The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• CE Corner
• CooperVision® Resources to Support Eyecare Practices
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message June 2020

Dr. Wendy Gross

As the weather heats up and summer approaches, reality sets in that life isn’t quite the same as it was this time last year. We live in a new world. More and more things are going digital and the comfortable routine we once had has become uncomfortable, scary, unknown, but also beautiful.  We live in an unprecedented time of transformation, forced to step out of our comfort zones, and challenge ourselves to bring about positive change.

That being said, I want to congratulate the 2020 Optometric graduates!  Your dedication, hard work, and resilience during this historical time has not gone unnoticed.  The first few months after graduation can be difficult for new graduates for various reasons, but it is safe to say that the transition into optometric practice in 2020 will look very different than it did in the past.  After completing a rigorous four-year program, passing Boards and licensure exams, and practicing as an intern, the next steps may seem like an assortment of unknowns. Some graduates will continue on to one of the many Residency programs around the country, and others will begin their search for a place to practice Optometry in our community.

If you’re a new OD, the California Optometric Association (COA) and San Diego County Optometric Society (SDCOS) are here to help make your transition a little easier.  The COA provides Resource Guides to help with obtaining state licensing, DEA and NPI numbers, as well as getting credentialed with the various insurance panels and vision plans in our state.  Career resources are also available such as job search tools and optometric business and career webinars.  COA membership is free as a student, but also free for the first year after graduation and discounted over the next five years.  If you are a new or recent graduate, make sure to take advantage of these benefits.

At the local level, SDCOS offers new grads a variety of resources and opportunities to find their career path. Dr. John Fitzpatrick maintains our society’s classifieds and job connection list, which is a great tool if you are looking for a job, looking to hire someone, or looking to buy or sell a practice.  Please reach out to him at jpfod@aol.com with any inquiries.  The society newsletter and website also provide great information for new graduates or doctors new to San Diego. Please don’t hesitate to reach out to any of our Board members about what resources are available to you as a new OD.  The AOA, COA, and SDCOS are here to help.

I also encourage Optometrists in our community to reach out to new graduates and new doctors in the area to help them during their transition, especially during this unprecedented time.  By showing them the benefits that COA and SDCOS have to offer, it can be extremely impactful and helpful to them while at the same time growing our membership and strength as a society.

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Retina Corner 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

One of my favorite surgeries to perform is repairing retinal detachments. It is a wonderful feeling to be able to tell a patient, sitting in my exam chair and terrified of the vision they have lost or feel is slipping away, that they will be ok, that in the vast majority of cases I can fix the problem and restore their sight. In fact, retinal detachment repair is perhaps the defining procedure of the vitreoretinal surgeon. It is one of the things we focus on in fellowship training with countless surgeries performed to hone our surgical skill. This month, I would like to go through our various approaches, and, if you will bear with me, I think it might be helpful to go through them similar to how I describe them to my patients.

With that patient sitting in the chair, the first thing I tell them is that everything is going to be ok. After I reassure them, I like to explain all the options to my patients regardless of whether or not they all apply to them. My thought is that this mini lecture will be empowering in a time where they must feel extremely vulnerable, even though the vast majority will simply go with the option I recommend. First, I explain how retinal detachments happen. I point to the model on my desk, orient them to the front and back of the eye and point out the cornea, lens, vitreous, and retina. Next, I describe the retina as a very thin and delicate tissue that lines the inner back wall like wallpaper made out of Kleenex lining the inside of a fishbowl. In front of the retina, I tell them, is the vitreous gel, which is transparent and resembles uncooked egg white. This gel is composed of water, collagen, and hyaluronic acid, and has a condensed collagen “skin” on the outside – like the latex on the edge of a water balloon. I describe how as we age the collagen breaks down, the vitreous liquifies, and the “skin” of the vitreous separates from the retina – similar to peeling tape off of that delicate wallpaper. You can imagine that if the adhesive is too strong the tape might rip the wallpaper. If this happens to the retina you have a retinal tear, and if the liquified vitreous gets through the tear and under the retina, you have a retinal detachment.

With this background, I then explain our options for repair. I explain that all we really need to do is to seal the retinal break(s). If we can do that, the fluid should resolve spontaneously. The three options include pneumatic retinopexy, vitrectomy, and scleral buckling. It is important to explain the advantages and disadvantages of each, to help the patient decide the best approach for them. These are summarized in the table below. I also explain each procedure briefly. Pneumatic retinopexy can be done in the office and has a fairly high success rate with excellent visual outcomes. It involves using laser and/or cryotherapy to create a scar around the tear, sealing the retina to the RPE, and injecting a gas bubble into the eye to flatten the tear and allow the scar to heal. As the gas bubble is relatively small, excellent post-operative positioning is critical, and can be challenging for some patients. Vitrectomy is a surgical procedure where the vitreous is removed, the subretinal fluid is actively removed, laser is used to barricade the tear, and a large gas bubble is placed. This is an excellent procedure for most cases, is very effective and minimizes positioning, but requires scheduling in an operative room, is expensive for uninsured patients, and has guarantee of accelerating cataract formation. Lastly, a scleral buckle involves suturing a small silicone band to the external surface of the eye to physically indent the retina in the area of the tear as well as cryotherapy to create the scar. It has a success rate similar to vitrectomy, and avoids cataract acceleration, but has a longer surgical time and healing process, and changes the refractive status of the eye, which can be frustrating for pseudophakic patients.

Once we decide on the best procedure it is time to repair the detachment. I will save the details of these procedures for another time, but would be more than happy to explain them to anyone interested. We also have great videos of vitrectomy and scleral buckling, and a chapter I wrote on pneumatic retinopexy I’d be happy to share. Even better, let me know if you would like to join me in the OR to see a case!

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 PAIN IS NOT A 5TH VITAL SIGN

The AMA’s president said physicians played a key role in starting the so-called opioid epidemic by overprescribing pain medication, and now must do their part to end it.

“The problem is that too many physicians and policymakers equate assessing pain with giving opioids,” he said in an email to Pain News Network. “It appears that advocates for removing pain as a 5th vital sign are suggesting that if we just ignore pain then we won’t have it”.

The nation’s largest medical society is recommending that pain be removed as a “fifth vital sign” in professional medical standards – a move critics say will make it even more difficult for pain sufferers to have their pain properly diagnosed and treated.

Pain was first recognized as the fifth vital sign in the 1990’s, giving pain equal status with blood pressure, heart rate, respiratory rate and temperature as vital signs. The policy encourages healthcare providers to ask patients about their pain.

But critics say pain is not a vital sign, but more of a symptom, and cannot be measured like a patient’s temperature or blood pressure. They also claim The Joint Commission, a non-profit that accredits hospitals and other U.S. healthcare organizations, sets pain management standards too high, which contributes to opioid overprescribing.

The AMA’s main “solution” to the opioid problem is to stop asking patients about their pain.

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

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For everyone at CooperVision, our values of partnering, and being inventive, friendly and dedicated do not just apply during the best of times, they are even more critical in more challenging times like these. Our teams are examining every area of our business to identify opportunities to support you, mindful that many of you as small business owners are seeking additional resources to support your practices and your contact lens-wearing patients. In turn, CooperVision has instituted the following:

• Continued manufacturing and shipping. We are still in production, with full supply. Contact lenses are a medical device, and we understand their importance to your patients in their daily lives.
• Free shipping for direct-to-patient orders. CooperVision is now offering free freight for direct-to-patient contact lens delivery of any two boxes or more. The lenses will be shipped to patients via FedEx 2-Day Air or USPS on your behalf, coming from the eye care professional they know and trust. We are also providing reimbursement for Authorized Distributors to participate in this direct-to-patient delivery program; if you work with a distributor, please speak with them for details.
• Modified consumer rebate policies. To ensure your patients have enough contact lenses on hand—and to help you continue to drive sales of annual supplies—we have also temporarily modified our rebate policies. If a patient is in need of contact lenses or wants to purchase additional lenses before their supply is up, CooperVision will honor the patient rebate for an early annual supply purchase. And if you would like to extend contact lens prescriptions on a case-by-case basis for patients unable to get to their scheduled annual eye exam or if your office is closed, these patients can still take advantage of the CooperVision patient rebate. In both situations, your office will need to provide the patient with a copy of their last exam, along with proof of purchase of the annual supply. All other terms and conditions still apply.
• Extended payment terms. For eligible independent eye care practices in good standing, we are offering extended payment terms on current pending invoices. Given that your cash flow and business processes may be interrupted, we have implemented a 30-day payment extension, which will also apply to all orders placed directly with CooperVision and through our participating Authorized Distributor Network until May 31, 2020.
• E-commerce contact lens services. As office closures, limited hours, or emergency-only care hinder your usual services, we understand that you may also be exploring options for online contact lens purchases through your practice. We’d like to remind you that EyeCare Prime, a subsidiary of CooperVision, offers LensFerry-a doctor-friendly e-commerce contact lens service that enables patients to order lenses from your practice 24/7 via text, tablet, or computer, with deliveries directly to their homes.
• Supporting patient education. We know your patients have questions about the safety of contact lenses, lens wear and care in relation to COVID-19, and the direct-to-patient shipping process. We’re providing answers via our website and social media channels to support your own patient communications.
• CooperVision customer-facing team. Although our sales team is operating from home, they are still fully available to help and support you. Reach out to them if you need anything, and they will also be actively reaching out. Our aim is to help in whatever way we can. Customer Service also continues to operate at full strength and are there for you as well at 1-800-341-2020 (press 1 for Customer Service, 3 for service in Spanish, 4 for Consultation Support).
• Continuous Communication. On a biweekly basis (sooner should events dictate) you will hear from us through this format. However, in the meantime, please feel free to reach out to us through your sales representative or to our customer service team.

We are committed to supporting you in any way we can. Together, we will get through this.

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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!

Featured Annual Sponsors

This webinar qualifies as “live” CE for CA licensing requirements
Speaker: Pinakin Davey, OD, Ph.D., FAAO
Topic: Glaucoma- Diagnosis, Treatment, and Follow-up
Date: Jun 25, 2020 06:30 PM
Webinar ID:  845 7830 1114

To Join the Webinar
Join from a PC, Mac, iPad, iPhone, or Android device:
Please click this URL to join.

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Featured Annual Sponsors

This webinar qualifies as “live” CE for CA licensing requirements
Speaker: Dr. Srinivas Iyengar
Topic: Oculoplastics
Date: Jul 16, 2020, 06:30 PM
Webinar ID: 879 4740 6769

To Join the Webinar
Join from a PC, Mac, iPad, iPhone, or Android device:
Please click this URL to join.

 

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Participants must be signed into the virtual meeting for the full presentation time to receive a certificate. If this is your first time using Zoom and you are having difficulty with log-in, please feel to contact our administrative director, Nancy-Jo, at sdcos@sdcos.org  for assistance.

See 2020 CE schedule

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Classifieds

Practice for sale: Longtime established practice for sale in La Mesa. The seller wishes to retire and has set a very low purchase price to facilitate an immediate sale. Don’t miss out on this great opportunity to own your own practice.  Contact Dr. Levy 619-743-1442 (07/20)

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 (07/20)

Seeking motivated, entrepreneurial O.D. 20+ Year Veteran of the Optometry Profession, is seeking a motivated, entrepreneurial O.D. to start a new practice in City Heights district (second largest redevelopment zone in the City of San Diego). Custom modern office setting with a proven track record of success for medical practices (two prior eye clinics sold for a high premium at the same location). Opportunity to be involved with building and growing a practice from the ground up and building equity ownership in the practice. Spanish is a plus.  Familiarity with vision care insurance plans, managing optical, and experience in managing office staff is preferred but not required. This is an opportunity to take charge of a practice, grow equity in it, and create a greater opportunity than working on an hourly basis. New grads that are motivated and are willing to put in what it takes will also be considered.  Please email  spousti@live.com for more info. (07/20)

Equipment For Sale Nikon speedy 1 Autorefractor ($1200) MPOD MPSII ($10,000) portable fundus camera (Nikon handy nm 200-D) ($2500) and Reichert NCT ($1000). Email David at  info@beyondoptometry.com (08/20)

 

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

• 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!!

• Nargis Barkzai
• Anita Koo
• Garrett Pennell
• Kathryn Recker

Please update your information on www.eyehelp.org