September 2024

Happenings of the Society

What an incredible month! This has truly been a memorable August for many reasons. The August President’s message covered a couple of society projects we had underway. If you missed them, bummer but for you but they will be back. Stand Down San Diego has come and gone. This is where we assist veterans in San Diego, both homeless and otherwise. What an amazing experience it was. I performed 83 exams on Friday. I was exhausted but on cloud nine. Helping these men and women get glasses was incredible.

For example, my last patient served in Vietnam and is in his 80s. I introduced myself, asked how he was doing, and he mentioned that he had lost his glasses a few years ago and couldn’t afford new ones. He was unable to see clearly, either near or far, and was walking with a crutch. I refracted him and found he needed +2.00 distance lenses with a +2.00 add. I took him to the Lions tent, where they were providing glasses for veterans, and picked up a pair of +2.00 lenses and +3.50 readers. When he put them on, he started to cry. He said, "I can see." I then gave him the +3.50 pair and asked him to look at his hand. I’m not sure who was crying more—that's what we do! We help people see. Next year, you all need to experience this. It is truly incredible.

On Sunday Aug. 11th, we had our 5-hour CE. Dr. Paul Karpecki hit it out of the park, and Dr. Pillar nailed it too. If you weren't there, you missed a fantastic CE. Then, on August 19th, we started our school screenings for the South Bay School District. Over the next six months, we will be screening 12 schools—more than 5,000 children. We need your help—please sign up to assist. Helping children see is how we can give them a good start in their education… again, that's what we do. August was a remarkable month, and September will be just as rewarding. The school screenings will continue, along with additional fun activities.

The school screenings only address part of the issue. Once we have referrals, we need to get those children glasses. This is where the Lions Optometric Vision Clinic comes in, but we need doctors to volunteer. Please consider it. Volunteering benefits us all. We need each and every one of you to give back. Giving back allows you to experience the joy of helping others. Please consider contributing; you’ll love the feeling and joy it brings.

On Thursday, September 26th, the CE will be at a new location: 5280 Carroll Canyon Rd, Suite 300, San Diego, CA 92121, at West Pac in Sorrento Valley. We chose this location to accommodate our North County doctors. Traffic going north is manageable, but heading south can be difficult. Dr. Michael Ammar and Dr. Rakhi Melvani will be discussing retina and cornea topics. They are excellent speakers, and you won’t want to miss this. Make sure to note the address. There’s a lot going on, which is why our society is so great. Dr. John Pack is also looking for board members to step up and join the SDCOS Board. We aim to maintain a strong Society, and we need you to join the board. Don’t forget the Holiday Party on Sunday, December 1st, at Tom Ham’s Lighthouse.

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

Thursday, September 26
NEW LOCATION: WestPac Headquarters: 5280 Carroll Canyon Rd Suite 300, San Diego, CA 92121
Dr. Mike Ammar (1Hr Retina)
Dr. Rakhi Melvani (1Hr Cornea)

https://bit.ly/HiltonMissionValley

• 2024 CE Schedule

• 2024 SDCOS Board of Directors

Looking for Volunteers for these future events:

Looking for Volunteers for these future events:

1) 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)

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)

2) 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

Pearls of Wisdom from an OD 

Ananya Jalsingh

Part of SDCOS’s mission has always been to serve the public through excellence in community service. Today I am reflecting on my optometry journey as it has been exactly 4 years for me in practice. Having been the greatest challenge in my life so far, it also has been the most rewarding. I have so much gratitude for the endless wisdom from my peers and mentors, but above all my greatest pearl comes from engaging oneself in meaningful community service projects and global initiatives. From being an SVOSH member during schooling, I have been graced with multiple opportunities to be one of those volunteer Optometrists I once greatly admired. Along with volunteering regularly at our local Lions Optometric Vision Clinic, I have also been on international missions including remote villages of Fiji, Jamaica, India, and Mexico. Not only have I been able to hone my doctoring skills, but I have also become a more fulfilled practitioner. It is the most rewarding corner of Optometry to witness people make positive, transformative strides with their lives and livelihood, because of the changes you made with their vision.

Participating in local community volunteering efforts also has the added benefit of providing exposure to your practice and is an excellent way to advocate for our profession. Some naive examples include, providing certain number of eye exam/glasses vouchers per month to local shelters, picking one day per quarter to schedule patients through a local charity, holding a “Glasses Drive” for donating old Rx, unused or discontinued frames, participating in vision screenings in nearby schools, and/or conducting your own vision screening at local health fairs. Not only are you able to make a major difference in lower-income communities, but are also on a small scale level generating interest in Optometry as a profession with minority children for the next generation.

Therefore, my greatest pearl of wisdom that I learned from my young career thus far is to unleash your full potential as a healthcare practitioner. Whether that need is halfway around the world or just down the street, please use your optometric skillset to bring access to eyecare for 

Retina Corner

Retinal Artery Occlusions, Is There Anything We Can Do?

By Michael J. Ammar, MD
Retina Consultants San Diego

Dear SDCOS friends,

In this month's Retina Corner, I wanted to discuss central and branch retinal artery occlusions (CRAOs, BRAOs). They are a well-known cause of significant visual morbidity and often result in legal blindness. For many years, it was thought that nothing can be done for these patients but in recent years there has been significant investigation into possible ways to preserve or improve vision. This resulted in a paradigm shift in the way we think about and manage acute painless vision loss. In this article, I will discuss RAOs and how we now approach these cases.

RAOs result from the partial or complete blockage of blood flow in the central or branch retinal arteries. Once this blockage happens, the reduced blood supply to the inner retinal layers quickly causes ischemia. This is followed by cytotoxic edema, which is visible as retinal whitening during a fundoscopic exam. In response to the damage, inflammation occurs, and about six weeks after the initial occlusion, retinal atrophy and thinning begin to develop. Sadly, the neural tissue is then irreversibly damaged with a significant loss of vision.

In clinical practice, a key question is determining when exactly irreversible retinal damage occurs. Studies in rhesus monkeys indicate that irreversible damage to the retina begins approximately 105 minutes after the onset of a vaso-occlusive event, with extensive, irreversible damage occurring by 240 minutes. However, this experimental model, which involves using a microclamp on the central retinal artery, may not fully represent the pathophysiology of real-world CRAOs. More recent research suggests that complete central retinal artery occlusion might lead to retinal infarction within 12 to 15 minutes. However, this estimate is based on extrapolation from brain ischemia studies, so it should be interpreted with caution.

The causes of RAOs can be quite broad. The vast majority are embolic in nature (95%) with only 5% of cases being non-embolic in nature. These other 5% include arteritic etiologies such as vasculitis, infection, malignancy, coagulopathy, trauma, and cardiovascular disease. Embolic RAOs may be differentiated based on exam features. Cholesterol emboli are the most common type and are typically yellow, while platelet-fibrin emboli appear gray and calcium emboli are white. A study found that in cases of RAO, 74 percent of emboli were cholesterol, 15 percent were platelet-fibrin, and 11 percent were calcific. Less frequently encountered emboli include tumor emboli, leuko-emboli, fat, air, and septic emboli. In a prospective study on cardiovascular risk factors for CRAOs, 20 percent of patients with CRAO were found to have atrial fibrillation. CRAO-inducing emboli can occur spontaneously or be triggered by recent intravascular procedures, such as cardiac catheterization. Additionally, injected cosmetic facial fillers can sometimes cause CRAO.

A critical shift in our management of these patients happened with the Academy of Ophthalmology (AAO) formally recommended that all CRAO, BRAO, and even transient ischemic attack (TIA) patients be treated as active stroke patients. When a RAO is initially diagnosed, it is essential to immediately transfer the patient to a stroke center for evaluation, as the risk of stroke is notably high, particularly in the first one to four weeks. One study found that 23 percent of patients with CRAO had acute brain infarcts on MRI within an average of 24 hours from symptom onset. Despite these infarcts, 89 percent of these patients did not report additional neurological symptoms.

Unfortunately, a safe and effective treatment remains elusive for RAOs. The window for therapeutic intervention to be successful is so small that by the time an RAO is diagnosed it is often too late. Even if diagnosed in time, there is still an additional delay in arranging aggressive interventional care. Still, several treatments have been tested for RAO, but most have shown limited or mixed efficacy, and some carry significant risks of serious side effects. One approach involves reducing intraocular pressure to decrease resistance in retinal arterioles. This can be achieved with IV acetazolamide or mannitol, topical intraocular pressure drops, or anterior chamber paracentesis. Digital ocular massage is another method that aims to fluctuate intraocular pressure, theoretically pushing the clot distally. Other treatment strategies include using vasodilators like pentoxifylline to increase blood oxygen content, inhaling carbogen, or administering sublingual isosorbide dinitrate. Additionally, hyperbaric oxygen therapy, which increases blood oxygen tension, has also been proposed as a potential treatment option. Both intra-arterial and intravenous thrombolytics have been investigated in RAO management; however, there is strong controversy regarding their use. The EAGLE trial (European Assessment Group for Lysis in the Eye), which compared intra-arterial lysis to conservative treatment, was halted early due to significant safety concerns. Intravenous thrombolytics were found to pose dangerous risks, including intracranial hemorrhage or death, with little to no improvement in visual acuity reported.

In conclusion, when encountering an acute RAO, it is critical to get these patients to a stroke center as soon as possible. Unfortunately, we still are without an effective treatment for these cases. We are hopeful that scientific investigation and further research will one day lead to novel interventions that can help better protect and recover vision in these populations.

I hope that you found this month's Retina Corner informative and insightful. If you have any questions or if there is anything I can assist you with, please don't hesitate to reach out to 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

Sponsor Spotlight

Dani Boughton

Where do you work?
Roya.com

How many years have you been in the industry?
11 years

What are your favorite activities?
Cooking, trying new foods/restaurants, and exercising!

 

Classifieds

Optometric Practice for Sale, in National City.  Owner wishes to retire after 40 yrs.1200 sq ft, excellent location and excellent for a second office. 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- 12/24)

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)

Orange County Optometry Practice. Orange County Optometry Practice. Ideal merger candidate. $340,000 gross. 30+ years of goodwill. Great location! Good visibility. Contact Frank Lic CA 2091491 - 425-985-8390 or frank@omni-pg.com. (CAO105)

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 Lic CA 2091491 - 425-985-8390 or frank@omni-pg.com. (CAO112)

Moreno Valley High Visibility Well-Established Optometry Practice. Well-established high visibilityoptometry practice grossing 500K with more room to grow. Contact Frank Lic CA 2091491 - 425-985-8390 or frank@omni-pg.com. (CAO114)

Associate OD opportunity in Santee. We are interviewing now to add to our growing private practice inside Santee Costco. You have the freedom to practice at the level you're most comfortable with. Optos/OCT on every patient. Easy EHR, automated phoropter, amazing staff, grateful patients. Email truenortheyecare@gmail.com for further details on salary and availability (8/24)

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.$600 Base pay + production bonus. Hours: Mon-Fri 10-6:30  Sat 9:30-5. Email kmichel@vistaoptometry.net with resume and availability. (9/24)

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)