer and we are so proud of her!  A contested election of Trustees resulted in our very own Dr. Erin Swift being re-elected as COA Trustee for a second term. Congratulations Dr. Swift!

Another topic discussed at House of Delegates was AOA’s national public awareness campaign, “Think About Your Eyes”, or “TAYE”.  This campaign was designed to educate the general public on the benefits of vision health and promote the importance of annual comprehensive eye exams.  California delegates voted to continue to actively participate in this campaign, and with our help and added resources, we will continue to propel this campaign to even greater heights in 2020.

This month is “National Save Your Vision Month”, and the AOA is promoting awareness around digital eyestrain and the importance of receiving regular comprehensive eye exams from a doctor of Optometry.  The campaign is focused primarily on blue light’s impact on overall health.  According to 2016 AOA Eye-Q survey data, the average American spends seven hours per day using digital devices. This overexposure to blue light from digital devices over extended periods of time can lead to vision damage, disrupted sleep cycle, and more.  As Optometrists, it is our duty to educate our patients about the signs and symptoms of digital eyestrain.  These include eyestrain, headaches, blurred vision, dry eyes, and neck/shoulder pain.  The AOA recommends five tips that can be easily implemented in office spaces.

• • Follow the 20-20-20 rule: Take a 20 second break, every 20 minutes and view something 20 feet away.
  • Keep a distance: The AOA recommends sitting a comfortable distance from the computer where you can easily read all text with your head and torso in an upright posture and your back supported by your chair. Generally, the preferred viewing distance is between 20 and 28 inches from the eye to the front surface of the screen.

• View from a different angle: Ideally, the computer screen should be 15 to 20 degrees, or about 4 to 5 inches, below eye level as measured from the center of the screen.
• Decrease glare: While there is no way to completely minimize glare from light sources, consider using a glare filter. These filters decrease the amount of light reflected from the screen.
• Blink often: Minimize your chances of developing dry eyes when using a computer by making an effort to blink frequently.

I would encourage our society’s optometrists to educate themselves about these national campaigns to reinforce the OD’s distinction as primary eye care physicians. You can capitalize on the growing conversation in consumer media by factoring these campaigns into your practice’s marketing strategy. Materials such as customizable articles, press releases, and social media content are available on AOA’s website.

The next COA event will be Legislative Day in Sacramento on April 22nd. I encourage everyone to join us on this trip to the capitol. There are important discussions that need to take place with our legislators regarding bills that could potentially threaten our profession, as well as bills that could allow the expansion of our scope of practice. Please let me know if you are interested in participating. The more representation we have, the stronger our voice will be!

---

---

---

Retina Corner Choroidal Melanoma

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

Happy March, everyone. The holidays are behind us and spring is close at hand! Honestly, this is one of my favorite times of the year with a bit of lull in excitement and lots of time to spend with family. We just spent an amazing week in Steamboat Springs, Colorado – snowboarding with my 9 year-old through fresh powder, dog sledding through a state park, snowtubing on a ranch, and snowmobiling in the middle of a blizzard. It was incredible. Well, back to reality. Back in my fellowship, I had the privilege of training with Carol and Jerry Shields – the king and queen of ocular oncology, and two of the best mentors of my career. This month I thought it would be helpful to share some of the pearls they taught me about choroidal melanoma.

To start we should note that, while the most common primary intraocular malignancy, choroidal melanomas are rare, accounting for only 3.5% of all melanomas with an incidence of 6 patients per million. Choroidal melanomas arise of melanocytes of the uveal tract. Most patients are asymptomatic, with lesions discovered on routine exam as elevated, pigmented lesions deep to the retina. Patients are typically in their 50s to 80s, most commonly Caucasian. The key initial management point for choroidal melanoma is to distinguish it from much more common pigmented fundus lesions. The main differential diagnosis includes benign choroidal nevus, congenital hypertrophy of the RPE, metastatic lesions, hamartoma of the retina and RPE, hemorrhagic detachment of the retina, RPE, or choroid, and diffuse melanocytic proliferation.

Of these, the most important differentiation is between a choroidal nevus and a small choroidal melanoma. Differentiating small choroidal melanoma from choroidal nevus can be remembered using the mnemonic “to find small ocular melanoma” (TFSOM), where T = thickness greater than 2 mm, F = subretinal fluid, S = symptoms, O = orange pigment and M = margin touching optic disc. The rule of thumb is that melanocytic choroidal lesions that display two or more factors probably represent small choroidal melanomas, showing growth in over 50% of cases.

Fortunately, we have our examination and imaging modalities to look for these risk factors. Particularly helpful are ultrasonography, fundus autofluorescence, and OCT. Ultrasound is probably the key diagnostic test and when imaging choroidal melanoma, reveals low to medium internal reflectivity, as well as the dimensions of the lesion. Small choroidal melanoma is often characterized by orange pigment overlying the lesion. This fluid is rich and lipofuscin, and correlates with hyperautofluorescence on fundus autofluorescence imaging. Optical coherence tomography confirms the choroidal location and helps to confirm or exclude associated subretinal fluid.

Exam and imaging modalities will differ for other lesions on the differential diagnosis. Choroidal hemangioma is a circumscribed, round or oval lesion with variable coloration but not brown. The lesion is elevated, dome-shaped, and a solid mass on ultrasound with high internal reflectivity due to the presence of multiple vascular channels. Choroidal metastases are typically echo-dense on ultrasound with higher reflectivity than choroidal melanoma. OCT of choroidal metastases may reveal a lumpy bumpy configuration of the inner choroid. Lastly, CHRPE is a flat, pigmented lesion at the RPE. CHRPE is hypoautoflouorescence and OCT discloses flat, thickened, irregular RPE and absent RPE within lacunae.

I hope that this article was useful. As always, I welcome email or text curbside consultations of patients you are worried about, including cases you think might be choroidal melanoma.

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 QUESTIONS FROM PATIENTS

Most of us spend a good share of our chair time answering questions from our patients. I doubt if we all answer each question in the same words unless we have a script. I know that patients will often tell me what their last optometrist or physician told them, and unless they got it twisted around in their memory, I have to shudder a bit over what they think they were told, and I’ve heard some doozies.

But, how would you answer this question posed by a golfer in Golf Magazine some years ago in a column titled “You Asked For It”:

QUESTION: Can you explain how to use awareness of eye dominance to my advantage and how to account for it in the set-up?

This was asked by Calvin Hsu of Weston, FL. The answer was offered by Craig L. Farnsworth, OD, whose credentials included the fact that he was president of Sports Eye Enhancements, Inc. and consultant to many tour players.

Here’s how Dr. Farnsworth answered: “First an explanation. Your dominant eye gets information to your brain a little faster, and is responsible for your aim to a target.” Then he described how to determine dominancy with a hole in a piece of paper, which he referred to as the “aiming” eye. Then he talked about cross dominance, ie, a right handed player with left eye dominance.

Continuing, he wrote: “Cross-dominant players sometimes fight a reverse pivot. If you are cross-dominant, try setting up with your dominant eye behind the ball by rotating your head toward the appropriate ear. (Right ear, if right handed.)

“People who are not cross-dominant sometimes need to open their stance a little for both putting and the full swing, whereas cross dominant players usually do best with a square stance. Also, it’s best to close your non-dominant eye using spot alignment or the markings on your ball to aim,”

Obviously, Dr. Farnsworth knows a lot about golf as he is the author of See it and Sink it: Mastering putting through Peak Visual Performance (HarperCollins).

I probably wouldn’t have explained it quite that way, if at all, and I wonder how many of you would even try to answer it, as well.

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 Featured Event Sponsors

March 22, 2020, 5-HOUR CE

Speaker: Dr. Mile Bujic

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

Wanted Part-time and fill in Optometrist. Sunday availability is a plus. The practice is equipped with automated equipment, Optos, and EHR. For more details email sdeyedr@gmail.com (03/20)

For Sale.  Zeiss GDX 3582 Centervue DRS Matrix Fields machine Atlas Topographer. Make an offer. Contact  schinnod@pacbell.net (04/20)

 

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

• 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

• 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!!

• Paige Chain
• Christina Hii
• Benjamin Szu
• Harrison Yang

Please update your information on www.eyehelp.org