The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• Healthy Eyes Advantage: Here To Support Your Practice Growth
• Rhopressa
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message February 2021

By Alexandra Scovill

As healthcare professionals, we are all aware of the dangers of COVID-19 and the effects it has had on our businesses, daily lives, and even loved ones. Despite closing our offices, social distancing, and wearing masks, the numbers continue to rise. Luckily, thanks to the hard work of numerous scientists, there are two vaccines available in the US! At January’s SDCOS board meeting, the board members and I had the opportunity to meet with Dr. Jennifer Tuteur and Dr. Denise Foster from the San Diego County Health & Human Services Agency to discuss all things COVID and vaccinations. I am going to use this newsletter to relay some important information they shared with us regarding the vaccines.

Both vaccines available (Moderna and Pfizer) are mRNA vaccines, which means it is not the live virus. This is new technology but both have proven to be safe and effective! Studies have shown a 95% efficacy in preventing severe illness, hospitalization, or death if infected by the virus. San Diego’s goal is to vaccinate 70% of the population by July 1, 2021 in order to create herd immunity against the virus. Optometrists and your office staff are able to be vaccinated now by going through the county. You can visit the San Diego County’s website (www.coronavirus-sd.com) to register yourself and your office staff for the vaccination. They are trying to make it easily accessible by offering the vaccine through county health vaccination events, “super stations”, mobile vaccination teams, hospital-based sites, clinic-based sites as well as through pharmacies. Even though there are many different sites, appointments are filling up fast because the city is limited by the number of vaccines they receive as well as by the number of volunteers they have to administer the vaccine. As optometrists, we can help! This is one of the main reasons AB 443 was passed, and yet another reason why being a COA member and participating in Legislative Day is so important! We now have the ability to help distribute the vaccine to the population! If you are certified and interested in volunteering to help administer the vaccine, you can register here: https://www.healthcarevolunteers.ca.gov.

If you have not yet gotten your vaccine certification, there are still ways for you to help prevent further spread of the virus:

• Get vaccinated
• Social distance and wear masks even if you have been vaccinated
• Restrict non-essential travel to <120 miles, even if you remain in state
• Enable CA Notify (app) on your iPhone or android phone to help the CDC track the virus

From December 10, 2020 to January 13, 2021, San Diego county went from 100,000 to 200,000 cases of COVID-19. We have confirmed community spread of the UK variant which has been found to be 50% more contagious. Luckily, the vaccine appears to be effective against all new strains that are being identified. The vaccine is not recommended for everyone depending on other health conditions (recent COVID infection, pregnancy/nursing, immune deficiency, etc…), but if you have no contraindications, the San Diego County of Health & Human Services Agency recommends being vaccinated to prevent further spread and keep you, your patients, and your loved ones safe.  Stay safe, and I hope to be able to see all of you in person in the near future.

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Retina Corner Ocular manifestations of COVID

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

Happy February everyone! I hope that you all have gotten vaccinated by now. This may be a bit ridiculous, but for me the psychological relief of feeling immune to a deadly virus has been priceless. What a milestone. Speaking of COVID, Dr. Orlando Guiang of Mira Mesa Optometry sent me a fascinating patient the other day – a healthy young man with cotton wool spots and small retinal hemorrhages reminiscent of hypertensive retinopathy (figure). He had a recent history of uneventful SARS-Cov-2, and had fully recovered from his symptoms. These findings are interesting and have been seen by others, and I thought this would be a great opportunity to review the retinal and ocular manifestations of this disease which has overshadowed our lives for the past year.

As we all know, SARS-CoV-2 has led to a global pandemic with millions of affected patients and hundreds of thousands of deaths. While primarily a respiratory disease, SARS-Cov-2 has effects throughout the body including the cardiovascular system, the GI tract, kidneys, liver, blood, musculoskeletal system, and central nervous system. As a part of the CNS, it is not surprising that SARS-Cov-2 has ocular and retinal manifestations.

One of the first reported findings was conjunctivitis. This presents similar to other forms of viral conjunctivitis with bilateral conjunctival erythema, epiphora, chemosis, and a follicular reaction. Enlarged pre-auricular and submaxillary lymph notes are also present. The incidence is unclear, but has been reported to affect as many as 32% of patients, and it may be a presenting symptom of infection. Again similar to other viral conjunctivitis, the cases are self-limiting, and supportive care is indicated. On the other hand, conjunctival injection can also be seen in Kawasaki Disease (KD), which is another reported association of SARS-Cov-2. KD is a rare condition that affects young children and is characterized by fever, rash, lymphadenopathy, and oropharyngeal changes (strawberry tongue). In the eye KD may cause iridocyclitis, keratitis, conjunctivitis and/or subconjunctival hemorrhage, and optic nerve edema.

Retinal findings are, of course, more interesting than any of the above (I’m not biased). Reports of affected patients are very similar to what we saw in Dr. Guiang’s patient, and include cotton wool spots and macular microhemorrhages along the vascular arcades. These are often seen in the absence of intraocular inflammation, and likely represent a transient microvasculopathy. Only rare cases of large-vessel occlusion have been reported. The microvasculopathy appears to be due to complement system activation with endothelial cell damage, thrombus formation, and microvascular damage. Retinal findings are expected to fully resolve, and observation with careful attention to other possible vascular events is warranted.

As this pandemic continues and evolves, I am certain that we will learn of additional ocular manifestations. As always, the retina is a window to the health of the rest of the body, and it is interesting to consider how retinal findings might be followed to determine the effect of both acute and chronic infection.

Best wishes, and until next time,
Nik

Nikolas London, MD, FACS
Retina Consultants San Diego
415-341-5456 (cell)
london@rcsd.com

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Eye See written by Dr. Byron Y. Newman WHEN IT’S WRIT BY HAND

Illegibility in a shopping list, memo, or love letter, may cause some consternation to the reader, but it has reached epidemic proportions in the business world, including the professions.

One big city department store, for example, reports that approximately 20,000 unreadable sales slips hold up $165,000 or more in purchases each year. Sloppy numerals, according to the U.S. postal service, accounts for the more than 25 Million “dead letters” undelivered annually.

And, how many unreadable Rx’s? I once fired an OD whose writing on our examination form was unreadable. Graphologists say that numerals that could be deciphered in several different ways can be a sign of dishonesty.

In the practice of optometry, the critical plus or minus sign plays an important role with numbers having to be deciphered by a labman? If they’re for single vision lenses, you might be upset, but what if it’s for a bifocal in transitions and AR coating?

Penmanship, which busy doctors scribble are noted for their lack of, is an art form, according to Bradford R. Boss, president of the Writing Instrument Manufacturers Assn., in Washington, D.C.

Illegibility may be serious in a prescription for medication, but also in an Rx for glasses; the expense, delay and aggravation for all parties, often leads to a lost patient and an appearance of incompetence. The suggestion to watch out for tricky letters and numbers is well taken.

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

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Healthy Eyes Advantage: Here To Support Your Practice Growth

January 28, 2021

Justin Manning, OD, MPH, FAAO, Executive VP of Professional Strategies, Healthy Eyes Advantage

Healthy Eyes Advantage (HEA), the next generation marketplace for more than 10,000 independent eye care professionals, is thrilled to continue our support of the San Diego County Optometric Society (SDCOS) to advance the future of optometry. Over the last 20 years, HEA has given more than $12 million to state optometric associations across the country, and we are proud to support the optometric profession.

It’s inarguable that 2020 challenged all of us: doctors, patients, and the industry alike. I believe, however, that 2021 presents a unique opportunity to elevate our eye care practices, whether your goals include attracting new patients, advancing medical eye care, and/or managing a more efficient and profitable business. HEA is eager to partner with you in this endeavor.

Our Mission: Fueling Your Growth

Group purchasing services form the core of our business, but HEA’s unique program benefits extend far beyond the industry-best discount and rebate programs we have with more than 200 vendors. HEA also delivers:

• Consolidated billing — save time and money by receiving and paying just one monthly statement; our members have reported that we reduce their administrative workload by a whopping 30%;
• The Coding Coach — a no-cost comprehensive billing and coding toolkit that includes newsletters, webinars, a comprehensive database of searchable FAQs, and a telephone hotline/email service staffed by certified coders;
• SmartData Solution—the industry’s easiest-to-use practice analytics dashboard that helps you understand your bottom line and maximize your practice revenue like never before; available at no charge to HEA members;
• Practice Boosters — a simplified approach for leveraging new technology, new services, and new methods for growing your practice. HEA Practice Boosters include AMD, Innovative Tech, and Medical Software Essentials; and
  PracticeAdvantage — make 2021 the year you achieve your goals with HEA’s PracticeAdvantage program, a monthly subscription-based consulting and staff development program powered by Williams Group.

PracticeAdvantage clients receive:

• • monthly strategy sessions with a PracticeAdvantage coach
  • unlimited inbound consulting for any day-to-day or big picture practice questions
  • online staff education and business development training platform

PracticeAdvantage program participants are achieving financial success they never thought possible and always have a trusted business advisor to collaborate with when making practice decisions, both big and small.

I encourage you to check out the PracticeAdvantage Podcast, with new episodes released every other Monday, streaming on Apple, Google, Stitcher, and Spotify. Each episode delivers business management tips and strategies from experts in 25 minutes or less.

Getting Started

There’s never been a better time to power up your practice. HEA Solutions Specialist Dave Halverson is eager to guide you through the process. To learn more about joining the largest community of independent eye care professionals — or if you are already an HEA member interested in the HEA benefits mentioned here — call or email Dave at 951.532.4493 or dhalverson@hea2020.com. You may also visit HEA at www.hea2020.com to learn more about our program benefits.

Dave Halverson

Justin Manning

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Rhopressa

It is an exciting time to be in the field of glaucoma. For decades glaucoma specialists were equipped with only a few pressure-lowering eye drops and the trabeculectomy or aqueous tube shunt to prevent blindness in their patients.  Glaucoma specialists now have more treatment options which range from minimally invasive surgical procedures (MIGS) to the advent of new ophthalmic solutions.  One of these novel treatments is a topical netarsudil ophthalmic solution (Rhopressa, 0.02%; Aerie Pharmaceuticals) which was approved by the Food and Drug Administration (FDA) in 2017. Rhopressa is a rho kinase inhibitor and it is indicated for the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.1 While most glaucoma drops work by reducing the aqueous production or increasing the trabecular aqueous outflow, Rhopressa uses a combination of three mechanisms to lower IOP. In addition to the aforementioned, Rhopressa also decreases episcleral venous pressure – this combined mechanism of action allows for increased efficacy.2  Clinical trials demonstrated noninferiority timolol studies, achieving similar efficacy to timolol 0.5% ophthalmic solution.2 In clinical trials, Rhopressa excelled in patients with lower baseline IOP which is thought to be in part due to its utilization of the episcleral venous pathway. The tolerability of Rhopressa is quite good among patients, however, potential adverse effects include conjunctival hyperemia or hemorrhage and non-visually significant corneal verticillata, which resolve upon discontinuation of the medication. Rhopressa can be used as a first line agent but in combination with other IOP lowering drops, especially prostaglandin analogues, greater IOP lowering results can be achieved.

In my clinical practice, I warn my patients of potential ocular injection and reassure them that over time the redness may improve.  For patients bothered by persistent injection consider over the counter brimonidine tartrate ophthalmic solution 0.025% (Lumify; Bausch & Lomb). I will often consider Rhopressa as a second line agent after prostaglandin analogue latanoprost ophthalmic solution 0.005% or even initially with Rocklatan (netarsudil and latanoprost ophthalmic solution 0.02%/0.005%; Aerie Pharmaceuticals).

In the battle against irreversible vision loss and blindness from glaucoma, ophthalmic providers now have additional effective and low risk medications at their disposal.

1) Food and Drug Administration. Rhopressa: Highlights of prescribing information. www.accessdata.fda.gov/drugsatfda_docs/label/2017/207795Orig1s000lbl.pdf.

2) Serle JB, et al. Am J Ophthalmol 2018; 186:116-127.

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CE Corner We are committed to helping you fulfill your CE requirements through our local virtual meetings with the support of our sponsors!

Featured Annual Sponsors

Speakers: Dr. Nikolas London, MD and Dr. Arash Mozayan, MD
Topic: Retina Symposium
Date: April 1, 2021
Webinar ID: 817 6853 8402
Passcode: SDCOSCE

Free for SDCOS members
Free for COA/AOA Members
$50 for Non-members
Free for Students
Free for Sponsors

To Join the Webinar
Join from a PC, Mac, iPad, iPhone, or Android device:

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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 2021 CE schedule

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COA events

OptoWest: February 28th

Other upcoming COA event dates:

• March 15th
• May 17th
• July 19th
• September 20th
• October 18th

Check out the COA website for more info: www.coavision.org

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Classifieds

PRACTICE FOR SALE One of the longest continuous running practices in Coastal North County. Serving Solana Beach since 1977. The practice has always been noted for quality care and high technology. Featuring a beautiful optical boutique with a full finishing lab. Practiced as solo, but could accommodate multiple doctors with up to three exam lanes. Co-management of Lasik, cataracts, and medical in place for years. Strong community referrals from local schools and businesses. Contact Michael Foyle at 858 481 7262 or email mfoyleod@yahoo.com (03/21)

Turnkey practice available in Murrieta, California. It has modern equipment including a digital exam lane and Optos Daytona, 1 exam lane plus a tech workup room, and a bright and open optical. The practice currently sees about 150 patients per month during COVID with room to expand. Murrieta has some of the most affordable housing costs in Southern California with fantastic schools, local wineries, and is less than an hour to the beach and mountains. Email murrietaoptometryforsale@gmail.com for more information. (02/21)

Practice for Sale: North County “Carlsbad” upscale high-end practice. Owner at the same location over 30 years, boasts a strong net with easy hours. Great visibility location within high traffic Vons Center, theatres, library, great restaurants, great tenant mix. Office current remodeled with glass showcases, LED lighting, granite countertops, designer wallpaper, light wood floors. Updated equipment in the exam and pretest room with blue tooth transfer. Great opportunity to own a modern practice and be independent with much room for continued practice growth. Call Howard Levy, OD 760-310-8492 or email bluesdoch@yahoo.com PRICED TO SELL! (02/21)

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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

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.

The LOVC has Reopened!!

Please call or email the clinic if you are interested in volunteering:

• 619.298.5273
• lionsvisionclinic@gmail.com

Alterations to the schedule to accommodate social distancing are in place and PPE will be provided for all volunteers/staff/patients.

New flooring was installed with the donation from the SDCOS 2019 golf tournament and a special thanks to Dr. Phil Smith!

Please think of the LOVC for your end of year charitable giving, visit our website:  lionsvisionclinic.org

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DONATE GLASSES
Please 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

SDCOS was on NBC 7! click here to see the clip

• Click here for most recent SDCOS Board Meeting Minutes
• Click here for the 2021 CE schedule!
• Click here for COA membership benefits!

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Welcome, new members!!

• Kevin Hoang
• Stephen Choy
• Basanti Shaw
• Terra Barnes

Please update your information on www.eyehelp.org