San Diego County Optometric Society
The San Diego View
Inside this Issue:
- President’s Message
- Retina Corner
- Eye See
- The Best of Both Worlds
- What’s in a Name? What’s in a Label?
- CE Corner
- Volunteer Corner
- SDCOS Announcements
By Alexandra Scovill
August is children’s eye health and safety month! As a mother of a one-year-old, and knowing a baby at my church who was recently diagnosed with retinoblastoma, this one is dear to my heart. Most parents do not understand the significance of eye exams for their children. But as optometrists, we know how important they are. We know that some children who are struggling in school, are labeled with learning disabilities, or are called lazy actually may be having difficulties with their vision. Disorders such as amblyopia and strabismus can make it very difficult for children to succeed in school, and many go undetected. In infants, vision problems may lead to delayed developmental milestones like crawling and walking. A study found that 1 in 5 preschool children have a vision problem and 1 in 4 school aged children need to wear glasses. Here is a list of things we can remind parents to look out for:
- Squinting one eye
- Poor depth perception
- Constant eye rubbing
- Chronic tearing
- Extreme light sensitivity
- White pupillary reflex
The American Optometric Association recommends that every child have their first eye exam between 6 months and 1 year old. At this age, treatment for amblyopia or other vision disorders are easily treated. For this reason, the InfantSee program offers no-cost eye exams to children between 6 months and 1 year old, no matter the parents’ income. If your office is not equipped to see children, please refer your patients with children to InfantSee.org to find a doctor near them. It is also important to remind patients that a vision screening at school, or a visual acuity check at the pediatrician’s office is not a replacement for a comprehensive eye exam. Many screenings screen for refractive error, and not ocular health. As we know, babies should have a dilated exam, most importantly to check for retinoblastoma. As I mentioned above, a child at my church who is the same age as my daughter, was recently diagnosed with retinoblastoma at a routine eye exam. She, unfortunately, lost her eye, but we are hoping that the early diagnosis saved her life.
As optometrists, we have the ability to completely change a child’s life by giving them the gift of sight, giving them comfortable vision by treating binocular disorders, or even saving their life. Please help me in spreading the word about the importance of childrens’ eye health!
Cross My Heart and Hope to Die, Stick a Needle in My Eye
By Nikolas J.S. London, MD FACS
President and Director of Research, Retina Consultants San Diego
Chief of Ophthalmology, Scripps Memorial Hospital La Jolla
Cross my heart…. the ubiquitous childhood pledge with the threat of an eye injection as the ultimate consequence for lying. I guess that makes me the embodiment of evil. While my wife might not disagree with this, I sure hope that our patients aren’t miserable with the frequent eye injections some of them require in order to preserve their vision. We actually go to great lengths to minimize pain with intravitreal injections (IVI), and I thought it would be helpful to discuss this topic as we can absolutely use all of your help with this. This month I would like to discuss why injections can hurt, and how to mitigate this, both during the injection process as well as following the injection, as some patients can even have days of discomfort, which sounds like torture, and is very likely preventable.
While this might seem obvious, let’s first discuss why intravitreal injections might hurt. The main issues are 1) the needle, 2) the lid speculum, 3) the topical antiseptic (i.e. povidone iodine aka betadine), and 4) iatrogenic ocular surface disease from all of the above. If we tackle these one-by-one, we can minimize their impact and make the experience less uncomfortable. In fact, many of our patients (especially new patients and snowbirds who receive injections elsewhere) often happily remark that they can’t even believe we did the injection. The needle is the most obvious point, and perhaps the easiest to minimize. To start, with #1, the needle, we are very careful about our topical and local anesthesia, using what I call “layers” of numbing – we apply topical tetracaine, followed by a cotton pledget soaked in 4% lidocaine applied to the injection site, followed by either subconjunctival lidocaine or several minutes of topical Tetravisc. We then give the anesthesia 5-10 minutes to take effect before performing the IVI. For the injection itself, we nearly always use very small 32-gauge needles. For #2, the lid speculum, this is easy. At least for myself I simply do not use one. I gently retract the upper lid with my finger with no issues. Problem solved. For #3 and #4, these really go together and this is where we can use your help. Unfortunately, betadine is the most commonly-used topical antiseptic to prophylax against endophthalmitis, but it can sting like hell. While IVIs used to involve copious use of betadine, we now use only a drop or two on the injection site. Even with this, about 20% patients can occasionally have lingering burning and discomfort. This mostly affects our patients with pre-existing ocular surface disease, including rosacea and dry eye syndrome. We can and do treat it with topical NSAIDs and occasionally corticosteroids, the best treatment is prevention and I frequently try to educate my patients on optimizing their ocular surface. This is where you all come in – while I am decent at Retina, I am not a great dry eye doctor. The extent of my advice is usually aggressive lubrication prior to the injections, but I nearly always encourage them to see their optometrist.
So, we can use your help. I am sure you all have patients receiving IVIs and if you do, please ask them about pain with the injections. If they have it, please let them know that it is mostly preventable and that the best thing is to probably work with you to develop a comprehensive plan for treating ocular surface disease. If anyone is interested, I would love to work together to develop guidelines for our patients, and maybe even study their effect. Maybe something similar to the DEWS stepladder algorithm for dry eye management. Might be a nice presentation or publication!
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
EDUCATE THE PUBLIC
Norbert Kastner, OD, FAAO, on assuming the editorship of the New Jersey Journal of optometry some years ago, pointed out the need to educate the public and legislators more than ever.
“We must shout out messages loud and clear, “ he said.’ Then he summed it up in one sentence.
“”The public must be made to realize that a discounted pair of glasses is not a solution to their vision problems.”
CELEBRITIES WEARING GLASSES
Benny Goodman, Orchestra leader known as the King of Swing was asked the question, “Is it a drawback to wear glasses in show business or sports?”
In a current magazine at the time, he answered, “Definitely not. I’ve worn them for years and believe they helped my career. They made me look distinguished and important Plus, there are many celebrities who wear spectacles in entertainment. There’s Lionel Hampton, Ella Fitzgerald, John Denver, John Lennon, Steve Allen and Elton John. In sports there’s Arnold Palmer, Hale Irwin, Billie Jean King and Reggie Jackson, just to name a few. Even though contact lenses are available, wearing glasses is part of a popular lifestyle.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
The Best of Both Worlds
By Rasa Tamulavichus, OD
Rasa Tamulavichus, OD, co-owner of a 13-location practice in Chicago, talks about her favorite aspect of private practice optometry, her love of cold-starts, and her thoughts on the future of optometry.
What’s in a Name? What’s in a Label?
By Cindy Belliveau, BSME, MSME, Visionary
The question is the same since a name is simply a label used to identify a person. And what is in a name… or label? Just ask Romeo or Juliet. Their names lead to their demise. Most of us don’t have such tragic outcomes when we have mishaps with labels. Like my aging mother who used bug spray when she thought it was hair spray? While not tragic it is an example of the importance of good labeling.
What does good labeling mean for contact lenses? A contact lens won’t answer when you call it by name. And putting a sticker on a lens kinda interferes with the function of the lens. Kidding aside. It is especially challenging to keep from mixing up contact lenses since one contact lens looks pretty much like another. The FDA recognizes the importance of labeling and has an entire section dedicated to labeling (CFR Title 21 Subpart K – Labeling and Packaging Control). Therefore, it is entirely the responsibility of the manufacturing facility to incorporate processes to keep from mixing contact lenses.
Fortunately, labeling technology has advanced through the years. The first label reportedly appeared around the year 1700 and was used to label small medical containers. By the 1800’s every respectable winery used printed labels to promote their product. The technological advancements of the 21st century brags quick response (QR) codes, near-field communication (NFC) tags and many other types of smart labels. But again, what does the new technology mean for contact lenses?
Contact lens labeling has evolved along with other industries. The FDA requires material lot number and unique device identification (UDI) tracking for all lenses. Manufacturers have responded with physical package labeling that include these with much more information. However, the package label still does not help us differentiate lenses when they are not in the package. Enter the role of the contact lens laser etcher.
The laser etcher is part of the lathing machine and uses a low intensity laser to etch markings, words or images into the front surface peripheral edge of the contact lens. The marks do not interfere with vision and provide a reliable means for identifying a unique lens. Examples of markings include the following:
- Patient Name or Practice Name for customization
- Diagnostic lens markings used for fitting
- Invoice Number for in-office tracking
- Manufactured date to remind a patient when to consider lens refresh
- R and L to distinguish two lenses
- Fitting set lens labels to keep the set in order
The ultimate goal of laser etching a lens is to help us keep from mixing them. However, it is also a cool tool that can help with lens identification, tracking and diagnostics.
We are committed to helping you fulfill your CE requirements through our local virtual meetings with the support of our sponsors!
Other upcoming COA event dates:
- September 20th
- October 18th
Check out the COA website for more info: www.coavision.org
Practice for Sale: This well-established practice is located in North San Diego County in a new retail building. Steady annual gross revenue with strong net profit. The current owner focuses on medical eye services and general optometry. Revamp the optical dispensary, increase marketing and watch this practice reach new heights! All ophthalmic equipment, transition assistance are included in the sale. Long-term lease, 1500 square ft., large optical space, 2 exam lanes, 1 pretest room, 1 contact lens room, 1 waiting room, 1 dispensing room, 1 Dr.’s office, & 1 storage room. For further inquiries Contact John David email@example.com (08/21).
Exceptional Eye Care San Diego, CA At OUR OPTOMETRY OFFICE, we are a diverse staff with unique specializations. We are looking for a caring & qualified optometrist to join our team. OD & CA optometry license required. We are looking for an OD with EXCELLENT communication skills. We are offering competitive salaries, modern medical equipment in a private practice setting. Please send current resume and availability to Valerie Vasquez by email at firstname.lastname@example.org (09/21).
Full-time Optometrist: Multi-location private practice is hiring a full-time Optometrist. Highly trained staff provide full work-up, latest digital technology, friendly team culture, benefits, competitive pay. Send resume to MichelleKingOD@gmail.com (09/21).
FT Optometry position; opening in North County, San Diego. The candidate should know about Cataract/Refractive surgery pre and post-operative care. The candidate should be familiar with all refractive surgery modalities and premium IOL’s. Optometric residency in refractive, medical, or primary care is preferred but not required. Requires CA license and TPA certification. Salary based upon experience. Please email CV to email@example.com (08/21).
Practice for sale: Long-time 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 firstname.lastname@example.org (08/21).
PT Optometrist: Optometrist needed for premier growing refractive eye center located in San Diego. The most important qualifications are a good personality to exceed patient expectations and exhibit a willingness to learn. This opportunity is a fast-based environment at a beautiful office and convenient location. Please email a cover letter with resume to Dr. Schiff at email@example.com (08/21).
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 (08/21).
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 firstname.lastname@example.org (08/21).
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.
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 email@example.com
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!!
- Zachary Cruz
- Vady Khalil
- Amanda Thai
- Eng Ann Sung
- Lani Centeno
- Phoebe Chen
- Stephen Choy
- Cynthia Huang
Please update your information on www.eyehelp.org
Phone: 619 663 8439
Fax: 800 643 8301