San Diego County Optometric Society
The San Diego View
Inside this Issue:
- President’s Message
- Retina Corner
- Eye See
- Shamir Blue Zero TM
- Stories of Resilience: A Pathway to Growth
- CE Corner
- Volunteer Corner
- SDCOS Announcements
By Alexandra Scovill
As I am writing this, I San Diego County has just entered the Orange Tier of quarantine! Over one million San Diegans have been vaccinated! The burden of disease of COVID-19 is rapidly decreasing! This means that San Diegans are going to feel more comfortable going to the eye doctor for their eye exams. Hopefully this is good news for your practices as many of us are still recovering from the initial shutdown. As your practices begin to pick up, let’s not forget about our mission as members of the society, and the reason we became optometrists: to help those in need.
The San Diego Optometric Society has a long history of volunteering for the Lions Optometric Vision Clinic to provide quality eyecare to those who qualify. These include people who are unable to obtain assistance through private insurance or other social service agencies. They may be low-income families, or those undergoing rehabilitation programs. What better way of helping these people get back on their feet than by giving them the gift of sight! The LOVC provides its patients with comprehensive eye exams, low-cost glasses, dilated retinal examinations, and glaucoma screenings. At the moment, there is a long waiting list to get an eye exam because the clinic was closed for a while during the COVID-19 quarantine.
The LOVC makes it easy to volunteer your time! They are open Monday through Friday, 9am-1pm. However, they are willing to remain open for an afternoon shift from 12-2pm or a rare Saturday shift for those of us that work during the week. You set your schedule of how many patients you want to see. So it is really a small time commitment, you can still see half a day of patients in your office after volunteering! The clinic has all the equipment you need, including Optos photography! The staff is wonderful and very helpful. They work up your patients for you and take care of glasses orders and referrals, when necessary. The hardest part is just picking up the phone to schedule your time!
Another opportunity to give back is the North County Veteran Stand Down happening September 17-19th. Healing California will be there providing eye exams, as well as making and dispensing single vision prescription glasses onsite to homeless and at-risk veterans and their families. Veterans make up a large portion of our community, so let’s give the gift of sight to these service members who have given so much for us. The clinic is open 8am-5pm each day with morning, afternoon, or all-day shifts available. To sign up, go to the following website: https://healingca.org/upcoming-clinics/ncsd
Please let our board members know if you have any questions! I encourage all of you to volunteer at one or both of these clinics to help those in our community who need it most.
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 May! Wow, these months seem to fly by. The London family is doing well… Max (10) is playing lacrosse like his dad did back in the day, Jack (8) is as cute and stylish as ever, and Cole (5) is still a crazy rascal. We recently did a fun science experiment at home growing crystals, and the next day I saw an interesting patient I thought I would share. Getting to the punchline, she has a crystalline retinopathy of the left eye, but the question was why, and it is a good opportunity to review the differential diagnosis and workup of this fascinating condition. I will present the case to you below and end with my best guess as to what the etiology is and why I come to that conclusion.
These are the color fundus photographs and OCT b-scans of the right and left eye of a 59 year-old South Asian woman sent to me for evaluation of the left eye. She noted transient episodes of visual obscuration affecting the left eye that lasted 1-2 minutes and consisted of “horizontal and vertical lines” across her vision, that resolved spontaneously. She denied any other symptoms and is very healthy other than hypothyroidism. Her only medication is levothyroxine, and she denied any smoking, alcohol abuse, or recreational drug abuse. Her ocular history including a remote retinal tear in the left eye, treated with laser. Her visual acuity was 20/20 OU, with normal IOP and normal anterior examination. Her retinal exam was unremarkable OU other than iridescent refractile particles involving the left macula (figure). These were randomly distributed on the macula, and appeared to reside at the level of the posterior hyaloid on OCT (see blue arrows).
What is your diagnosis?….
So, clearly this patient has a crystalline retinopathy, with the findings on slit lamp exam even more impressive than the photos suggest. For those of you who have seen a patient with this, it is always remarkable to see. The first thing to do when seeing a patient with crystalline retinopathy is to consider the broad categories of the differential diagnosis: 1. Rare genetic diseases, 2. Vascular disease, 3. Idiopathic causes, 4. Toxic exposures, and 5. Metabolic disorders. All are important to consider, but some can be quickly ruled out in our case.
Toxic etiologies tend to have a distinct pattern, and would be have a history of exposure (although this history can be forgotten). The breast cancer treatment, tamoxifen is a classic cause of crystalline retinopathy, and would likely be evident in the history. These crystals tend to be deposited in the temporal macula. Canthaxanthine is a self-tanning agent that may lead to a ring of crystal deposition around the foveal avascular zone. Ethylene glycol consumption may cause secondary oxalosis, with crystal deposition throughout the retina and subretinal space, unlike our patient.
Genetic and metabolic causes include Bietti’s Crystalline Dystrophy, Cystinosis, Hyperoxaluria, and excessive rhubarb ingestion, and would be associated with systemic findings and/or other ocular signs and symptoms, which our patient did not have.
Talc retinopathy is a notorious cause of crystalline retinopathy, and is typically associated with intravenous drug use. The crystals often follow the vasculature, unlike in our patient, and she denied any IV drug abuse.
Perhaps most telling of all is that our patient has unilateral findings, whereas many, if not all, of the above would present bilaterally. Moreover, we have an important clue from the OCT, which reveals the crystals at the level of the posterior hyaloid, and not within the retina itself. This implies that the crystals are more in the vitreous than the retina itself. This leaves us with a diagnosis of “chronic retinal detachment.” While our patient did not have a true retinal detachment, she did have a history of a treated retinal tear in that eye, and I believe this is the origin of her findings. The pathogenesis of the crystals is unknown, but they are believed to derive from the subretinal space, and may represent hemosiderin laden macrophages, erythrocyte breakdown products, or shed photoreceptor out segments.
Regardless, this is more of an incidentaloma for our patient as she appears to be completely unaffected. Her visual symptoms are unlikely to be related, and are more likely to represent an ocular migraine. Of course, we will continue to watch her closely and consider alternative explanations for the crystals if new information is revealed.
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,
Nikolas London, MD, FACS
Retina Consultants San Diego
written by Dr. Byron Y. Newman
JULIET, JULIET, ARE YOU OK?
When Romeo viewed the apparently dead Juliet, he was puzzled and said to her, (according to Shakespeare,)
“Ah, dear Juliet.
Why art thou yet so fair? Shall I believe
That unsubstantiated death is amorous?”
Unfortunately, Romeo accepted without question, the lifeless nature of Juliet. Never did he attempt to learn if, indeed, Juliet was alive; according to a letter published in JAMA several years ago.
“Ponder the circumstances had Romeo been trained in modern day cardiopulmonary resuscitation (CPR) stated the letter. Romeo could have acted to confirm or deny his suspicion, such that after his little speech he could have knelt down and used the following stage direction:
( Romeo embraces Juliet’s shoulders, shaking her and says,)
“Juliet, Juliet, are you ok?”
(Romeo supports Juliet’s head and neck, opening her airway, his face near hers, he looks, listens and feels for Juliet’s respiration)
Of course, the authors continue with possible dialogue, changing the direction of the play with his knowledge of CPR, and sustaining her life until further help arrives.
Possibly this could change the play from a tragedy to a medical lesson.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
Shamir Blue Zero TM
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Stories of Resilience: A Pathway to Growth
By Michelle King, OD / November 23rd, 2020 (Updated 4/15/2021)
As a second-generation optometrist, you could say optometry is in my blood. I grew up around my mom’s private practice, where patients were treated like family, and I am continuing that legacy today in my own growing practice.
COVID-19 impacted our practice like it did most others. During the eight weeks that we were closed to routine care, we did our best to continue to serve our patients, maintaining a small crew to handle emergencies, complete and dispense jobs in progress, mail eyewear, and fill prescriptions. The extension of the VSP Primary EyeCare Plan to all members during that time was really helpful, allowing us to assist even more patients in need. My favorite pandemic patient story was an essential worker, a truck driver, with eye pain and decreased vision whose wife had been calling around frantically trying to get him seen. We brought him in, diagnosed him with iritis, and quickly got him the medication he needed so he could get back on the road—without ever having to step into a crowded Emergency Room.
When not providing emergency care, we spent the downtime getting up to speed on a number of topics and obtaining CE credits through Premier Academy360 from VSP Global. We also took advantage of the many reopening resources that helped us get ready to reopen for routine care. Once we did, the process was smooth but gradual, and we are happy to report that we are at about 80-90% of our pre-COVID patient flow. We were also pleased to bring back all the staff, including a new associate we hired just before the pandemic started.
We hired our new doctor early this year to support the growth of our practice. It was really important to find the right person—someone who fit with our culture, was highly qualified, and who shared our philosophy of caring for patients like family. In the past, we have tapped our local society, optometry schools, and other channels for candidates. This time we decided to try Premier Pathways from VSP Global. The process was so easy—we filled out a questionnaire and then met with a senior recruiter who developed an attractive custom ad for us. The job listing was so well thought out and professional—it definitely exceeded our expectations. Within days, we had responses from highly qualified candidates who met all our requirements and even our wish list items. After three interviews, we selected our new doctor. The entire process took about a month. We were really pleased and are already working with Premier Pathways on our next hire.
In addition to staffing assistance and education opportunities, there are many benefits we’ve experienced through partnering with VSP and being part of the Premier Program. It starts when we answer the phone at the practice—which I do on occasion. One of the first questions is often, “Do you accept VSP?” To which, we respond, “Yes, we do. In fact, we’re a Premier Program location.” That usually solidifies the deal, and patients make the decision to come to us. We also appreciate the partner savings on popular brands such as Maui Jim, Gucci, and YSL, and our patients love the discounts we pass along to them. Lastly, we benefit from the My Marketing Team marketing tools, which help us engage with our patients through social media.
There is no question that these times are challenging for us all. Nevertheless, as my practice continues to grow, I am optimistic about my future and the future of our profession. As I see it, there will always be changes and obstacles to navigate—the future is bright for those of us who are passionate about our work and are willing to adapt and grow.
We are committed to helping you fulfill your CE requirements through our local virtual meetings with the support of our sponsors!
Featured Annual Sponsors
July 8 2021
Speaker: Seema Nanda, OD
Webinar ID: 867 4182 2360 Passcode: 586979
The registration link for the Zoom meeting: https://us02web.zoom.us/webinar/register/WN_16QqocGeSMaE7_rVI9z1Wg
Other upcoming COA event dates:
- May 17th
- July 19th
- September 20th
- October 18th
Check out the COA website for more info: www.coavision.org
Optometrist needed Mondays, Thursdays, and Saturdays for busy Independent Practice inside Mission Valley Costco. If interested, please contact Dr. Slicker’s personal cell at 619.977.7703 or email at email@example.com (06/21).
Optometrists needed: Acuity Eye Group is seeking Doctors of Optometry for several Southern California locations. Part-time or Full-time. Excellent compensation and benefits. Please email Denise Shugerman with your resume and inquiries: firstname.lastname@example.org (05/21).
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 email@example.com (06/21).
Monarch School Screening
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:
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
Please contact the society office at 619-663-8439 for arrangements to pick up.
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 firstname.lastname@example.org
For updated information and resources regarding COVID in San Diego, please register using this link. This will sign you up to receive weekly emails from the San Diego Health and Human Services Agency, including weekly tele-briefings on everything COVID.
- Click here for most recent SDCOS Board Meeting Minutes
- Click here for the 2021 CE schedule!
- Click here for COA membership benefits!
Welcome, new members!!
- Amir Ghanipour
- Harrison Yang
Please update your information on www.eyehelp.org
Phone: 619 663 8439
Fax: 800 643 8301