August 2024

Happenings of the Society

The San Diego sun is definitely upon us and it is wonderful summer.   On Thursday July 18th Dr Kellie Satterfield spoke on lumps, bumps and lesions.  She did an amazing job...Thank you Dr. Satterfield.  On Sunday August 11 is out 5-hour CE we have Dr Paul Karpecki speaking on innovations in Pharmaceuticals and what’s new on ocular surface disease.  Dr. Angelique Pillar will be speaking the last hour on Glaucoma.  They are both first class speakers.  You do not want to miss this.  On Thursday September 19th we will be having Dr. Amar and Dr. Melvani speak.  We are also changing the location to Sorrento Valley.  We are going to have the meeting at the West Pac office.  This is super easy to get to and more convenient for our North County members. More information on this soon.  The last CE of the year will be in November with Dr. Doran Spencer.  Again, thank you to our board and especially Dr. Sloan Rajadhyksha for all her hard work securing these top speakers throughout the year.

The Linda Vista Innovative Center is going strong.  This is Dr Bev Bianes’ project.  If you have not gone over there to check it out you need too.  It is amazing and makes you proud to be a member of such a strong society.  Remember Diversity is our Strength!

Another major project we have going is the South Bay school screenings starting in August.  We have teamed up with the South Bay Lions Club, VSP, School Nurses, the Sweetwater Unified School District along with Board member, Marti Emerald to screen every school aged student in every school in the district.  Our goal is to do 2 schools a month.  There are 12 schools in the district.  This is a huge undertaking and we need your help.  More details will be upcoming but please contact me if you are interested in volunteering for a couple of hours to help change a child’s life by giving them the gift of sight.  A student can learn so much better when they can see what they are doing.  Please do your part.  The last project of SDCOS for the year is the Veteran Village of San Diego 2024 Stand Down on August 9-11.  We are working with the Lions Optometric Vision Clinic and Optos to do screenings to over 600 veterans.  This is a wonderful event to help our veterans.  We need your help.  Please consider helping.  Call Enrique at 619-298-5273 to put your name in.

These projects along with all the other things your SDCOS is doing is why we are who we are.  I am so proud to be a member and I am so glad each of you are too.  Have a great month and see you at the upcoming CE events.  Also do not forget to mark your calendars for the Annual SDCOS Holiday Party at Tom Hams Lighthouse on Sunday December 1st.  The location is fantastic.  We picked Sunday evening so no December Night traffic.  What a great way to start off the December craziness.  Stay tune for more information in coming months.

Have a great month everyone.  Take care and God Bless each of you

Eric
 

OD Relations Liaison

Please contact Dr. Ananya Jalsingh, OD, Society Optometrist Relations Liaison at odjobs@sdcos.org 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.

Upcoming CE Meeting

5 hour CE Sunday August 11
Hilton San Diego Mission Valley
Paul Karpecki: Innovations on pharmaceuticals (2Hr) and What's new in ocular surface disease (2Hr)
Angelique Pillar: Early Glaucoma Detection, and the role of lasers in glaucoma management (1Hr)

https://bit.ly/HiltonMissionValley

  • 2024 CE Schedule

  • 2024 SDCOS Board of Directors

Looking for Volunteers for these future events:

1) Lions Optometric Vision Clinic will be providing vision care at the VVSD 2024 Stand Down and is seeking eyecare professionals from SDCOS to volunteer at the event.

OPTOMETRISTS (4 per shift)
1. Friday August 9th          (8 am-12pm & 1-5 pm)
2. Saturday August 10th   (8 am-12pm & 1-5 pm)
3. Sunday August 11th      (8 am-12pm)


2) SDCOS Project of the Year: School Screenings at all 12 of the South Bay schools. School locations will be announced as we get closer (all located in South Bay) 
(8 am-12pm)

1. Monday August 19th
2. Wednesday September 4th
3. Monday September 16th
4. Wednesday October 16th
5. Monday October 28th
6. Monday November 4th
7. VSP Mobile Clinic will be there on Thursday and Friday November 14, 15
8. Monday December 9th
9. Wednesday January 22nd (2025)
10. Monday February 3rd (2025)
11. Wednesday February 19th (2025)
12.  Monday March 17th (2025)

3) Monarch school screening: 1 Dr needed for each day (or 2 for 2.5 hours each) to help at the VSP Mobile Clinic 

1. Tuesday November 12th
2. Wednesday November 13th
If you would like to volunteer or would like any additional information about these events, please contact Dr Bob Meisel at rmeisel47@gmail.com 

Retina Corner

Current Management of Symptomatic Vitreous Opacities

By Nikolas J.S. London, MD FACS
President, Retina Consultants San Diego

Dear SDCOS,

I hope everyone is enjoying the dog days of summer! Seems like a lot of stuff going on with the Olympics and political upheaval – what a change from two years ago! We at RCSD are also plugging along. Life is good as a retina surgeon and the four of us are doing our best to improve the lives of our amazing patients. Gene therapy for wet AMD, gene therapy for GA, exciting new molecules for AMD treatment, peeks at photobiomodulation for dry AMD. The present is fun, but the future looks even better. One of the ways we can improve the lives of many patients is a bit underappreciated and certainly underutilized: vitrectomy for symptomatic vitreous opacities (SVOs). The treatment effect is truly amazing and these patients sit high among my happiest. I’d like to take this chance to review what we know about treating SVOs.

While my personal experience is remarkable, it is important to be evidence-based. The evidence for treating symptomatic vitreous opacities (SVO) with pars plana vitrectomy (PPV) is primarily based on retrospective studies and case series, which I will do my best to summarize below.

Efficacy seems clear to me. No pun intended. Especially my pseudophakic patients like golfers there is frequently a “wow” effect.

  • Multiple studies report high patient satisfaction rates, ranging from 85% to 100%.

  • Schiff et al. reported complete resolution of symptoms in all six of their cases.

  • Delaney et al. found resolution of symptoms in 93.3% of 15 cases.

  • Schulz-Key et al. reported 88% satisfaction in 73 cases.

  • More recent studies by Sebag et al. and Mason et al. showed improvement in contrast sensitivity and visual function in 93-96% of cases.


Safety concerns are critical to consider, the number one being cataract progression though honestly not a significant concern for many patients given their age and the excellence of our community cataract surgeons.

  • Cataract formation: Incidence ranges from 22.5% to 60% in phakic eyes, depending on the study and follow-up period.

  • Retinal detachment: Incidence varies widely between studies, as low as 0% in some studies. I usually tell my patient the risk is around 1/1000. For some reason the risk appears to be slightly higher than with other vitrectomy indications.

  • Other complications: Cystoid macular edema (0.6-5.5%), epiretinal membrane formation (1.3-3.6%), and rare cases of endophthalmitis have been reported.


Quality of life impact:

  • Wagle et al. found that patients were willing to take a 7% risk of blindness to get rid of SVO, comparable to risks accepted for diabetic retinopathy and age-related macular degeneration treatments.

  • de Nie et al. reported that 65% of patients were bothered by floaters all the time, with significant impacts on reading, computer work, and night driving.
     

Newer techniques:

  • Small-gauge vitrectomy (25G and 27G) and "floaters-only vitrectomy" (FOV) show promising results with potentially fewer complications, but long-term data is limited. We are also seeing advancements in our surgical equipment, including extremely high vitrectomy cut rates up to 20k, which should lower the risk of vitreous traction leading to retinal tear formation.

  • Meticulous surgeon attention to PVD induction (and if performed at all), leaving a peripheral vitreous skirt (ie a non-aggressive approach), and very careful examination of the peripheral retina are critical to reduce safety concerns.

There are alternative treatment options for SVOs, but the efficacy is limited.

  • Nd:YAG laser vitreolysis has limited evidence of efficacy and safety, with mixed results reported in the few available studies. I tell patients that yag vitreolysis may lead to about a 40% improvement in symptoms with improved safety compared to vitrectomy. One big downside is the high out of pocket cost.

  • Supplements for SVOs is a very interesting approach, but I must admit a lack of knowledge here. Some studies I have seen are encouraging, but it is hard to imagine what the MOA is and if oral supplements really can impact vitreous collagen and other proteins. That said, I would never discourage a trial of supplements in an interested patient, especially with a backup plan for vitrectomy if needed.


In summary, if it is not obvious already, I greatly enjoy removing SVOs for patients. While most studies are retrospective and have limitations, it’s hard to argue with the big smile on the face of the patient in my chair. It will help to have more prospective studies to better evaluate treatment options and outcomes for SVOs. It is also important to carefully consider patient selection and informed consent, given that the procedure treats a non-blinding condition but carries potential risks. Included here is a SVO referral form that may help to identify potential candidates for this procedure.

Thanks so much for reading this month’s article! Please feel free to reach out anytime via text, email, or call. Always happy to chat about Retina or even just to say hello. As always, we are here to help as best we can.

Best wishes, and until next time,
Nik


Nikolas London, MD, FACS
Retina Consultants San Diego
415-341-5456 (cell)
london@rcsd.com
www.rcsd.com

How to Remove “i Can’t Retire” From Your Planning Mindset

This article provides three ways for business owners to more successfully plan for retirement, along with the consequences of taking these actions.

There’s a big difference between not wanting to retire and not being able to retire. Even business owners who intend to die at their desks can appreciate the safety net of financial independence should something unexpected occur. But many business owners look forward to an ideal future without implementing the proper planning to achieve it.

Today, we’ll discuss ways to mitigate the risk of not having enough money to retire on your terms.

Start by understanding the Asset Gap

A common mistake successful business owners make is assuming they have more than they need, while assuming they need less than they do. The difference between what you currently have and what you must have to achieve financial independence is called the Asset Gap.

Understanding your Asset Gap is critical to mitigating the likelihood that you won’t have enough money to retire. (And even if you intend to work until you die, knowing your Asset Gap is crucial to achieving other goals, such as providing generational wealth for family or leaving a lasting business legacy.)

There are several things you can do to begin determining your personal Asset Gap.

  • Obtain a professional business valuation

  • Accurately assess your net worth with help from your CPA

  • Discuss your vision of an ideal future with a trusted advisor


Obtaining a professional business valuation helps you understand what you need to do to reach a value that will one day allow you to retire with financial independence.

Accurately assessing your net worth can have two positive consequences. First, it gives you an idea of what you’re working with. Second, it can help you dispel misperceptions about what you want in retirement (more on this shortly).

Discussing your vision of an ideal future with a trusted advisor can help you map the steps you need to take to reach that ideal future. It can also show you if your ideal future is realistic, which can reduce the likelihood of taking an impossible path.

Be realistic about your wants and needs

Retirement is a dream for many business owners. But that dream can turn into a nightmare if you don’t know what it will take to fulfill your wants and needs.

For example, many business owners underestimate how long they’ll live. This underestimation can create a financial bind where they simply don’t have enough money to maintain the quality of life they’ve gotten used to. There are vanishingly few, if any, business owners who want to have to scrimp and save to survive their golden years.

Instead, it’s a good idea to determine some of the following facts:

  • How long you and your spouse/partner are likely to live after your retirement

  • How much money you must have to fulfill your needs in retirement

  • What you intend to do in retirement, and how much it will cost you


It’s a risky proposition to “figure it out as you go.” If you can figure these things out while you’re still in control of your business, you’re more likely to make decisions from a position of strength, rather than from a position of desperation.

Look before you leap

Retiring without financial independence is a huge gamble. However, understanding your Asset Gap, along with what you want and need from retirement, are two strong ways to work toward financial independence.

Nonetheless, pursuing retirement on your terms can be full of surprises.

For instance, you may want to transfer your business to a child, only to find out that the child was only still in the business to make you happy and has no intention of running it when you leave.

Likewise, you may decide you want to sell your business to a third party, only to find that while they will pay you enough for financial independence, they also plan to lay off 95% of your workforce when you leave.

Trying to anticipate these surprises by yourself is often a fool’s errand. After all, you’re still running a business that many people—including yourself, your family, and your employees—rely on. But with help from a dedicated Advisor Team, you can more deftly anticipate and plan for contingencies and surprises on your way to retiring on your terms . . . even if that means never retiring at all.

We strive to help business owners identify and prioritize their objectives with respect to their businesses, their employees, and their families. If you are ready to talk about your goals for the future and get insights into how you might achieve those goals, we’d be happy to sit down and talk with you. Please feel free to contact us at your convenience.

The information contained in this article is general in nature and is not legal, tax or financial advice. For information regarding your particular situation, contact an attorney or a tax or financial professional. The information in this newsletter is provided with the understanding that it does not render legal, accounting, tax or financial advice. In specific cases, clients should consult their legal, accounting, tax or financial professional. This article is not intended to give advice or to represent our firm as being qualified to give advice in all areas of professional services. Exit Planning is a discipline that typically requires the collaboration of multiple professional advisors. To the extent that our firm does not have the expertise required on a particular matter, we will always work closely with you to help you gain access to the resources and professional advice that you need.

This is an opt-in newsletter published by Business Enterprise Institute, Inc., and presented to you by our firm.  We appreciate your interest.

Any examples provided are hypothetical and for illustrative purposes only. Examples include fictitious names and do not represent any particular person or entity.

Nichole Mayer & Will Hage are Registered Representatives and Financial Advisors of Park Avenue Securities LLC (PAS). Securities products and advisory services offered through PAS, member FINRA, SIPC. Financial Representatives of The Guardian Life Insurance Company of America® (Guardian), New York, NY. PAS is a wholly owned subsidiary of Guardian. WestPac Wealth Partners LLC is not an affiliate or subsidiary of PAS or Guardian. Insurance products offered through WestPac Wealth Partners and Insurance Services, LLC, a DBA of WestPac Wealth Partners, LLC. | Mayer CA Insurance License #0F54659 | Hage CA Insurance License #0D97541 | 2024-174182 Exp. 05/26

Pearls of Wisdom from an OD

Dr. Courtney Cape

A great resource that I use to help review and interpret macular OCT scans is my VA Palo Alto residency mentor's website, https://www.octscans.com/. He not only shows the structures but also helps identify what different diseases look like. He is very knowledgeable and helpful!

Classifieds

Optometric Practice for Sale, in National City.  Owner wishes to retire after 40 yrs.1200 sq ft, excellent location. Price discounted at 75K OBO. Please call Jeff Neighbors (Broker) at 1-515-851-2280 or Greg Marlay (owner)  at  619- 477-4166  Please come by and we will be happy to show you the office.  (8/24)

Optometric Office in Escondido for lease.  Three operatories, a lab, large front office area, testing rooms, dispensing optician area, large waiting room, contacts room, lounge, ADA restroom, and 2,044 square feet.  Currently occupied by North County Eye Center and available May 2024.  Contact Jim at jimlund08@gmail.com or at (760) 747-7800. (8/24)

West Sound Well Established Optometry practice with 35 years goodwill and adjusted net profit of 350K  High Profit Port Hadlock Optometry Practice Available. Well Established Optometry practice with 35 years goodwill and adjusted net profit of $350K. Nice building with easy access, good road visibility and ample parking.  Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (WAO107)

Small town Whatcom County vision clinic with 70 years goodwill. Small Town Optometry practice with 70 years goodwill. This practice has been in existence since 1949 and has been providing excellent customer care ever since and is very well known in the community. The real estate is available as well. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (WAO108)

West Sound Ophthalmology Practice for sale West Sound Ophthalmology Practice. For more information Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (WAO109)

Spokane Optometry Practice for sale. Highly Profitable Spokane Optometry Practice. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (WAO110)

Well established Kirkland practice grossing 425K in nice professional building next to medical offices. Low key environment with long-term staff and low overhead. Seller will stay on for transition. Nicely appointed with room to expand. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com.(WAO111)

High Visibility Renton Optometry Practice. Modified startup practice with over 20 years goodwill. Seller has been slowing down and heading for retirement. This practice can easily be built up with little effort. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (WAO112)

Family Medicine Clinic in Beautiful Normandy Park. Annual collections of $625,000 in fast growing practice. Family Medicine practice located in Normandy Park, WA. Annual collections over $625,000 in fast growing practice. Great location with newer build out and equipment. Contact Rod Johnston at 206-979-2660 or Rod@omni-pg.com. (WMO9011)

New Optometry Practice in Temecula. Very modern up to date optometry practice in Temecula, California. Collections keep getting better every year. Lots growth potential. Located in a beautiful area. Seller is very motivated. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (CAO112)

Busy Portland Optometry Practice. Opportunity to buy an affordable optometry practice in Portland, OR near daily drivers, restaurants and entertainment. Ready to operate with an established patient base of families and young professionals with new patients weekly. Excellent equipment package including automated exam lanes, updated diagnostic technology and EHR. Contact Frank Sciabica at 425-985-8390 or Frank@omni-pg.com. (ORO101)

Part-Time Optometrist Needed, Half Day Shifts: We are offering an excellent opportunity for a dedicated Optometrist to join our highly-rated and stress-free practice. Enjoy highly competitive pay, including bonuses, for working just 2 to 3 half-day shifts per week. Our environment is professional yet relaxed, as evidenced by our excellent reviews and the satisfaction of our patients, making your work hours a breeze. If you are motivated and passionate about eye care, we would love to hear from you.  Fluency in Spanish is preferred.  Please submit your resume to bnemati@earthlink.net or contact us via text at 858-504-2020 to apply. (5/24)

Busy Private Practice looking for an associate OD in San Diego and Camp Pendleton military base. Generous base pay plus easy daily bonus pay. Please send resume and questions to:  marineeyecare@gmail.com (7/24)

Optometrist needed any day of the week at the Mission Valley Costco. If interested please contact rslikker@san.rr.com or 619.977.7703 (6/24).

Associate OD needed at the Vista Costco. 2-4 days per week available. Base pay + attainable bonus. Hours: Mon-Fri 10-6:30  Sat 9:30-5. Email kmichel@vistaoptometry.net with resume and availability. (6/24)

Build Ownership in a Growing Optometry Practice, Even as a New Grad. 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 and 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 spousti@live.com (2/24)

Looking for a motivated business-minded optometrist who is tired of the daily grind of a corporate practice, and wants to be their own boss while building equity. Our dynamic, high-potential private optometry practice is seeking an optometrist who is passionate about providing exceptional eye care and looking to take their career to the next level. With us, you won’t have to work 9 hours a day in a corporate practice, just to make a modest $500-$600 per day. Instead, you can earn much more and work just a quarter of the time you would have to spend in a corporate practice. Plus, you’ll have the opportunity to build equity in the practice, meaning your hard work will pay off in the long run. If you’re ready to add a second location or if you are a new grad, we want to hear from you. Please email us at: spousti@live.com (2/24)

Wanted: Used, good condition, Retinal Camera and Autorefractor. We are looking for a reliable non-mydriatic retinal camera and autorefractor for our optometry practice. If you have recently upgraded and no longer need your used one, we appreciate you reaching out to us. Thank you. spousti@live.com (2/24)

Exceptional Opportunity: Thriving Optometry Practice & Prime Medical Office Building in San Diego FOR SALE, with the REAL ESTATE. Unlock the potential of your optometry career with this golden opportunity! Highly profitable and growing optometry practice for sale in Central San Diego, together with its modern Medical Office Building. Discover the perfect blend of profitability and growth in this dynamic location (the second most active redevelopment zone, after downtown, in San Diego). Whether you're starting a new practice or expanding an established one, this is your chance to shine in a highly dense area, strategically positioned near more than 80 schools and 9 minutes from Downtown San Diego, and surrounded by 4 major freeways. Step into the future of healthcare with a contemporary medical office building, featuring three separate suites, that can be joined if needed into one big clinic and a total of 7 highly upgraded and move-in ready exam rooms. What sets it apart? Half of this impressive structure can be leased to other medical professionals, delivering a steady income stream, while the other half continues to house the thriving optometry practice. Seize the moment to drive your practice's growth while building equity in a high-potential, modern commercial real estate property. This isn't just an opportunity; it's a game-changer for those who dream big. For more details, please reach out via email (bnemati@earthlink.net).  (2/24)

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