The San Diego View

Inside this Issue:

• President’s Message
• Retina Corner
• Eye See
• Ocular Surface Disease: A Cutting-Edge Treatment Modality
• Dr. Julio Echegoyen’s Light Adjustable Lens RLE Story
• CE Corner
• Classifieds
• Volunteer Corner
• SDCOS Announcements

President’s Message September 2021

By Alexandra Scovill

The San Diego County Optometric Society is one of the largest societies in the state of California. Our vision is to be “America’s finest optometric society”. To achieve this we work hard to protect and advance the political interests of optometrists, both locally and at the state level. This past year has been particularly successful in this regard. This success helps to further the profession of optometry and better serve our patients. Another way we work to be the finest society is by providing world class speakers for the continuing education for our members. Finally, we also serve our community by volunteering at the Lion’s Optometric Vision Clinic, Veteran Stand Down, and the Richard Rex Memorial Fund. Although COVID has made it a bit more difficult to have some of these events, our board members are working hard to make sure the citizens of San Diego get the care they need.

The only way we are able to achieve these efforts is by the support of our wonderful sponsors! Our sponsors not only provide financial support, but also extend discounts to members for using their products and provide resources to help with building practices and optometric careers. Additionally, sponsorship helps fund our public awareness projects and advocacy efforts, as well as our website, social media, and other SDCOS social events.

We usually have a vendor appreciation dinner every fall to thank our sponsors. Like everything else this year, we will be thanking our sponsors a little differently. We will be inviting them to our holiday party, tentatively scheduled for December 18th, 2021. As a member, I encourage you to show how much you appreciate the support of our sponsors. Take time to sit down with them at the holiday party, get to know them, and hear their ideas of how they can help you and our Society in the upcoming year.  It is important to support the sponsors who are so passionate about supporting our society and profession!

Finally, I would like to recognize and give a warm Thank You to each of our current sponsors who have stuck with us during the pandemic. First, our platinum sponsors are Science Based Health, American Eye Associates, Essilor, NVISION Eye Centers, VSP Global, and EyeCarePro. Our sustaining sponsors are Alcon, Bausch and Lomb, Cooper Vision, Gordon Schanzlin New Vision Institute and TLC Laser Eye Centers, Healthy Eyes Advantage, La Jolla LASIK Institute, Optovue, Shamir, Sun Ophthalmics, Visionary, Wells Fargo, and WestPac Wealth Partners.

SDCOS remains a strong and successful society because of them. I will work hard to make sure the relationship with our sponsors continues to improve and I hope you will do the same! They are here to help not only our society, but they also want to see your finances flourish, your practices thrive, and your patients see better! Thank you SDCOS sponsors!

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Retina Corner Retina Consultants San Diego

By Michael J. Ammar, MD and Nikolas J.S. London, MD FACS

Dear SDCOS,

It is with great pleasure that I introduce you to an amazing new retina surgeon in town and our new associate, Dr. Michael Ammar. We are thrilled to have him join us, and I encourage you to check out his bio on our website to learn more about him. He can be reached anytime on his cell at 480-323-9196 and I am sure he would love to hear from people so he can get to know our wonderful community. Dr. Ammar has kindly agreed to write this month’s Retina Corner, and chose something very near and dear to my heart, some of the recent and ongoing clinical trials in our field that are likely to bring revolutionary new treatment options to our patients. Your patients may ask you about these as we are still enrolling in several, so this excellent summary should empower you to discuss them. Of course, you can always reach out to us for more detail. That’s enough from me, on to Dr. Ammar! Take care everyone.

Hi everyone, thank you Dr. London for the overly kind introduction and hello to all of our readers! I am talking about clinical trials today because like many others I am excited about the potential therapies around the corner that may soon revolutionize the landscape for the management of eye disease. Today were talking specifically about diabetic retinopathy. Patients with these conditions are often young, of working age, and require close follow up. These factors make the burden of their disease and monitoring/treatment extremely challenging. In this article, we outline ongoing phase 2 and 3 clinical trials that may forever change how we approach diabetic retinopathy (DR) and diabetic macular edema (DME).

High Dose Aflibercept

The PHOTON study (NCT04429503) is a phase 2/3 clinical trials comparing the safety and efficacy of high dose (8mg) aflibercept with the current FDA approved standard dose (2mg) of aflibercept. This study is comparing high dose aflibercept every 12-16 weeks to regular dose every 8 weeks. The hope is that this higher dose injection may be longer lasting and result in fewer visits for our patients.

Faricimab

YOSEMITE (NCT03622580) and RHINE (NCT03622593) are two identical phase 3 clinical trials assessing the safety and efficacy of faricimab, a new treatment targeting a different pathway than traditional intravitreal injections. These trials are comparing faricimab intravitreal injections every 8-16 weeks to aflibercept every 4-16 weeks. This is the first medication to target the Ang-2 pathway, which is thought to play a major role in diabetic retinopathy. By targeting multiple pathways this medication could result in more effective and longer lasting intravitreal injections. Again, this would be wonderful for patients as it would decrease the treatment burden of our patients by requiring fewer visits and injections.

Brolucizumab

KINGFISHER (NCT03917472), KITE (NCT03481660), and KESTREL (NCT03481634) are all phase 3 clinical trials evaluating brolucizumab. Brolucizumab targets similar pathways to traditional intravitreal injections such as bevacizumab, aflibercept, and ranibizumab but is a much smaller molecule. This smaller size allows for a much higher concentration of drug delivered per treatment. While age-related macular degeneration (AMD) studies have proven the efficacy of brolucizumab, it has yet to be widely adopted by retina specialists due to the risk of occlusive vasculitis. Nonetheless brolucizumab remains FDA approved for AMD and has shown tremendous benefit for many patients sometimes being the only injection that works for them. Therefore, in the right clinical scenarios, it is still utilized by many in the ophthalmic community.

Port Delivery System (PDS)

PAGODA (NCT04108156) and PAVILION (NCT04503551) are phase 3 clinical trials investigating a drug familiar to us, ranibizumab, delivered in a new novel way. The PDS is a surgical implanted depot system that delivers ranibizumab slowly over the course of months. It can be accessed in the subconjunctival space to refill the depot system with fine gauge needles. This depot can hold a large volume of ranibizumab that is released slowly until a refill is needed. These clinical trials are assessing whether passive diffusion of anti-VEGF from the PDS can decrease the frequency of intravitreal injections. Preliminary results have been extremely exciting in that 98% of patients are stable on refills every 6 months. These refills can be done safely and quickly in office. This has the potential to dramatic decrease the treatment burden on patients.

RGX-314 Gene Therapy

ALTITUDE (NCT04567550) is a phase 2 clinical trial investigating a viral vector that encodes a gene which produces a molecule similar to traditional ranibizumab. The viral vector is delivered into the suprachoroidal space where it infects local tissues which then produce the drug continuously. This creative and science-fiction-like approach to management has the potential to completely eliminate the need for injections as patients would essentially make their own medication in their eyes around the clock!

ADVM-022 Gene Therapy

INFINITY (NCT04418427) is a phase 2 clinical trial also investigating a viral vector that encodes a gene which produces aflibercept. Unlike the RGX-314 gene therapy, ADVM-022 is delivered intravitreally. There are many benefits to this delivery system which avoids the suprachoroidal space and can be delivered quickly and easily in office. However, there are concerns about possible inflammation.

CONCLUSION

Diabetic retinopathy may be on the verge of a therapeutic breakthrough not seen since the approval of ranibizumab in 2006. New medications, novel targets, and innovative delivery systems are all demonstrating promising results. If these treatments can produce safe and efficacious results with fewer treatments and longer intervals, they may very well revolutionize how we approach diabetic eye disease and potentially many other eye conditions!

That’s all for this month’s edition of Retina Corner.  I am excited and privileged to be joining your community and am greatly looking forward to getting to know and work with you all more closely. If you have any questions or if there is ever anything I can help with, please feel free to contact me at any time.

Best wishes, and until next time,

Mike
Michael Ammar, MD
Retina Consultants San Diego
480-323-9196 (cell)
ammar@rcsd.com

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Eye See written by Dr. Byron Y. Newman I’M FURIOUS

It seems to me that the dispensing opticians have it all backwards. I’m not sure who changed the law to permit free eye exams with purchase of glasses, but it’s wrong.

The way the advertising should be is NOT a free eye exam with the purchase of glasses, but free glasses after the purchase of a complete and up to date eye examination. After all, it takes a lot of work to be licensed as a doctor of optometry, and to give away that service after buying cheap glasses is a miscarriage.

I’m not sure if you remember my tale of the man who came into my office, placed his monogrammed brief case on my desk, and said, “I’m going to make you a very rich man.”

I was intrigued, as anyone might be, and said, “Tell me more.”

“Well,” he said, “I represent 50,000 union members, and I’m going to send them all to you. You offer them a free eye examination and write out the Rx for you to sell them glasses if they need them.”

I told him he had it backwards. How about if I charge them for my eye exam and give them the glasses, if they need them, free. My license came at years of work, and to give that away free rubs me against the grain.

He picked up his monogrammed brief case and left.

Frankly, I’m mad, and I think a free eye exam should still be against the law. If I was still in practice, I would fight to have the law changed back to the way it was, outlawing free eye examinations.

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

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Ocular Surface Disease: A Cutting-Edge Treatment Modality

By Paul Karpecki, OD, FAAO

Finally, Feeling Better About Ocular Surface Disease Clinic Days

For years, I dreaded Ocular Surface Disease (OSD) clinic days.  In over 20 years of practice, it’s only in recent decade where I looked forward to my OSD clinic days.  So much has changed over the years in diagnostics and treatments that I finally feel like “this is a lot of fun”.  And it’s not just me – patients are happy, and they’re telling friends.

Why OSD?

OSD is multifactorial and variable, and it feeds into almost everything that we do as clinicians. People want to be free of eye irritation, and they want to see really well. Whether it’s trying to minimize contact lens dropout, co-managing for cataract surgery, or helping that patient with MGD – all of these relate strongly to ocular surface health.

Innovative Technology that Makes it Easier

Along the way, I’ve learned a great deal from my peers as well as personal clinical observation. I’ve also been helped tremendously by new research, new diagnostics and simply learning to differentiate dry eye from other conditions that can sometimes resemble dry eye – such as asthenopia or conjunctivochalasis.

But without innovative treatments, my OSD clinic days would not be so enjoyable. In particular, I want to focus on one treatment that’s become a mainstay of my OSD clinic today.  Despite each case demanding its own approach, one treatment in particular has been especially versatile in my own clinic. Surprisingly it turned out to be a nutritional supplement.

GLA – the OSD omega

In reviewing the literature, I was surprised to see so much clinical research on an omega called gamma linolenic acid (GLA) for various forms of dry eye.  Studies include: post-PRK, contact lens, Sjogren’s, MGD and more. GLA, not found in fish, flax or in appreciable amounts in the diet, is actually the precursor for a prostaglandin called PGE1, that plays a crucial role in tear production.

HydroEye – a Cutting Edge, Research-Based Supplement

The research in this area really mirrored what I was finding in my own clinic. For several years I had been finding a surprising degree of success with HydroEye – a unique oral nutritional supplement incorporating GLA, along with specific levels of EPA and nutrient cofactors. I had tried fish oil, and just about every other nutritional formula on the market, but nothing seemed to work as well.

Clinical Research that Explains my Experience

When an especially impressive clinical study was published in Cornea (2013) it began to explain what I had been noticing with my own patients. The study looked at a group of post-menopausal women – finding that HydroEye significantly improved symptoms, suppressed key markers of inflammation, and maintained corneal smoothness.

Making it easier

If I were stuck on a desert island with just a handful of dry eye treatments – and a lot of dry eye patients – HydroEye would clearly be one of those that came along. My OSD patients can attest to this – this product has made a tremendous difference in their lives.

Dr. Karpecki can be contacted at karpecki@karpecki.com.

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Dr. Julio Echegoyen’s Light Adjustable Lens RLE Story

By Cindy Belliveau, BSME, MSME, Visionary

As a board-certified ophthalmologist and refractive surgeon at Gordon Schanzlin New Vision Institute, Dr. Julio Echegoyen is an expert in vision correction. However, being a eye patient for the first time gave him a new perspective. Dr. Echegoyen had refractive lens exchange (RLE) performed by Dr. Alison Gordon. RLE corrects vision by replacing the eye’s natural lens with an intraocular lens implant (IOL) and Dr. Echegoyen chose the new Light Adjustable Lens™ from RxSight®.

Born in El Salvador, Dr Echegoyen came to the U.S. as a child to escape the ongoing civil war. While the rest of his family moved back, he was determined to pursue the American dream. He worked as an EMT before pursuing medicine at the University of California, Irvine. He found his calling in ophthalmology, which allows him to change people’s lives for the better by improving vision and restoring sight.

As a hyperope, Dr. Echegoyen would have loved to get LASIK years ago, unfortunately, he was not a candidate. He could not tolerate contacts and had become used to wearing glasses, but life as a glasses-wearer became much more frustrating when the COVID-19 pandemic started. Dr. Echegoyen needed to add tape to his mask in order to prevent his glasses from fogging up and the tape irritated his skin. He had been waiting until he was a candidate for RLE, which in most people is sometime after 40.

When it came time to choose an IOL for his RLE surgery, Dr. Echegoyen had a unique advantage since he has experience counseling patients on their IOL options. Dr. Echegoyen took into account the experiences of his patients as well as the advice of his colleagues. He knew that he needed a lens that would provide him with high-definition vision so he could perform surgeries without the need for glasses. He chose the light adjustable lens (LAL) because it could deliver great vision without loss of contrast or side effects like glare or halos.

A major benefit of the light adjustable lens is that it is the only IOL in which the prescription can be changed after it is placed. In the weeks after surgery, the patient has several painless UV light treatments to adjust the prescription.

Dr. Echegoyen is very happy with his results. After a life of wearing glasses from morning to night, he now has improved near and far vision and almost never needs them. As a surgeon who also enjoys outdoor activities, he is enjoying the freedom of clear vision. He is most excited to wake up and see the alarm clock in the morning without having to put glasses on.

Gordon Schanzlin New Vision Institute is at the forefront of vision correction technology and was the first vision correction practice in San Diego to offer the light adjustable lens. Our team of experienced surgeons are leaders in their field. Contact us today to learn more about the light adjustable lens or other vision correction options in San Diego.

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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:

• September 20th
• October 18th

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

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Classifieds

CLASSIFIED ADVERTISEMENTS

Turnkey practice is available in Murrieta, California. The last 12 months gross is $480K with a net of $165K. It has modern equipment including a digital exam lane, iCare Tonometer, and Optos Daytona. The optical is bright and modern with around 600 frames. The current gross is on 37 doctor hours during the week and no weekend hours at this time. Located near the vineyards, this area has some of the most affordable housing costs in Southern California with fantastic schools and is less than an hour from the beach and mountains. Asking for $225K OBO, plus inventory.  Willing to negotiate for a quick sale! Contact murrietaoptometryforsale@gmail.com for more info. (09/21).

Part-time optometrist needed for optometry office in Chula Vista.   The doctor will be working with excellent support staff who provide full work-up. Come and join our great team!  Please email CV or questions to emascareno@yahoo.com or call  Dr. Mascareno at 619-254-0115 (10/21).

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 a current resume and availability to Valerie Vasquez by email at valvasquez282@gmail.com (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).

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 drlevy@pacbell.net (09/21).

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 americaneyeglasses@gmail.com (09/21).

Part-Time OD wanted: In search of an optometrist for 1-2 days a week as an employed OD of a Target Optical sublease. Extremely clean, organized, and high-tech office where we are laid back and have fun helping patients with full-scope optometry needs. Ideal candidates would be friendly, outgoing, business-minded, and available starting mid/late September. Competitive daily rate and other bonuses available. Email drkellykeane@gmail.com if interested. (10/21).

Maternity leave coverage from January to March. Full time, Monday-Friday, 8-5 with a 1-hour lunch break. The position is in the optical department of Castillejos Eye Institute in Chula Vista. Please contact Olga Ramirez, at castillejoseyeinstitute@hotmail.com (10/21)

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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.

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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

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!

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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