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 2021

By Alexandra Scovill

This past year has been a historic year, not only for the world, but for COA as well! This year the COA had more legislative wins than any year previous! They were able to allow optometrists to administer COVID-19 vaccines, have live online CE approved, include optometrists in phase 1A for COVID immunizations, secure adult eyeglass coverage for Medi-Cal patients, telehealth payment parity, among others! And they are still working on more! Thanks to the COA I am currently fully vaccinated, I can complete my CE from the safety (and comfort) of my home, and am able to take a course to help distribute the vaccine!

Without the COA advocating for our rights as optometrists, none of this would have been possible, and many of us might even be out of work. If you had trouble seeing the benefit of being a member before last year, I don’t think I have to tell you how important it is now. We tend to take things for granted sometimes, the fact that we can dilate patients, use TPAs, or treat glaucoma. Especially those of us who entered the profession once these rights were already secured. Seeing the COA act so swiftly to help ensure my ability to continue to work, get paid, and attend CE during a pandemic has convinced me of the importance of being a member! The monthly payments are a small price to pay to be able to have a future as an optometrist.

In addition to all the wins from the past year, here are some other benefits of being a COA/AOA member:

1. Continuing education: The COA is now offering free online CE in addition to discounted rates for members to attend OptoWest, Monterey Symposium, and the AOA’s Optometry’s Meeting! As I am writing this, both the Monterey Symposium and Optometry’s Meeting are scheduled to be in-person this year!
2. Increased awareness: AOA works tirelessly to promote optometry with integrity and demonstrate how doctors of optometry care for patients’ eye health both in the exam room and in everyday life. A concerted public awareness campaign seeks to educate Americans about the importance of regular, in-person, comprehensive eye exams and the dangers of taking shortcuts in their eye health. The AOA also offers practice listing opportunities for members on their website under “find a doctor”.
3. Paraoptometric resource center: As a practice owner, you can enroll your entire staff to have access to the paraoptometric resource center. This online toolkit has information for training staff to help them become more knowledgeable, productive, and successful.
4. Legal Service Resource Program: The Legal Service Resource Program offers 30 minutes of free legal advice to members each month.
5. Insurance: AOA Excel offers malpractice insurance, life insurance, and disability insurance to members. New grads who become AOA members can enjoy 50% off malpractice insurance their first year in practice, then 25% off their second year!

Speaking of insurance, we know that it is important to have insurance, that is why most of us have malpractice insurance, health insurance, life insurance, etc. We are able to see the value in monthly payments for insurance. You can think of your COA/AOA dues as insurance; insurance that our profession will not only be around a while, but will be thriving. So thank you all for being members and I encourage you to take advantage of all the benefits your membership offers!

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Retina Corner Pepto Bismol Retinopathy?

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

Dear SDCOS,

I hope everyone is well and had a wonderful Easter! Great to see the beginnings of spring, and the beginning of the end of the pandemic. What a year. Here’s to the end of impersonal zoom meetings, constant face masks, and avoiding others (literally) like the plague! Considering we may have all spent a bit more time eating and drinking, and less time outdoors and exercising, I think I have the perfect case. As I have done before, I would like to present this as if it is a patient you are seeing in your clinic with a quick CME-like question.

Case Report:

A 49 year-old man with a history of hypertension and morbid obesity presented with a 3-week history of binocular diplopia. He began a fad diet consisting primarily of large quantities of water and fruit juice six months prior to presentation.  Subsequently, he experienced a rapid 60-pound weight loss, from 450 to 390 pounds. He does not have a family history of hypercholesterolemia.  Examination revealed 20/20 best-corrected visual acuity bilaterally, normal IOP, and a right cranial nerve IV palsy. His anterior segment exam was unremarkable. Fundus exam revealed a clear vitreous, normal optic nerve head, and unremarkable retina. However, the retinal vessels were creamy-pink and ghost-like.

At this point, with the patient sitting in your exam room, what would be the most informative next step for evaluating the retinal condition?

1. Refer the patient to a neuro ophthalmologist for evaluation of the CN IV palsy.
2. Refer the patient to your friendly retina specialist for fluorescein angiography.
3. Refer the patient to your closest lab for blood work.
4. Refer to patient to the ER.

Evaluation of the cranial nerve palsy is important, and more etiologies causes include trauma, vascular disease, aneurysm, and increased intracranial pressure. Our patient denied trauma, which is the most common cause. Evaluation for the other etiologies is important but is unlikely to help with the retinal pathology. A retinal-specialist evaluation would be very appropriate. Fluorescein angiography to evaluate the vasculature and rule out vasculitis would be helpful, but vasculitis is unlikely given that there is no uveitis and the retinal vasculature is uninflamed. Vasculitis manifests as segmental whitening along the vessel walls, and is often associated with vitritis. Referral to the nearest emergency room would be helpful to get the patient plugged into the medical system and to get the appropriate ancillary and laboratory testing – not a bad answer at all, and one I would give full credit for. The most informative next step, however would be obtaining bloodwork. This is a case of the rare retinal condition, lipemia retinalis. In this case laboratory workup showed elevated triglyceride level of 22,539 mg/dL, total cholesterol of 2,306 mg/dL, fasting blood glucose of 231 mg/dL. The patient was referred to his primary care physician who diagnosed with extreme hyperlipidemia and secondary diabetes. He was treated  with atorvastatin and metformin with complete resolution of lipemia retinalis and cranial nerve palsy over the subsequent six months. Of note, there was no evidence of aneurysm on brain imaging.

Lipemia retinalis is a rare condition characterized by extremely high triglyceride levels. It should prompt a systemic evaluation of lipid levels and referral to a primary care physician. The fundus appearance can normalize within 1-2 weeks with appropriate treatment. It is important to rule out pancreatitis and familial hypercholesterolemia. No treatment is needed for the retinal findings.

Well, that’s our Retinal Corner for this month. Please take care, everyone. As always, feel free to contact me anytime with questions.

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 ONE SENTENCE SUCCESS FORMULAS

One sentence success formulas such as “Early to rise….” have been around for centuries.

Speed up to the modern era and we have several one sentence formulas, such as the one for losing weight: “Decrease the amount of food you put in your mouth and increase your physical activity.” Running across that item created the urge to find more of these.

For students and others who have things to do, I found this bit of good advice for success: “Decrease the amount of time wasted and increase the amount of time spent accomplishing your goals.”

Simple, but effective.

To those of you belonging to service clubs, other groups, and even to members of our optometric society, we all hear about the importance of bringing in new members. Yes, there’s a formula for that: “Invite potential members to attend as guests.” It works and it’s easy.

I suppose if you were willing to devote a little time to coming up with success formulas for things in your home and/or office, you could find them or better yet, create them.

A good one that has been going around for years is composed of only a 10 word sentence composed of two letters each: “If it is to be, it is up to me.”

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

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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!

• See 2021 CE schedule

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COA events

Other upcoming COA event dates:

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

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

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Classifieds

Equipment for sale Canon CR- 1 Mark II digital retinal camera computer included $1250 or best offer. Contact at 619-518-1886 or shervinyaz@yahoo.com (04/21).

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 TOO SELL! (04/21).

PRACTICE FOR SALE  located in Fletcher Hills/San Diego CA. Over 40 years in practice at the same location on Fletcher Parkway which has great visibility, easy access, and a lot of travelers in this area.  The office has 600 sq ft of space including a reception/waiting room, a front desk area, a lane for exams, and a workspace. The rent is very reasonable and we have a strong patient base. This is a great opportunity to own your own private practice at an affordable price. Contact Richard Carlson at 619-463-9975 or email sddrrick@gmail.com (04/21)

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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!!

• Amir Ghanipour
• Harrison Yang 

Please update your information on www.eyehelp.org