11835 Carmel Mountain Rd. Suite 1304-211
San Diego, CA 92128
September 2025
On August 9th, SDCOS and the Thumbprint Foundation collaborated on project called “Vision of the Future”. Approximately 60 kids were screened at the Salvation Army Door of Hope facility and 17 were identified as needing a comprehensive eye exam and possibly glasses. They were all provided vouchers to visit optometrists in the local community. This was a pilot program that we hope to expand to several of the Rescue Mission campuses.
On August 8th, SDCOS volunteers served our veterans at the Liberty Station Stand Down event and conducted 101 patient exams! Please be on the lookout for additional volunteer opportunities in the future. Remember the Lion’s Vision Optometric Clinic is always in need of assistance.
I would like to invite all our members and their families to our first annual SDCOS Summer Social on Saturday September 13th from 1-4pm at Poinsettia Park in Carlsbad. We will provide food, drinks and entertainment for the entire family! This is a great opportunity to connect with collogues and friends. Hope to see many of you there!
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.
The annual Veterans Village San Diego Stand Down was held at Liberty Station in early August, where four SDCOS ODs played an integral role in helping 101 veterans with their prescription vision needs. More than 200 OTC readers and 200 pairs of sunglasses were dispensed, along with eyewear cases.
In addition to vision services, the event also provided dental and medical assistance, as well as support from multiple local and county organizations to connect hundreds of veterans with social services and other resources.
During the two-day clinic, LOVC staff and local Lions Club volunteers assisted countless others with non-prescription sunglasses and OTC readers.
The North County Stand Down will be held in Vista in mid-April 2026, postponed from its usual October date.
For this and other volunteer opportunities, please contact Bob Meisel.
Looking for Volunteers for these future events:
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) 619-818-3031
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
Retina Corner
Pneumania
Dear SDCOS Friends,
I hope that everybody has had a wonderful summer as we suddenly find ourselves charging into fall. For this month’s Retina Corner, I will be sharing a couple of cases from my clinic.
As is often the case, I had a couple of patients present back-to-back with similar pathology. A 73-year-old woman (Patient 1) presented with a growing “grey balloon” in her inferior field of vision in the left eye associated with a few flashing lights a week prior. At the time of her presentation, she was 20/20 with a normal appearing OCT and superior rhegmatogenous retinal detachment associated with a cluster of three retinal holes between 12:00 and 1:00. (Figure 1A,B).
The next week, a 76-year-old man (Patient 2) presented with a progressive nasal visual field defect following a burst of new floaters that first appeared a month prior in his left eye. His uncorrected visual acuity at the time of presentation was 20/80 ph 20/40 with a normal OCT and a temporal rhegmatogenous retinal detachment with a small superotemporal causative tear. (Figure 2A,B - The edge of the RD is seen at the temporal margin of the fundus photo).
Both of the patients were excellent candidates for pneumatic retinopexy, and following a discussion of the risks, benefits, and alternative treatments, received same day treatment. Following administration of subTenon’s anesthesia, cryopexy was performed with direct visualization of the cryotherapy tissue reaction around the edges of the breaks with scleral depression. Then, 0.4cc of undiluted, expansile perfluoropropane was injected via the pars plana and an anterior chamber paracentesis was performed to bring the eye to physiologic pressure. Both patients were discharged home following the procedure with strict positioning to keep the retinal pathology maximally tamponaded by the gas. They returned on postoperative day 1 with a good gas tamponade and sealed breaks. Patient 1 did not have any residual subretinal fluid and was completely reattached (Figure 3 A,B).
Patient 2’s retinal detachment had resolved and the break was flat, but there was voluminous dependent subretinal fluid inferiorly without any open retinal breaks (Figure 4 A,B).
Both patients were counselled to continue positioning and were followed closely in the clinic. Patient 1 returned on postoperative day 7 with new subretinal fluid in the nasal quadrant without a discernable tear on scleral depressed exam (Figure 5, fluid visualized by white arrow). She was repositioned onto her left side to support the nasal retina, and when she returned 2 days later, the fluid had reabsorbed and peripheral laser retinopexy was performed in the area of previously seen subretinal fluid. With further follow-up, the retina remained fully attached and no additional laser was required.
Patient 2 was followed closely, and the inferior subretinal fluid was noted to be absorbing and no new breaks or tears were identified (Figure 6). At the time of last follow-up both patients remained fully attached, maintained excellent vision, and did not require additional treatment or intervention.
Pneumatic retinopexy plays an important role in the management of rhegmatogenous retinal detachments, particularly those involving superior retinal breaks. The procedure is best indicated in patients with a single or multiple closely grouped superior retinal breaks confined to the superior eight clock hours (between 8 and 4 o’clock), clear media for adequate visualization, and the patient’s ability to maintain appropriate head positioning postoperatively. Pneumatic retinopexy is generally avoided for cases involving inferior retinal breaks, high grade proliferative vitreoretinopathy, or an inability to comply with positioning. Pneumatic retinopexy has some advantages over surgery in that it is minimally invasive and can be performed in-office, offering less delay to treatment and faster visual recovery compared to scleral buckling or pars plana vitrectomy, though with a slightly lower single procedure success rate.
Postoperatively, there are a couple of scenarios that can be encountered, such as the appearance of new foci of subretinal fluid with a new retinal break(s), such as in Patient 1, that can be addressed via positioning and adjunctive laser retinopexy or surgical intervention. Another common finding is the presence of inferior, dependent, slowly resolving fluid, such as was seen in Patient 2. This fluid typically resolves over several weeks, and barring new symptoms or signs of re-detachment, does not require intervention. These cases underscore the importance of close follow-up to promptly identify and address any progression or recurrence. In experienced hands and appropriately selected cases, pneumatic retinopexy remains a valuable and effective option in the surgical armamentarium for retinal detachment repair.
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
Where Do You Find Time for Planning?
One of the biggest sources of friction in planning for a successful future is time. Successful business owners like you aren’t sitting around, twiddling your thumbs, and wondering what to do with all this extra time you have.
How can you, with everything else you have to do, find time to create plans for a successful future that may not even be close right now??Consider some of the benefits of having a plan compared to the downsides of not having a plan. Let's look at a quick fictional but representative story to show these two sides of the same coin.?
Eye Trouble?
Twin brothers Jonathan and Joey Larson had been in competition since the day they were born. They did not get along and did everything they could to outdo each other. They each founded companies in the same industry that were regional powerhouses on different sides of the country and achieved success in entirely different ways.?
Jonathan was a Type A, hands-on, down-in-the-weeds kind of business owner. Everything went through him, and nothing got done without him. He rarely met with his advisors unless he was facing an emergency. He figured it was good enough that he knew where everything was and could tell you exactly what would need to be done if something ever happened to him. He simply never took the time to write it down.
Joey was a more reserved, hands-off, hire-people-smarter-than-me business owner who would rather reduce his risk than take a gamble on something big. Even with his busy schedule, he met with his advisors every month to make sure that all of his plans were in motion. He put everything in writing so that if anything ever happened to him, outside of the grieving, the business could function as if he were there.?
During a routine eye exam, Joey's optometrist shared concerns about some of his medical scans. She recommended that he see a specialist to rule out something serious. After seeing a specialist, he learned that he had a malignant, but operable, brain tumor.
Although Joey did not feel comfortable sharing this diagnosis with his company, he gave his brother a call to warn him. After all, they were twins. If this could happen to Joey, it could happen to Jonathan.
As usual, Jonathan did not take his call. Joey messaged his brother, urging him to get checked out. He never heard back.?
What a Difference a Plan Makes?
After coming to terms with his diagnosis, Joey quickly gathered his advisors and explained how important it was to enact his business continuity plans. He had always prepared for the worst, and in this case, it made a huge difference in how it affected his future success.?
His plans included strategies for handing daily operations off to his next-level managers, ensuring that his business would run smoothly as he fought cancer. This would allow Joey and his family to have the financial means and time to fight his disease.
Though it took two years of surgery, chemo, and occupational therapy to get Joey back up to working speed, Joey's business ran as if he had been there every single day thanks to his planning.?
Jonathan faced a much worse fate. Six months after he ignored Joey’s call, Jonathan suffered a seizure during an important conference where many of his largest investors were in attendance.?
His doctors found that, like his brother Joey, he was suffering from a malignant brain tumor. However, his had begun to spread because he had not caught it as early as Joey had.?
Worse still, though Jonathan knew everything he wanted to have happen to his business, he had never created a formalized plan for how to execute on his desires.
His business began to falter as he had to dedicate more and more time to his health. Things that used to get done quickly never got done at all. Jonathan's subordinates didn't know what to do because everything went through Jonathan.?
Just as Joey was going into remission, Jonathan died. Without Jonathan at the helm, his business began to collapse. Not long after Jonathan's death, his brother Joey bought the business and absorbed it into his own.?
Making Time for Success?
For many business owners, the hardest part about finding time to plan for a successful future is setting up the initial meeting.?
It's easy to get bogged down in all of the details that planning for a successful future brings with it. Tax-mitigation strategies, hiring next-level managers, or simply finding the right advisor to get the ball rolling are not easy tasks. If they were, every business owner would do it!?
But similar to starting your business, you can't get anywhere unless you take that first step. The good news for many business owners is that the first step in planning for a successful future often starts by finding the right advisor to build the team and plan for you.?
Getting Started
An Exit Planning Advisor could help you iron out many of the nitty-gritty details that stop business owners from taking that first planning step.
Whether it means determining how much money you need to achieve financial confidence, creating a business continuity plan should something happen to you before you're ready to leave your business, or optimizing your business to achieve as much growth as possible, it will likely take a team to help you achieve your goals.?
The nice thing about the Advisor Team is that often times, you don't need to build it. Your Exit Planning Advisor helps you build it, which could give you time back. The team then advises you on strategies to pursue and implements those strategies for you.
In many cases, the time required to plan for a successful future is front loaded, helping you take advantage of strategies that you may not think you need now, but you'll be relieved to have later, when you may need them.
As the story of Jonathan and Joey showed, if you wait to plan until you need to plan, you may not have time for the planning you need. If you plan before you need it, you may be able to better position yourself to address the unexpected when it happens.
We strive to help business owners identify and prioritize their objectives with respect to their businesses, their employees, and their families. If you have questions on this topic, we can help with more information or a referral to another experienced professional.
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. 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 offering investment products, as well as a registered investment adviser offering financial planning and investment advisory services. PAS is a member of FINRA and SIPC. Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Please consult your tax, legal, or accounting professional 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 | 7919996.1 Exp. 05/27
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