The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• From Oceans to Eyes: Seeing the Big Picture of Our Patients’ Health
• CooperVision: Innovation Continues
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message June 2021

By Alexandra Scovill

June marks the beginning of summer! And this year, it marks another milestone in starting to re-open as we continue to make progress in defeating this virus! Maybe you are a practice owner looking for more help as patients begin to flock to your practice for those new glasses and contacts they have been putting off for the past year.  Maybe you are a new graduate looking for work, or figuring out how to run a business for the first time! I remember feeling immense anxiety as I transitioned from my residency program into the “real world”. How do I get my license? What is an NPI number? How much malpractice insurance do I need? I had so many questions!

I wish someone had told me about the COA Optometric Resource Guide available to members. As students, you are encouraged to join as a student member which is a free membership that lasts the entirety of your graduating year. That means that new grads still have free access until January! This Optometric Resource Guide gives you all the information I wish I had at the time. It clearly lays out everything you have to do to complete your licensure, how to become a Medicare/Medi-Cal provider, and what an NPI number is and how to apply for one. It also offers practice management tips including HIPAA guidelines, CA scope of practice laws, how to keep medical records, clinical practice guidelines, telehealth information, and more!

If you are still searching for a job after graduation, or are looking for a change in positions, both the COA and SDCOS offer job postings. SDCOS offers a unique job connections service where you can be put on a list of doctors looking for a position that will be sent to doctors looking to hire! I, personally, found my dream job on the SDCOS website right after completing my residency! I saw the job posting and noticed that the SDCOS president was an employee at the office looking to hire. So I emailed him to get more information and decided it was a good fit! Three years later, I am still at the same job that I would not have gotten if it weren’t for the Society’s website (or the help of the President). Please do not hesitate to reach out to any board member with questions about job searching, we are all happy to help!

Also, plans are in the works for a possible outdoor BBQ this summer for new members to be able to meet with board members! If you are a new grad or have recently moved to San Diego, keep an “eye” out for more information coming soon! We would love to meet you in person and get to know you better! We are always thrilled to have new members as that makes our society stronger and our voices louder. Together we can accomplish so much for our profession!

---

---

Retina Corner Macular Microperimetry

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,

Greeting again, and I hope everyone is doing well. Hopefully this topic is not too mundane, but I wanted to review one of the less common imaging techniques we use in Retina, microperimetry. We are all familiar with perimetry in to analyze peripheral visual fields for our glaucoma suspects and patients, but in retina we use a slightly different technique to analyze macular function. As you all well know, perimetry refers to the systematic mapping of a visual field function, similar to the testing of pixels on a television screen. Abnormalities can be used to help clarify a diagnosis, as well as to monitor disease progression, and perimetry is particularly useful in patients with diseases of the optic nerve, retina, and/or visual pathway. Whereas traditional perimetry focuses on the peripheral visual field, eye movements make it relatively unreliable for macular pathology. Macular microperimetry minimizes the impact of poor fixation and correlates visual function with anatomy by superimposing functional results over visible anatomic changes.

In our clinic, we use microperimetry fairly frequently, as a part of clinical trials looking at new therapeutic options for macular degeneration, to evaluate macular health prior to cataract surgery, to look for “pristine” macular health prior to premium IOL placement, as well as to learn about and follow newly-discovered macular pathologies such as pentosan polysulfate sodium (Elmiron) toxicity.

There are several commercially-available microperimeters, including the Nidek MP-1 (Nidek Technologies, Padova, Italy), Optos OCT/SLO (Optos, Dunfermline, Scotland, UK), and) MAIA (CenterVue, Padova, Italy). The MAIA is widely used and is the machine this review focuses on. The MAIA uses three different techniques to analyze retinal function, including 1) high-resolution retinal imaging produced by a scanning laser ophthalmoscope, 2) fixation stability and preferred retinal locus identification, and 3) macular sensitivity via microperimetry.

As for the nuts-and-bolts, the standard MAIA microperimetry exam tests a 10-degree area with 37 points. The luminescence of the points is measured in apostilb (asb) on a relative decibel scale, from 0 to 36 where 0 is the brightest stimulus and 36 the dimmest. On the results printout (Figure), the scale is color-coded with green representing normal values, yellow suspect, red abnormal, and black representing scotomas. These stimuli are projected onto the macula in a set pattern, which can be customized if preferred. The standard projection strategy is called “full-threshold 4-2,” where the machine increases intensity in 4dB increments until a stimulus is seen and then decreases in 2dB increments until not seen. Other strategies include a faster, supra-threshold strategy for patients with known macular pathology known as 4-Levels-Fixed, and a supra-threshold strategy for patients with severely affected central vision known as “scotoma finder” to monitor the progression of scotomas. Given the subjective nature of pattern interpretation, not to mention difficulty comparing patterns over time, MAIA also provides a single numerical value called the Macular Integrity Index (MPI) as a quick assessment of a patient’s responses. The MPI roughly categorizes a test as normal (0-40), suspect (40-60), or abnormal (60-100).

Finally, information on fixation stability and preferred retinal locus are assessed by tracking eye movements 25x/second and plotting the distribution over the SLO image. The cluster of points represents the PRL. Fixation stability is measured in two ways: the percentage of fixation points within a distance of 1- and 2-degrees, termed P1 and P2, respectively. If 75% of points are within P1 the fixation is termed stable. If less than 75% of points are within P1, but more than 75% are within P2, fixation is termed relatively unstable. If less than 75% within P2, fixation is termed unstable.

Figure. Sample MAIA microperimetry report for the left eye of a patient with diabetic macular edema. The top left image shows an SLO fundus image. To the right of this is a the SLO image with overlying sensitivity values and fixation points demonstrating the preferred retinal locus. Beneath the SLO image is an interpolated sensitivity map and the fixation plot. In the lower right are some graphical representations of the data, including the color-coded macular integrity index, the color-coded average threshold, a histogram of threshold values (grey) compared with normal distribution (green), and finally a fixation graph showing the amplitude of eye movements.

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

---

---

Eye See written by Dr. Byron Y. Newman WHAT IS A PATIENT?

About 50 years ago, Ann Landers ran an item from a reader titled “What is a customer?”

It was excellent but, by just changing the word customer to patient and making a few other modifications it becomes more interesting reading for a professional optometrist.

So here it is and just as good as it was 50 years ago.

WHAT IS A PATIENT?

A patient is the most important person in my practice.

A patient is not dependent on us; we are dependent on them.

A patient is not an interruption of our work, he or she is the purpose of our work.

Patients do us a favor when they come in.

A patient is a part of our practice, not an outsider.

Patients are not just statistics: They are flesh and blood human beings with feelings and emotions, just like ourselves.

Happy patients become our public relations department referring their friends and neighbors to our practice.

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

---

---

FROM OCEANS TO EYES: SEEING THE BIG PICTURE OF OUR PATIENTS’ HEALTH

By Henry Makini, OD, May 11, 2021

When I was in my fourth-year externship, one of my advisors gave me a valuable piece of advice that I’ve never forgotten: whatever you do, make sure your patients walk out with a positive experience. That advice really resonated when I opened my own practice. I realized that patients who had a positive experience because of their involvement in their care during their visit were more likely to come back and to follow my recommendations than those who did not. As Doctors of Optometry, we have a unique opportunity to educate patients not only about their vision, but about the role vision care plays in their overall health. In my practice, we have found this to be especially true with the early detection of diabetes. (read more…)

---

---

CooperVision: Innovation Continues

Hi team! I can’t believe that we are almost halfway through 2021. This is a great time to regroup and implement a successful game plan for the rest of the year. CooperVision has been working hard to continuously deliver improvements and enhancements to its product portfolio and offerings. I wanted to highlight some important details and ensure that we are all aware of this helpful information:

*Biofinity Toric XR: CooperVision expanded the parameters of this lens by 15,840 unique prescriptions. The expansion went live on May 5th of this year, and orders are ready to be fulfilled. The sphere powers have increased from (+/-) 10.00 to (+/-) 20.00. The lens has 11x cylinder powers, ranging from -0.75D to -5.75D in 0.50D steps. There are also 36 axis options, as the lens goes from 5 degrees to 180 degrees in 5-degree steps. In total, there are 32,796 unique prescriptions possible with Biofinity Toric XR. CooperVision has always been phenomenal in the toric space, and this parameter expansion enables more astigmatic patients to feel the difference with Biofinity Toric XR.

*MyDay Toric: CooperVision recognizes that astigmatic patients need a premium toric lens in a 1-day modality. This is exactly what MyDay Toric is. There is a plethora of reasons to fit this lens, but the 5x most important reasons are the following:

1. Proven Design: MyDay toric has the same proven optic design as the most prescribed toric lens on the market, Biofinity toric
2. Broad Range: MyDay toric now provides correction for nearly 80% of your astigmatic patients. 960+ new SKUs will be added in 2021, with a target of matching Biofinity toric’s SKU range in the near future.
3. Exceptional Vision Quality: MyDay toric provides predictable orientation, consistent visual acuity, and lens stability
4. Comfort: Patients gave MyDay toric an overall comfort rating of nearly 90 out of 100.
5. Legacy of Expertise: With a history of design expertise and innovative technology, significantly more Eye Care Professionals agree that CooperVision has the best overall toric lenses.

*MiSight: Myopia management is an area of focus that has been experiencing rapid growth and development. There are a few products on the market to aid in myopia management, but one product truly stands out. MiSight 1 day is the innovative contact lens that goes beyond vision correction. MiSight 1 day is the first and only contact lens FDA-approved to slow the progression of myopia in children age 8-12 at initiation of treatment. The MiSight 1 day lens is the cornerstone of the Brilliant Futures Myopia Management Program, a comprehensive myopia management approach offered by CooperVision. If you are not yet certified for MiSight, I highly encourage you to reach out to your CooperVision rep and begin the certification process as soon as possible. This lens and this program are industry gamechangers.

CooperVision thanks each one of you for the continued support. Have a successful second half of 2021!

---

---

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

July 8 2021
Speaker: Seema Nanda, OD
Topic: TBD

Webinar ID: 867 4182 2360 Passcode: 586979
The registration link for the Zoom meeting: https://us02web.zoom.us/webinar/register/WN_16QqocGeSMaE7_rVI9z1Wg

• See 2021 CE schedule

---

COA events

Other upcoming COA event dates:

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

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

---

Classifieds

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! (06/21).

Optometrist needed: Veterans Administration (VA) seeking several optometrists to administer evaluations to veterans. VA will train office and staff, offering $225 for a 30-45 minute evaluation. Over 100 veterans are currently on a waiting list. For further information http://bit.ly/VETERANEVALUATIONSERVICES

Practice for sale: Longtime established practice for sale in La Mesa–seller wishes to retire–Seller 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 at 619-743-1442 or email at drlevy@pacbell.net (06/21).

Optometrist needed Mondays and/or Thursdays for busy Independent Practice inside Mission Valley Costco.  If interested, please contact Dr. Slikker’s personal cell at 619.977.7703 or email at rslikker@san.rr.com (07/21).

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 mfoyleod@yahoo.com (07/21).

---

Volunteer Corner

Monarch School Screening

Contact Dr. Bob Meisel for more information at rmeisel47@gmail.com ; www.monarchschools.org

---

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

---

DONATE GLASSES
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 sdcos@sdcos.org

---

SDCOS Announcements

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