The San Diego View

Inside this Issue:

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

President’s Message April 2020

Dr. Wendy Gross

As I write to you today, we are all in the midst of a rapidly evolving situation and historic public health emergency. On March 11, the World Health Organization characterized COVID-19 as a pandemic, and, on March 13, the President of the United States declared a national emergency.

COVID-19 is a respiratory disease caused by a novel coronavirus.  The virus was first detected in China, and has now been detected in more than 100 locations internationally, including the United States. Reported illnesses have ranged from very mild or no symptoms to severe, including illness resulting in death. Those more at risk of severe illness include older adults and those with serious chronic medical conditions. At present, there is no vaccine available to protect us against COVID-19 and no medications approved to treat it other than palliative care.

The CDC predicts widespread transmission of the virus in the United States will occur and in the coming months, most of the U.S. population will be exposed. This could translate into an overwhelmed healthcare system and devastating effects to our economy.

At present, global efforts are focused on lessening the spread of the virus and reducing the impact of this disease. California Governor, Gavin Newsom, declared a State of Emergency to make additional resources available, formalize emergency actions already underway, and help the state prepare for broader spread of COVID-19.  Newsom also issued a “stay at home” order for all California residents.

As health care professionals, it is our duty to follow public health guidelines to help limit the spread of disease and help “flatten the curve”.  Under governor Newsom’s guidelines, comprehensive eye examinations are considered non-essential services.  The COA has strongly recommended that optometrists practicing in California voluntarily suspend nonessential or nonurgent optometry care temporarily. Optometrists should reschedule routine eye exams and be available for urgent, non-routine care.

The COVID-19 pandemic is having an immediate and devastating impact on the practice of our profession, and this is a challenging time for many of us.  In response to these challenges, the Governor, AOA, COA, and SDCOS has responded in the following ways:

• Governor Newsom has announced that the Department of Consumer Affairs has the authority to waive CE requirements for health professions for the next 60 days.
• Over 10 hours of Free CE for COA members (Emergen-CE on the COA website)
• Free practice support webinar offered on the COA website
• Expanded telehealth options
• Free Legal Advice: COA members are eligible for 30 minutes of attorney services for free each month.
• All dues/assessments will be waived for two months for all members. If you are not a current member, I encourage you join today to take advantage of all the resources AOA, COA and SDCOS are offering during this time. New member dues will be waived until June 1, 2020.

Due to guidelines regarding social distancing, Legislative Day has been cancelled. The California Legislature is in emergency recess now with lawmakers practicing social distancing. When they resume, legislators may be asked to prioritize their bills, or drop any bills unrelated to the crisis. The main focus of the Legislature will be passing a budget.

Due to deteriorating economic conditions tied to the spread of the virus, COA’s request for increasing Medi-Cal reimbursement rates is no longer possible this year and eyeglasses coverage for adults under Medi-Cal is in jeopardy. We will not know for sure until the governor releases his revised budget proposal on May 15. Considering the current situation, COA has prioritized advocacy of the following issues:

• Online CE – COA has been advocating that the State Board of Optometry allow all hours as online CE during this crisis. The State Board of Optometry does not have the authority to do this without an order by the Governor. COA has been pushing for such an order.

• Small business relief – COA will be advocating for financial relief for optometric offices when the Legislature returns. COA also continues to advocate for an exemption from AB 5, legislation passed last year to increase restrictions on independent contracting. This crisis has put enormous pressure on optometry offices and AB 5 limits an optometrist’s ability to recover because it prevents most optometrists from being independent contractors.

• Financial assistance for optometry schools – COA will also be advocating for emergency funding for the optometric schools and colleges that have effectively been shut down by the crisis.

• Telehealth – COA will continue to advocate for new rules that make it easier for doctors to provide services via telehealth. Newsom has already directed that commercial and Medi-Cal managed care plans must allow members to obtain health care via telehealth when medically appropriate to do so. Providers will be reimbursed at the same rate, whether a service is provided in-person or through telehealth.

We have a tough road ahead of us, but please don’t forget that we are all in this together.  We will be sending out updates as new developments arise, but you can always visit the SDCOS and COA websites for updated information.  It is important to stay positive during this time, as we do our part to protect one another and overcome these difficult times.  “Difficult roads often lead to the most beautiful destinations.” -Zig Ziglar.

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Retina Corner Sudden Loss of Vision

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

April is upon us and most of us are laying low in our homes due to the COVID-19 pandemic. What strange times – it is surreal to me how quickly and dramatically things have changed over the past several weeks. As you read this, we are likely at or near the peak of the crisis, hopefully with light at the end of the tunnel. As a retina practice, our group is still seeing our more urgent patients including those receiving ongoing anti-VEGF treatment, as well as emergency new patients. In that vein, I wanted to spend this month reviewing one of those urgent conditions, the patient who presents with sudden, often profound, loss of vision, and requires quick thinking. Before I give you the diagnosis I am referring to, let me present two similar cases to get the wheels turning.

Case #1: A 62-year-old man complains of a defined dark shadow in the lower part of his central vision of the right eye. Examination reveals a prominent whitening in the superotemporal macula with a Hollenhorst plaque at the proximal aspect of the whitening. What is the most appropriate initial management?

• Obtain erythrocyte sedimentation rate and C-reactive protein
• Refer to an internist for a carotid Doppler
• Refer urgently to a stroke center
• Send to a cardiologist for echocardiogram

Case #2: An 86-year-old man with acute visual loss in the left eye and a history of transient ischemic attacks involving right-sided motor function has macular whitening with preserved foveal pigmentation. Which of the following tests is most appropriate to diagnose his condition?

• Anti-nuclear antibody test
• Carotid ultrasound
• Fasting plasma homocysteine
• MRI of the brain

Both of these cases are classic presentations of retinal artery occlusion, the first consistent with a branch retinal artery occlusion (BRAO), and the second consistent with a central retinal artery occlusion (CRAO). Both require urgent attention. Case #1 reviews the management options. While all of the choices are reasonable to consider, the most appropriate first step in the vast majority of cases is to refer the patient to the closest emergency department (ED) for a stroke workup. This is never a popular option for patients, but is important to possibly prevent a significant cerebrovascular accident. The ED may initiate a “stroke code” with a workup including carotid and cardiac imaging, blood work, and brain MRI. Erythrocyte sedimentation rate and C-reactive protein are often obtained, but are not generally indicated as giant cell arteritis is typically associated with CRAO, but not BRAO.

Case #2 presents a classic CRAO. One of the key points in this case is that all of the findings suggest left-sided vascular dysfunction. Ipsilateral CRAO and hemispheric transient ischemic attacks in an elderly patient suggest the possibility of ipsilateral carotid atherosclerotic disease and secondary embolization. As with the first case, the best initial management is to send the patient directly to the ED for a stroke workup. In this case the most useful ancillary test is likely to be carotid ultrasound, which may reveal stenosis. In addition to carotid ultrasound, an echocardiogram to evaluate for valvular disease should also be considered, and, unlike BRAO, any CRAO patient over the age of 55 should also have urgent bloodwork to rule out giant cell arteritis – erythrocyte sedimentation rate, C-reactive protein, and a platelet count. As for the other answer options for Case #2, although several systemic conditions including as auto-immune disease, sarcoidosis, hyperhomocysteinemia, and hyperlipidemia may coexist with central retinal artery occlusion, these are less common than atherosclerotic causes. MRI of the brain would be reasonable given the history of TIAs and left-sided motor function deficit, but this would be non-localizing as to the cause of the CRAO. Susac syndrome could be suggested by a brain MRI but would be unlikely to present as a new vascular occlusion at this age.

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

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Eye See written by Dr. Byron Y. Newman THE McKOEWN THESIS

I hope this article finds you well. You’re probably safe at home wondering if this pandemic will ever end. It will, of course, eventually.

In the meantime many of our offices have had to close for the national emergency.

My previous wife used to deride optometry. She’d say, “What are you going to do in an emergency, check their eyes?” But I heard on the news that optometrists are being used in some hospitals during this crisis.

Back in August of 1991 optometry had a real slow down during Operation Desert Storm, where Iraq invaded Kuwait. The whole war was on TV and people stayed glued to their TV sets to watch it. During that period, no one came in or even called about anything and many practices came to a dead halt, including mine.

So to give you something to think about while you’re at home, read about the McKoewn Thesis and see what you think of all this.

McKeown challenged four theories about the increase of the western population since the 18th century:

1. McKeown stated that the growth in population, particularly surging in the 19th century, was not so much caused by an increase in fertility, but largely by a decline of mortality particularly of childhood mortality followed by infant mortality,
2. The decline of mortality could largely be attributed to rising standards of living, whereby he put most emphasis on improved nutritional status,
3. His most controversial idea, at least his most disputed idea, was that he questioned the effectiveness of public health measures, including sanitary reforms, vaccination and quarantine,
4. The sometimes very fierce disputes that his publication provoked around the “McKeown thesis” have overshadowed his more important and largely unchallenged argument that curative medical measures played little role in mortality decline, not only prior to the mid-20th century but also until well into the 20th century. McKoewn, a physician educated in British Columbia, did most of his work from the 1950s to the 1980s. So, it’s relatively recent. Controversy continues, although his underlying ideas regarding the effects of poverty and economic well-being are essentially correct, but not to the exclusion of public health bnefits and medical intervention since 1900 say others.
5. What do you think?

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

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Winners of Greater San Diego Science and Engineering Fair Announced

Three students were selected for prizes from the San Diego County Optometric Society at the Greater San Diego Science and Engineering Fair held in Balboa Park on March 11, 2020. Judges Byron Y. Newman, OD and Robert Meisel, OD awarded first Prize to 7th Grader Sydney Zhang for his project, “Early Determination of Dry Eye. Sydney attends Mesa Verde Middle School in Poway.

Second prize went to Liora Berg, an 8th grader from Soille Hebrew Day School in San Diego. Liora’s project was “Look Away to Prevent Eyestrain.”

Third Prize was awarded to the team of Arjun Chatha and David Samy, 8th graders from The Rhoades School in Encinitas. Their project was called “What do you See.”

The event was almost full, with only a small percentage of students missing. For sanitary purposes there was no hand shaking, only elbow touches for recognition, which evoked a bit of laughter.

The winner, Sydney Zhang, will be invited to our Sunday May 17th 5 hour seminar to display his project. This is about the 10th year we have selected winners from the fair to honor their interest in things optometric.

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Dr. Richard Rex Memorial Fund: Financial Help for Patients In Need

The Dr. Richard Rex Memorial Fund was established in 1991 by the friends and family of Dr. Rex, a San Diego optometrist who tragically died in a plane crash in 1989. He was a member of the San Diego County Optometric Society and practiced at Kaiser Permanente, specializing in contact lenses.

Most of us have patients in our practice who could benefit from financial assistance in the purchasing of their glasses, contact lenses, or low vision aids.  The memorial fund is used to provide a maximum of $100 towards those costs for patients without insurance, who had exams from optometrists who donated their exam time. Priority is given to children and those who require specialty contacts for medical reasons.

Any SDCOS member may apply for a payment of up to $100 towards material costs for such patients. Additionally, if you would like to make a tax-deductible donation to this fund, please make your check payable to:

Dr. Richard Rex Memorial Fund
C/O SDCOS
11835 Carmel Mountain Rd. Suite 1304-211
San Diego, CA  92128-4601

If you have any questions about this fund or would like to request an application, please contact Nancy-Jo at 619-663-8439 or email

Dr. Marcelline Ciuffreda at marcelline11@hotmail.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!

No CE in April. May CE has been cancelled due to the current pandemic. Please keep checking your emails for information about other CE opportunities that we will be offering soon

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.

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Classifieds

For Sale: Zeiss Humphrey Field Analyzer with Glaucoma Progression 745i with an internal printer, stand, chair and owner’s manual. Perfect condition. $5,000. Available now. Contact jhkmd5@gmail.com (05/20)

Full-time position (Monday through Friday) is available for an Associate Optometrist with a strong medical background. Large group practice includes 3 Optometrists, 3 Ophthalmologists, full-sized optical, and state-of-the-art equipment in a brand new clinic in Downtown Chula Vista. Job duties include medical co-management of ocular pathology patients along with routine eye care. Requirements include prior residency or minimum 1-year experience in a medical eye care setting, current CA Licensure, and Professional Liability Insurance. Basic Spanish language skills preferred. Competitive Salary. If interested please email a cover letter and CV to Olga Ramirez at castillejoseyeinstitute@hotmail.com (05/30)

Part-Time Optometrist Wanted. 2-3 days per week. Must be available some Fridays and Saturdays. Please email drmarbun@gmail.com (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

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Volunteer Corner

Monarch School Screening

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

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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.

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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

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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!

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Welcome, new members!!

• • Tiffany Turner
  • Fabian Luna
  • Karen Love
  • Kelly Keane
  • Kristin Difuntorum

Please update your information on www.eyehelp.org