San Diego County Optometric Society
The San Diego View
Inside this Issue:
- President’s Message
- Retina Corner
- Eye See
- CE Corner
- Volunteer Corner
- SDCOS Announcements
By Simona Grosu
2022 California Optometric Association House of Delegates Report
The 2022 COA House of Delegates met for its annual meeting on February 10th and 12th. Although originally scheduled to take place in person in San Diego, in the end it was decided to be held virtually once again due to a rise in cases of the new COVID-19 variant, Omicron. Hopefully, this will be the last time when it will be held via Zoom.
First off, I would like to congratulate our own Dr. Amanda Dexter for becoming the next COA President! We thank her for the relentless efforts and support to our local society, and now at state level. Well done, Dr. Dexter! We’re looking forward to your leadership!
Here are the highlights of the meeting.
On Membership – the pandemic took a toll on our revenue in 2020. As you are aware, dues were waived for all members for 2 months in 2020. In addition, over 300 dues waivers were applied in 2020. The good news is that dues grew nearly 3% in 2021, meaning we are starting to bounce back, and approach pre-pandemic levels. One aspect that you might not be aware is that maturing membership base and retirements cause a decrease in membership revenues. On the flip side, the ascending scale allows more new graduates to be retained and lead to full dues-paying membership.
The COA is working hard in engaging the students and the young ODs. In 2021 a few virtual events were created for them (i.e., New Grads, Careers and Networking, Town Hall, ODs on Finance) where close to 100 participants were present at each event. COA offers support to the young ODs with dedicated staff and student relations team. Outreach is achieved in numerous ways through student hub, OD resource guide, free COA events, and a student community on the COA app. And if you were not aware yet, yes, there’s in app for COA available now in the app store! COA member community will provide engagement opportunities for societies, teams, and subcommunities!!
COA will also start some pilot programs this year to better understand the market, conduct an analysis on members and non-members, and learn how it can provide more tangible benefits to increase market share. Measuring the CA OD market, we will hope to answer some questions on what is the perception of COA in the marketplace, and what benefits do CA ODs value and want.
Stay tuned for this survey coming out Spring/Summer 2022. Please participate in it, as it will have an impact on how COA moves forward.
On Advocacy – some important legislation was passed in 2021. AB 407 extended the scope of practice by eliminating the restrictive list of “allowed” drugs and conditions, and also authorized treatment of anterior segment conditions and IPL. Another law, AB 1534, prohibits now corporations that contract with physicians’ groups from interfering in an optometrist’s professional judgement. Law AB 691 was passed as well authorizing ODs to administer COVID-19 vaccines and perform CLIA-waived COVID-19 testing. And finally, SB 509 allows optometry school graduates to temporarily practice under supervision if they are unable to take NBEO Part III because of COVID-19.
In 2022, the COA’s advocacy will continue with priorities in scope expansion, Medi-Cal reimbursement rate increase, PIA-lab choice under Medi-Cal, and military personnel fee waiver.
On Health Care Delivery System – COA maintained relationships with VSP, EyeMed, and IEHP; it developed new relationships with Versant and Envolve; addressed billing issues of COA members; conducted membership survey on medical optometry. The priorities in 2022 are to develop more relationships with health plans, and communicate the value of optometry integration.
On Children’s Vision – The mission of COA Children’s Vision Team is to ensure children receive regular comprehensive eye exams. A social media campaign is being promoted as it’s a quick and easy way to spread the word about the importance of children’s eye exams. COA has created social media images for you to share with your patients. COA is also creating a directory of COA member optometrists who provide vision care to children. We plan to make this list available to parents and other health care providers. If you would like to be included, please complete the questionnaire on the COA website. And let’s not forget about the InfantSee program by Optometry Cares – The AOA Foundation. It is designed to ensure that eye and vision care becomes an integral part of infant wellness care to improve a child’s quality of life. Consider joining this program as well.
The priorities for 2022 are to create a children’s vision directory, and the launch of “Little Eye Pods” podcast. Stay tuned!
On Public Vision League – in 2021 COA reviewed the health plan contracts for legal compliance; intervened in litigation to ensure ODs can choose a fair and neutral arbitrator in disputes with health care plans; answered over 300 legal questions from COA members.
2022 priorities are looking for opportunities to advance and protect optometry through litigation.
On California Vision Foundation – COA continued the partnership with helping Healing California organization by providing optometry and staff volunteers at free clinics across the country. If you’re not aware already, Healing California is a non-profit organization that provides free, quality dental, medical, and vision care to those in need in California. For vision services, they set up complete vision exam stations and a lens lab where volunteer optometrists, ophthalmologists, opticians, and lab techs provide full exams and fabricate custom prescription eyeglasses on-site. Please consider volunteer.
On a last note, the COA finance team together with the COA board of trustees made the decision to sell the COA office building – 2415 K St, Sacramento. The team found that the income projections for leasing the building against the costs to maintain and service the building were not substantial enough to warrant keeping the building as an asset. The team recommended the board to consider creating a task force to oversee the sale of the building, including financial options, and the appropriate allocation of the proceeds from the sale.
The next COA event will be Legislative Day on June 13 – 21 as a virtual program. I encourage as many of you to participate as possible as there are many optometric issues of the day to be discussed with our elected legislators. COA will teach us about the issues in the morning, supplying us with talking points regarding bills that could potentially threaten our profession, as well as bills that would allow us increased freedom of practice. Being virtual, it will be even easier to participate. Please let me know if you are interested!
Thank you for reading the newsletter. Please don’t hesitate to contact me with any questions!
What happens to an intraocular gas bubble at 36,000 feet?
By Michael J. Ammar, MD
Retina Consultants San Diego
You’re going to put a bubble in my eye? A common point of confusion in the discussion of many retinal surgeries. Understandably so, as the concept of putting an absorbable gas bubble in the eye is confusing. What is it made of? What does it do? Where does it go? There are many questions that come to mind. When it was initially described, gas tamponade revolutionized vitreoretinal surgery and still today remains one of our most important tools. However, gas bubbles are not without risk. In fact, they can be quite dangerous and have led to permanent vision loss in otherwise healthy eyes. The reason is something called Boyle’s Law.
When discussing gas agents there are a few critical points to touch on. Patients cannot undergo any significant changes in altitude, no flying, no scuba diving, and no nitrous oxide anesthesia. Additionally, the importance of wearing a gas alert bracelet. This is because of Boyle’s law, which states that at a constant temperature, a given volume of gas is inversely proportional to its pressure. Therefore, as external pressure decreases, the size of a bubble increases. The same concept applies to higher external pressures. Gas bubbles will decrease in size at higher external pressures. This becomes much more relevant when applied to real-life scenarios. For example, at higher elevations there is lower atmospheric pressure and therefore expansion of intraocular gas. This can become dangerous if the expansion is enough to raise intraocular pressure. So how much elevation is too much?
Sea level in San Diego is 62 feet. A commercial jetliner such as a Boeing 737 has a cruising altitude of around 36,000 feet but the cabin is pressurized to be the equivalent of 8000 feet. When a gas bubble is in the eye, intraocular pressure increases roughly 10mmHg per 1000 feet. A plane can reach this altitude in as little as 5-10 minutes from take-off resulting in up to 80mmHg or more increase in intraocular pressure! That is enough to cause complete occlusion of the central retinal artery and lead to no light perception vision if not rapidly corrected. Though rare, there have been several published cases where this has happened. Patients developed sudden and severe pain and loss of vision which unfortunately did not improve.
A more common situation is traveling to higher altitudes by car with a gas bubble. This can sometimes be accomplished safely depending on the patient and a few factors. In general, the smaller the gas bubble the less dangerous travel will be. Depending on the size of the bubble, changes of up to 2000-3000 feet can be well tolerated by a healthy eye (assuming no other issues such as glaucoma). Taking breaks along the way allows the bubble to expand more slowly which gives the eye more time to adjust to the change in intraocular pressure. The expansion of smaller gas bubbles, in particular those 10% or less in size, is typically well tolerated. If just passing through an area such as a mountainous region, the IOP will decrease as altitude decreases. A uncommon situation is the use of nitrous oxide in the post-op period. Nitrous oxide anesthesia can lead to a very rapid increase in bubble size and intraocular pressure and should be avoided in patients with gas. This must be communicated to the anesthesia team before any procedure while a gas bubble is in the eye.
Lower altitudes can also be dangerous. With lower elevation, bubble size decreases as does intraocular pressure. If done rapidly, the eye can develop hypotony. This can lead to a number of intraocular complications such as choroidals, hemorrhage and/or vision loss.
I hope you enjoyed a little bit of chemistry and this month’s edition of Retina Corner! 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,
Michael Ammar, MD
Retina Consultants San Diego
written by Dr. Byron Y. Newman
HARRY POTTER AND THE DISAPPEARING OPTOMETRIST
Even those of you who have not had the pleasure of reading the very popular Harry Potter series of books, or have watched one of the movies, know that Harry Potter wears glasses. There are references to them through out the books, and noticeable in the movies of all the characters wearing glasses.
But nowhere does it say where he got them or how often he gets them checked and if so, by whom?
In one chapter, one “wizard in training” at Hogwarts broke his glasses and repaired them himself using his magic wand.
Sometimes, that’s what we really need. It would have been a great thing If J.K.Rowling, the author of the series, would have mentioned where he got his eyes examined in England and how often.
Harry’s glasses have created a stir in the U.S. with many young people asking for Harry Potter frames for their glasses. I think one or more frame manufacturer have developed a line of Harry Potter frames to fill the need. They’re also called John Lennon glasses.
Maybe Warner Brothers, which is doing a great job coming out with Harry Potter paraphernalia and sold in stores all over the country and may even sell frames. They could even include in the purchase a magic wand for repairs.
You can get Harry Potter eyeglass cases, and even those can be found on Amazon.
Check out Dr. Newman’s website, www.thehumorfactory.com!!!
We are committed to helping you fulfill your CE requirements through our local virtual meetings with the support of our sponsors!
2-hour CE Thursday, April 21, 2022
Stay tuned for location details, we may be in-person!
Speaker: Dr. Melissa Barnett
Topic: Breaking News! Presbyopia Updates and The Art and Science of Dry Eye and Contact Lens Wear
SDCOS Members: FREE
COA/AOA Members: FREE
Sponsors: FREE Non-Members: $50
OPTOMETRY PRACTICE FOR SALE: Coastal San Diego County This modern practice has been established for just over 5 years and is located in an affluent area of coastal San Diego County. Situated on a busy main street in town in a mixed-use commercial/residential building on the ground level with high visibility, the practice is beautifully designed and truly turnkey. Purchase includes 2 exam rooms, pre-test area, spacious dispensary, lab, frame inventory, and EMR. Revenue in 2021 was almost $400K on part-time doctor hours. Plenty of room for growth/expansion. Seller is motivated and willing to assist in the transition. Please contact Allison Robles at Practice Concepts at 714-797-1605 or email email@example.com for more info. (ID#76720) (03/22).
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 (03/22).
PRACTICE FOR SALE: Owner retiring from North County practice of 34 years. Remodeled office located in a professional building near Tri-City Hospital. Perfect opportunity to own your own optometric practice or have that second office location. Priced to sell! Contact Dr. Sherman at email@example.com or cell 760-208-3456. (03/22).
Equipment: One set of front surface folding mirrors for a 10-foot room. Wall mount bar with Reliance arm to hold microscope, phoropter, or otherwise. Ancient AO Airpuff Tonometer for a museum? Best offer firstname.lastname@example.org (03/22).
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 email@example.com (03/22).
Optometrist Practice For Sale 2021 gross revenue of $505K with $158K net cash flow. The practice has modern equipment in 2 lanes, including an Optos Daytona, Topography w/Meibography, 1 Automated Lane, and iCare tonometry. The current gross is on 37 doctor hours during the week and no weekend hours. The office & optical has modern design aesthetics and is located in a growing area of Southwest Riverside County. The current doctor is looking to move out of state to be closer to family. Please contact firstname.lastname@example.org for more information. (03/22).
Optometrist Wanted for Equity Ownership in Practice. Growing Practice at the Heart of San Diego with a 25+ Year Veteran of the Optometry Profession, with a successful history of growing multiple practices, is seeking a motivated, self-starter, entrepreneurial optometrist to join a growing optometry practice in City Heights. Practice is in a custom modern office setting, with great visibility, with a proven track record of success for medical practices. Working knowledge of Spanish is preferred. Opportunity to get involved (even as a New Grad) in a growing eye care practice from the ground up, earning equity toward part or full ownership. Please email your resume to email@example.com (03/22).
Practice for sale at 50% of current market value (priced at less than the replacement cost of the equipment & inventory). Doctor is retiring from long-established practice in Solana Beach. High-end dispensary, up to 3 exam lanes, and finishing lab. Great location with a strong returning patient base. Doctor is willing to stay part-time for patient retention. Strong gross and net on part-time hours with lots of room for expansion. Contact Michael Foyle at 858 353 0600, or email at firstname.lastname@example.org (03/22).
Optometrist needed Saturdays inside the Mission Valley Costco. Hours are 9:30 am to 5:00 pm with a 1-hour lunch. The base pay is $450. Please email resume to email@example.com (03/22)
Please contact Dr. Dave Sherman, Society Optometrist Relations Liaison at firstname.lastname@example.org or 760-208-3456 to be put on an official list for the following:
- fill-in/part-time work
- full-time work
- purchase/partner in/sell a practice
This service is offered free of charge to SDCOS members.
Monarch School Screening
Contact Dr. Bob Meisel for more information at email@example.com ; www.monarchschools.org
Please contact Dr. Meisel at firstname.lastname@example.org if interested in volunteering for the exams on the 15th and 16th of March or for the next vision screening in the fall semester.
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 2022 CE schedule!
- Click here for COA membership benefits!
Welcome, new members!!
- Justine Bailey
- Nathan Lee
- Emily Tam
- Keith Wan
Please update your information on www.eyehelp.org
Phone: 619 663 8439
Fax: 800 643 8301