11835 Carmel Mountain Rd. Suite 1304-211
San Diego, CA 92128
August 2025
As a society leader, I receive updates from the COA that keep us informed and educated regarding the latest legislative events and issues impacting our profession. The following update was sent a few weeks back:
On Friday (7/18), the California Department of Health Care Services (DHCS) announced that it would not raise doctor payments as planned.
This is because the federal government enacted a new law to end the MCO Tax starting July 4, 2025.
That tax was relied upon to pay higher payments under Prop 35, but now that money is going away.
California may need to cut $30 billion from the state budget this year.
That could mean significant cuts to Medi-Cal, like paying doctors less and removing some health benefits, including eye care.
COA is working hard to protect eye care services and ensure optometrists are paid fairly. Watch your email, because we may need your help soon to stop cuts to eye care in Medi-Cal.
I share this with you in my president’s message to illustrate a point. We’ve all heard optometry described as a “legislated profession”. The state and federal government dictate not only what we can and cannot do as doctors of optometry, but they also control reimbursement rates for government run health plans. This leaves us at the mercy of politicians anxious to balance a budget that always runs short.
While it may not be feasible for individual clinicians to lobby on behalf of our profession due to the demands of patient care, we are fortunate to have organized representation through the COA at the state level and the AOA at the national level. These organizations tirelessly advocate for our interests and ensure our voices are heard.
As members of the San Diego County Optometric Society (SDCOS), our dues directly support the legislative efforts undertaken by the COA and AOA. While the road to achieving fair compensation and expanded clinical privileges may be fraught with obstacles, the unwavering dedication of our professional organization remains a vital component of our success.
Thank you for your continued support and commitment to our profession. Together, we can work towards a more favorable future for optometry.
OD Relations Liaison
Please contact Dr. Lucia Millet, 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.
Volunteer Outreach
As part of the Lions Optometric Vision Clinic (LOVC) community outreach, a mobile clinic was held at the San Diego Center for the Blind. Their open house was held in early May to showcase the services available at the Center.
Drs. Erin Swift and Bob Meisel examined 18 attendees that morning, with 11 prescriptions written and filled by the LOVC team.
Looking for Volunteers for these future events:
Vision of the Future kids screening
August 9
10am -12pm
Salvation Army Door of Hope facility
2799 Health Center Dr. San Diego.
Exams at Monarch School
17-18 November 9-2pm
1625 Newton Avenue
San Diego
Please contact Bob Meisel if you’re interested in helping at these worthy events
rmeisel47@gmail.com
(C) 619-818-303
Upcoming CE Meeting
Thursday, September 25
NEW LOCATION: WestPac Headquarters: 5280 Carroll Canyon Rd Suite 300, San Diego, CA 92121
https://www.westpacwealth.com/
Speaker: Dr. Marc R. Bloomenstein, O.D.
Catering Theme: Tuscany
2025 SDCOS Board of Directors
Retina Corner
Melting Away Neovascularization with Anti-VEGF
Dear SDCOS Friends,
Welcome to Summer! I hope that you have enjoyed the recent editions of Retina Corner. For this month’s edition, I will be sharing a case that highlights the incredible efficacy of anti-Vascular Endothelial Growth Factor (VEGF) injections in the setting of proliferative diabetic retinopathy (PDR), specifically at regressing the neovessels and stabilizing the diabetic retinopathy (DR).
A 53-year-old gentleman with poorly controlled Type 2 Diabetes Mellitus (Hgb A1c 13.5%) presented with mild progressive visual decline OU and a sudden burst of floaters OS. The vision was 20/30 ph 20/25 OU. The intraocular pressure was within normal limits. Dilated fundus examination revealed PDR with neovascularization elsewhere (NVE) and mild neovascularization of the disc (NVD) in both eyes with trace preretinal hemorrhage and a cotton wool spot OD and mild vitreous hemorrhage present OS (Figure 1 A, B). Fluorescein angiography was performed confirming leakage and the OCT demonstrated that there was no macular edema.
The patient was reluctant to undergo panretinal photocoagulation and preferred initial treatment with anti-VEGF injections. A series of three monthly anti-VEGF injections was performed in each eye. At his follow-up visit, the patient noted improvement in the floaters OS and the general clarity OU. His vision had improved to 20/25 ph 20/20 OU. The neovascularization had regressed OU, the vitreous hemorrhage had cleared OS and only a trace interior preretinal heme remained OD (Figure 2 A, B). In addition to this, his overall retinopathy had significantly improved with only a few remaining dot blot hemorrhages in both eyes.
This case highlights the impressive efficacy of modern anti-VEGF therapy in the treatment of proliferative diabetic retinopathy. Anti-VEGF injections have become an important treatment option for proliferative diabetic retinopathy, with substantial evidence supporting their efficacy in promoting regression of retinal neovascularization. Landmark studies such as Protocol S by the Diabetic Retinopathy Clinical Research Network (DRCR) have shown that intravitreal anti-VEGF can produce visual outcomes equivalent to or better than panretinal photocoagulation (PRP), while also preserving peripheral visual fields and reducing treatment-induced retinal damage. Despite these advantages, anti-VEGF therapy requires frequent injections and close follow-up, raising concerns about long-term adherence and real-world effectiveness. Additionally, there is a small but important risk of tractional retinal detachment, or "crunch," following rapid neovascular regression in eyes with significant fibrovascular proliferation. PRP remains a valuable alternative or adjunctive treatment, particularly in patients with limited access to regular care or in eyes at high risk for tractional complications. In the case presented, notable regression of neovascularization with anti-VEGF therapy alone underscores its utility in selected patients, while highlighting the importance of individualized treatment planning that considers disease severity, follow-up reliability, and anatomic features.
I hope that you enjoyed this month’s edition of Retina Corner. As always, if you have any questions or there is ever something I can help with, please feel free to contact me at any time.
Best wishes, and until next time,
Thomas
Thomas Lazzarini, MD
Retina Consultants San Diego
626-537-5857 (cell)
lazzarini@rcsd.com
The Business Owner's Bucket List
Writing things down is an important part of achieving your goals, both while you're running your business and after you leave it. However, many business owners feel overwhelmed by the idea of writing down their post-exit goals and strategies. Some business owners say to themselves, "I'll worry about this when I need to." But this can be a trap that could create situations that are even more overwhelming down the road.
How can you, as a busy business owner, begin planning for a successful future even if you aren't ready to exit your business? The answer — along with some unexpected benefits — could be to create an informal, written Business Owner Bucket List.
Starting Small
Planning for your eventual business exit can be a big process. But just as an acorn grows into a mighty oak, starting small can be the beginning of something big.
To start, consider writing down the following questions in a notebook, on your computer, or in your phone:
In a perfect world, when would I retire?
What do I want to happen to my business once I leave it?
The answers you provide can be as short, informal, or even unrealistic as you like. The goal isn't to create a full plan right away — it’s simply to start thinking about your future while you're still in a strong position to shape it.
What's the Point?
The process of planning for a successful future, both inside and outside of your business, can take years to execute. Starting early — when you still have control of your business and can leverage its strengths — could position you to:
- Execute a strong Exit Plan.
- Pivot more effectively if unexpected challenges arise.
Example: You might envision exiting your business in 10 years, transferring it to a family member, and traveling the world in retirement. This prompts critical follow-up questions like:
Which family member would run the business?
Will my business be valuable enough in 10 years to afford my retirement lifestyle?
As you build on your bucket list, you'll dive deeper into these ideas and assumptions — but remember: it all starts with something small.
Good for Now, Better for Later
Another question to jot down:
- How much is my business worth, and why do I think that?
Answering this question can help challenge assumptions you may have about your business value.
Key Point: The most important goal for business owners post-exit is achieving financial independence. Failing to do so may mean returning to work — something few business owners find appealing.
Much of financial independence comes from the sale or transfer of business ownership. However, business value assumptions often create hurdles that must be addressed early.
Reducing Assumptions About Business Value
Businesses that look similar on the outside are not always similar on the inside. Relying on "rules of thumb" can lead to overvaluations that prevent you from strengthening your company for a profitable exit.
For instance, you might assume that because a similar business sold for a certain amount, yours would too. But without detailed information, this can be misleading.
Accurate Business Valuations:
Show where you are financially.
Help create strategies to grow business value.
Align growth with your planned exit timeline.
Bottom Line: If you wait until you’re ready to exit, your business may not be ready. Strengthening value early positions you to exit on your terms and strengthens your company while you’re still running it — freeing up more time to focus on what you truly love.
The Big "What Ifs"
A final question to add to your list:
- What would I do if something unexpected happened to me or my business before I retire?
No business owner wants to think about unexpected setbacks, but planning for them is essential.
Business Continuity Planning could help address events like:
Untimely death
Debilitating injury
Divorce
Other major disruptions
It ensures your advisors, family, and employees know what to do if you are suddenly unavailable. Continuity plans also often include:
- Access to personal financial accounts
- Passwords
- Critical documents
Providing a strategy for these situations helps protect your business and preserves your legacy.
Don't Eat the Bear in One Bite
Creating a Business Owner Bucket List allows you to:
Take small steps toward your largest goals.
Reduce feelings of overwhelm.
Strengthen both personal and business strategies.
Remember: Small steps now can help prevent you from heading down an incorrect or inefficient path later.
Consider starting your Business Owner Bucket List today.
How We Can Help
We strive to help business owners identify and prioritize their objectives regarding their businesses, employees, and families. If you have questions about creating your Business Owner Bucket List or planning your exit strategy, we can help — or refer you to another experienced professional.
The information contained in this article is general in nature and is not legal, tax, or financial advice. For personalized information regarding your particular situation, contact an attorney, tax professional, or financial advisor. This article is not intended to offer advice or represent our firm as qualified to advise in all professional service areas. Exit Planning typically requires the collaboration of multiple professional advisors. Where necessary, we will work closely with you to ensure you have access to the appropriate resources. This newsletter is published by Business Enterprise Institute, Inc., and presented by our firm. We appreciate your interest. Park Avenue Securities LLC (PAS) is a wholly-owned subsidiary of The Guardian Life Insurance Company of America (Guardian). PAS is a registered broker-dealer and investment advisor, member of FINRA and SIPC. Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Please consult your professional advisor regarding your individual circumstances.
Registered Representative and Financial Advisor of Park Avenue Securities LLC (PAS). Securities products and advisory services offered through PAS, member FINRA, SIPC. Financial Representative 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. | CA Insurance License #0D97541 | 7919974.1 Exp. 05/27
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