11835 Carmel Mountain Rd. Suite 1304-211
San Diego, CA 92128
March 2025
“Optometry is a legislated profession”. We’ve all heard this statement before, but do we really understand and appreciate what it means? Are we aware of how laws and regulations at both the state and federal levels define our scope of practice, licensing requirements, and patient access to care?
On March 3 the COA will host its annual Legislative Day in Sacramento. This is an opportunity for doctors from across the state to meet with legislators and their staff to educate them on current legislation and other issues impacting the profession of optometry. Advocacy efforts such as these by our optometric associations are essential in shaping policies to protect and advance the profession. We encourage any interested member of the SDCOS to attend this event and actively participate in defining the future of optometry in the state of California.
I would also like to take this opportunity to congratulate our SDCOS for winning 2 of the 3 society recognitions at the COA House of Delegates last month. Our society was awarded “Website of the Year” in recognition of its outstanding digital platform and “Project of the Year” in recognition of our society’s ongoing campaign to help nurses in the south bay elementary school districts screen children for visual deficiencies. Way to go SDCOS!
Finally, I would like to invite all of you to attend our annual 5-hour CE program on Sunday, March 23. The meeting will feature top notch CE, a vendor fair and an opportunity to network with colleagues. It will be held at the Mission Valley Hilton and registration begins at 7:30am. Hope to see you all there!
John C. Pack,O.D.
President SDCOS 2025
(619) 806-1282
jpackod@yahoo.com
Upcoming CE Meeting
5 Hr CE March 23rd
Location: Hilton San Diego Mission Valley 901 Camino Del Rio S. San Diego CA 92108
Registration Start: 7:30 AM
Lecture: 8AM-1:30 PM
Speakers:
Rakhi Melvani, M.D. Glaucoma
Max Parikh, M.D. Refractive Surgery
Alyssa Pack, O.D. AI application for Glaucoma Cases
Lisa Hornick, O.D. Treating Dry Eye in 2025
The LOVC held a vision screening and exam event at the downtown Lions Manor, a complex on Market Street that houses 159 low income residents in conjunction with UCSD, who provided other health care teams.
Enrique Rodriguez, manager of the LOVC, screened 49 residents and 20 were provided with OTC reading glasses, 15 got sunglasses and 6 had prescription Rxs ordered from the clinic. Drs Simona Grosu and Bob Meisel provided 32 exams for residents. LOVC board members Doug Wahl, Helen Quintanilla and Board President Mike Brandenburg assisted as well as several UCSD students, who interpreted for some Chinese speaking residents.It was a very successful event and provided needed eye care to an underserved population of San Diego
Retina Corner
Scleral Buckles, Retina’s Old Reliable
By Michael J. Ammar, MD
Retina Consultants San Diego
Dear SDCOS friends,
In this month's Retina Corner, I wanted to discuss a major tool in every retina surgeon’s armamentarium, the scleral buckle. Though it has been around for nearly 80 years, the scleral buckle technique is still a common approach in retinal detachment repair particularly in young populations and complex detachments. Today we will discuss it in more depth.
Pars plana vitrectomy (PPV) and scleral buckling (SB) are the most commonly performed procedures for managing retinal detachment (RD), both demonstrating high surgical success rates and significant postoperative visual improvement. While there is general consensus on the approach for specific types of RD, such as using vitrectomy for eyes with substantial media opacity, the optimal treatment for many cases of primary noncomplex RD remains debated.
In older adults, many studies have overall shown similar SSAS rates among SB, PPV, and PPV/SB. A large meta-analysis showed that there was no difference in single operation re-attachment rate between SB and PPV +/- SB for phakic or pseudophakic patients. However, certain patient characteristics may favor one surgery type over another.
There is a noticeable shift away from scleral buckling toward pars plana vitrectomy. Innovations like wide-angle viewing systems, 3D heads-up displays, and smaller-gauge instrumentation have enhanced the efficiency and safety of PPV, contributing to the decline of SB. As a result, SB is increasingly becoming a less practiced technique, affecting both new and experienced vitreoretinal surgeons, with its use now occurring in less than 20% of retinal detachment (RD) repairs. However, rather than being outdated, should be regarded as a foundational approach in the surgeon’s repertoire. A SB can offer benefits that a PPV cannot.
A SB counteracts the forces that contribute to RD while simultaneously enhancing those that facilitate retinal reattachment. An RD occurs due to a combination of vitreous traction and vitreous liquefaction, with ocular saccades enabling fluid to enter and spread within the subretinal space. By indenting the eye wall, SB directly reduces the magnitude of vitreous traction while also altering the direction of its force. Additionally, encircling bands reshape the eye into a more prolate form, decreasing the diameter of the vitreous base and thereby minimizing transvitreal traction. The indentation created beneath the retinal break shifts the existing subretinal fluid, promoting the reattachment of the retina to the underlying retinal pigment epithelium. This process often results in the displacement of liquefied vitreous, allowing more solidified gel to occupy the area and help seal the break.
In eyes with retinal detachment and fibrocellular membrane formation, tissue contraction generates posteriorly directed radial forces, which can lead to new retinal breaks or the enlargement of existing ones. Scleral buckling alters the natural concave shape of the eyewall to an iatrogenically convex contour, redirecting these radial forces outward along the buckle. This redistribution enables relaxation and flattening of a foreshortened retina without the need for membrane peeling or retinectomy. With careful case selection, SB can sometimes eliminate the need for PPV entirely.
I most commonly employ primary SB in younger phakic patients with an attached hyaloid, cases involving pathology across multiple quadrants, and situations where vitreous adherence is expected to be significant or abnormal. I also favor SB in eyes with a history of trauma, retinal dialysis, or retinoschisis. Additionally, I often more strongly consider combining SB with PPV in cases at high risk for recurrent detachment. This includes eyes that have previously failed RD repair, those with existing proliferative vitreoretinopathy, and patients with a history of inherited vitreoretinopathy, giant retinal tear, or RD in the fellow eye. I prefer an encircling band due to its ability to diffusely reduce transvitreal traction, address pathology across multiple quadrants, and maintain adequate buckle height over extended follow-up periods.
To minimize trauma to the sclera, I utilize sutures to secure scleral buckles to the sclera, particularly in cases with pre-existing ectasia, staphylomatous changes, or large myopic eyes with thin scleral tissue. External RD drainage is considered on a case-by-case basis, generally reserved for eyes with large RDs that remain significantly bullous after buckle positioning, extensive inferior subretinal fluid, or chronic fluid that is unlikely to resolve spontaneously in a timely manner.
Despite their age, scleral buckles have survived the test of time because of their immense benefits in the right patient. I employ them often and find them to be one of the most eloquent surgical techniques we have. 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
Ready or Not: Why Planning Now Beats Planning Procrastination
All successful business owners must eventually face a stark reality: One day, they will no longer run their business! If this idea makes you uneasy, you aren’t alone. Today, we’ll show you how preparing for a future you may not be ready for now can benefit you both today and when you are ready.
Overcoming ‘I’m not ready’
If you’re like many business owners, your business likely relies heavily on your presence for success. Your business may also support your family and non-business-related goals. This may make the idea of preparing the business for a future without you seem preposterous, especially if you have no plans to leave your business anytime soon.
But consider the other side of the coin: If your business, family, and personal goals rely on your presence as a business owner, what happens if you were unexpectedly forced from the helm—by death, injury, or otherwise?
In other words, if you’re indispensable to your business, it becomes extremely challenging to leave it, even when you are ready.
To reduce the likelihood that you’ll face this fate, consider taking the following actions, which can benefit you and your business now and in the future.
Hire next-level management
It’s hard to overstate the importance of next-level management. Next-level management can provide the expertise that shores up your business’ strengths, improves its weaknesses, and directly contributes to your most important goal: financial independence.
Better still, next-level management teams can help you focus on what you want for yourself, your business, and the things that matter most to you in the future. That’s because next-level managers can take your business’ most pressing issues off your plate.
Finally, next-level management is crucial to growing the value of your business. Next-level managers have track records of growing businesses to achieve ambitious goals. This growth can have a cascading effect, giving you more freedom to determine what a successful future looks like.
In short, next-level management can give you more control over your goals, both now and in the future.
Create Business Continuity Instructions
Business Continuity Instructions are another crucial aspect of planning for a successful future. These instructions can provide guidance to co-owners, managers, family members, and advisors in case you are no longer able to run the business (e.g., unexpected death or incapacity). This can help mitigate risks and offer solutions for the people who rely on you and your business to maintain their lifestyles.
Additionally, Business Continuity Instructions can help you uncover weaknesses in your business and improve upon them. For instance, a key aspect of Business Continuity Instructions is determining how to handle future contracts with important clients. In the process of creating these instructions, you may find that your company relies heavily on just a few large clients. This, in turn, can help you determine how to diversify your clientele, which can strengthen your business in the short and long term.
Looking to the future can benefit you now
Even if you aren’t ready for a future outside your business just yet (and even if you plan to die at your desk), taking steps toward planning for that inevitability can provide important benefits for you right now. By confronting the reality that no business owner owns their business forever, you can create plans to maximize your success while you are at the helm, while simultaneously giving yourself more freedom to pursue your goals inside and outside the business.
We strive to help business owners identify and prioritize their objectives with respect to their business, 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.
WestPac Wealth Partners is an Agency of The Guardian Life Insurance Company of America® (Guardian), New York, NY. Securities products and advisory services offered through Park Avenue Securities, LLC (PAS), member FINRA, SIPC. OSJ: 5280 Carroll Canyon Rd., #300 San Diego, CA 92121 619.684.6400. PAS is a wholly owned subsidiary of Guardian. This firm is not an affiliate or subsidiary of PAS. Insurance products offered through WestPac Wealth Partners and Insurance Services, LLC a DBA of WestPac Wealth Partners, LLC. | CA Insurance License #0I29680 | Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Consult your tax, legal, or accounting professional regarding your individual situation. | 7608407.1 Exp. 02/27
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