The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• CE Corner
• Insurance Needs of Small Business Owners
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message August 2020

It’s hard to believe that we’re more than half-way through the year, in the heat of summer, and many of us are still learning to cope with our “new normal” in response to this global pandemic. As we struggle with uncertainty about the future, it is important to stay positive and focus on the constants we can depend on.

August is National Eye Exam Month, and back to school season. While back to school may look a bit different this year, the value of good eyesight cannot be underestimated, whether it be for in-person or virtual classes.

It is important to remind parents that while vision screenings are an invaluable service, there is no substitute for a comprehensive eye exam by an Optometrist. Many parents are unaware that a child who can see 20/20 can still have difficulty with their vision in other ways. While the most common problem is refractive error, we know that there are many more potential issues such as amblyopia, strabismus, and binocular or accommodative deficiencies.

Many difficulties in school can stem from an undiagnosed learning-related vision problem. In fact, experts estimate that 80% of what a child learns in school is presented visually, and visual problems are often erroneously diagnosed as laziness, learning disabilities, behavioral issues, or even severe attention deficits.

It is our job as Optometrists to provide these children with the clear and comfortable vision they need to learn effectively and do our best to educate our patients on the importance of an annual comprehensive eye exam.

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Retina Corner CHRPE

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

August is upon us, the dog days of summer. I hope that everyone is doing as well as they can be, and staying sane. If anyone feels like their life is surreal right now, you are definitely not alone, but we will certainly all get through this together. Also, there are always silver linings. One of those for me is that I set up an extremely easy to use system for collecting and storing multimodal digital retinal imaging of interesting cases in the cloud. It has been an amazing process, and every single day I try to save at least one case that is a great example of a pathology, or is educational in some way. Most of these cases come from you guys, and I’d like to thank you for helping me to collect a really cool library. This month I would like to share a case that was sent in by Dr. Joseph Ambrose. A really thought-provoking case of congenital hypertrophy of the retinal pigment epithelium (CHRPE).

The patient was a 24 year-old, healthy young woman with a history of mild myopia and stable pigmented lesions involving the right fundus (figure 1). Dr. Ambrose sent her over to make sure they were benign, as he suspected. As you can see in the color fundus photograph, there are multifocal pigmented lesions in inferotemporal quadrant of the right fundus, varying in size from about 100 microns to about a disc diameter. Some of these have a “bear track” appearance. The OCT (figure 2) showed that the lesions are flat with overlying retinal thinning, and no choroidal thickening or subretinal fluid. I agreed with Dr. Ambose – these look very much like CHRPE, and it was reassuring to see no evidence of choroidal melanoma or other concerning diagnosis. As I examined the patient and evaluated her imaging, I asked her my routine questions when evaluating these types of lesions. In general, CHRPE lesions are very benign with about a 1% risk of adenocarcinoma development. One of the only things I consider is that some CHRPE-like lesions are associated with the condition Familial Adenosis Polyposis (FAP), which predisposes patients to colon cancer at a very young age. FAP is also associated with desmoid tumors, non-malignant connective tissue tumors of the abdomen, as well as dental and jaw abnormalities. So, it caught my attention when the patient admitted to having a fairly strong history of colon cancer. It is moments like this where you need to take a step back and carefully consider what you are looking at and how to best direct the care of this patient. Could these be the lesions of FAP? Was this healthy young woman at risk of colon cancer??

Due to her family history, I felt obligated to recommend seeing her PCP for evaluation and consideration of genetic testing and/or a colonoscopy, however fortunately for this patient I do not think she is at high risk. The CHRPE-like lesions seen in FAP do look somewhat like her photograph, there is good reason to be reassured. Unlike her single quadrant of lesions in a single eye, FAP-associated fundus lesions are commonly bilateral and haphazardly-distributed in multiple quadrants. Moreover, they typically have a pisciform (fish-like) shape with a partial halo of depigmentation at one edge of the lesion. Her lesions appear to be garden-variety grouped CHRPE. I certainly hope that I am right.

Thanks to Dr. Ambrose for sharing this very interesting case with us!

Thanks again for reading. Please don’t ever hesitate to contact me with questions about this or any other case. I am at your guys’ disposal and love to help when I can.
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 ALTERNATIVE MEDICINE

Our history forms are pretty involved now, so do we really need more history?

Asking patients if they use unconventional treatments might not even be on your questionnaire, but not having that info could get your patient into serious trouble.

In one case, a gentleman who had been drinking an herbal tea for several months because he heard it would relieve gastric distress, and it was soon discovered that the tea contained a toxin.

We’re being inundated with cures for various conditions, and it is reported by WebMD that more than half of adults in the US say they use some form of alternative medicine. There is Chinese medicine, weight loss pills, energy therapies, magnetic field therapies, and many others.

A good question to open this discussion is: Do you take anything to improve your health? or, perhaps: Are you trying to lose weight?

Another researcher indicated that more than 40% of Americans now use some sort of alternative therapy, spending about $13 billion out of pocket annually.

The National Center for Complementary and Alternative medicine (CAM) defines those practices as ‘not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.’ There are now more visits to CAM providers than have been made to primary care physicians.

The reason these mostly middle to upper class college grads use alternative medicine is to maintain or regain control over their health, and they feel that this might afford them a greater sense of personal achievement in decision-making.

Patients who use alternative and OTC advertised products also use orthodox Western Medicine, and about 70% of them don’t tell their healthcare providers that they are using these therapies for fear of being ridiculed.

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

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Insurance Needs of Small Business Owners

The dreams of small business owners and the business plans that outline the strategy to fulfill those dreams rarely include the insurance protections that business owners will need. Yet, having adequate protection can help your business succeed, while protecting you and your family from financial risk.

Consider these key insurance protections:

BUSINESS OWNER POLICY (BOP)

This is a typical package of coverage that addresses the basic and most important needs of the small business owner. This package includes:

• Liability coverage, which provides defense and damages protection if you, your employees or products and services cause bodily harm to a third party;
• Property insurance, which will cover buildings or other business property such as equipment, computers and inventory from losses due to fire, vandalism, theft, smoke damage, etc.;
• Business interruption insurance, which can provide income when events prevent you from conducting business
• Vehicle coverage for vehicles the business may own or for when employees use personal automobiles for business purposes
• Worker’s Compensation: This insurance covers employees who are injured on the job with wage replacement and medical benefits. In exchange for these benefits, employees forfeit the right to sue. All states require this coverage and levy stiff penalties for noncompliance.

Other insurance coverage that may be applicable to a smaller subset of business owners include:

PROFESSIONAL LIABILITY INSURANCE

Also known as errors and omissions insurance, this provides you with defense and damages in the event that you fail to provide, or improperly render, professional services. (Your general liability policy will not cover this risk.) Typically, this coverage is for professional firms, e.g., lawyers, accountants, consultants, and real estate agents

DATA BREACH

With unending stories of business data being compromised by hackers, if your business has sensitive or non-public information (on computers or in paper files), your business can be held responsible if this information is stolen.

BUY-SELL AGREEMENT

If you are in business with one or more partners, your business may want to consider a buy-sell agreement that provides, in the event of the death of one of the partners, the remaining partners buy out the deceased partner’s share from the surviving spouse. This avoids having a surviving spouse as a partner, which can cause complications for the business and the remaining partners. Life insurance on the lives of each partner can provide the necessary funds to complete the agreed-upon purchase.

KEY PERSON INSURANCE

If you have a valuable employee (e.g., a superstar salesman) whose loss would take considerable time for the business to recover from, the proceeds of a life insurance policy on a key employee would act as a financial bridge until you can bring on an equally effective replacement.

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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
Speakers: Lee Vien, OD, FAAO; David N Yang, OD, FAAO
Topic: Ocular Disease
Date: August 16th 2020 at 9:00 AM
Webinar ID: 833 7390 9800

$25 for SDCOS members
$50 for COA/AOA Members
$99 for Non-members

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

FOR SALE:  Topcon non-mydriatic retinal camera TRC-NW6S works great. Comes with 5 yr old Dell computer and monitor.  $1450.00Please contact Glenn at Gdem@cox.net  (09/20)

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 (08/20).

Practice for sale:  Established practice for sale in El Cajon. 30+ years in business.  The doctor wishes to retire and has set a very low purchase price to facilitate an immediate sale. Please call 619-444-9474. (09/20)

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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Please update your information on www.eyehelp.org