11835 Carmel Mountain Rd. Suite 1304-211
San Diego, CA 92128
October 2025
Happenings of the Society
On Tuesday, September 30, nearly 600 Doctors of Optometry and Optometry students canvassed Capitol Hill, directly engaging in over 280 meetings with their Members of Congress and their staff. This massive advocacy presence delivered a united message across Optometry's top legislative priorities. Advocates pushed for the urgent passage of the Dental and Optometric Care Access Act, and Vision Lab Choice Act, to combat costly, controlling and care-limiting vision benefit middleman (VBM) policies; demanded that Congress permanently fix declining Medicare pay rates and address Medicare advantage plans; and urged action to preserve access to veterans' eye health and vision care, as well as emphasized the criticality of the doctor-patient relationship within the contact lens marketplace. The strong turnout for AOA on Capitol Hill, including over 230 students representing every school and college of Optometry, ensured that Optometry's voice was heard loud and clear on Capitol Hill.
This type of advocacy on behalf of our profession is why we must continue to support our national and local societies. If not for your membership dollars, how would Optometry ever be able to wage these types of battles on the legislative front? We cannot be lulled into complacency and allow others to control our destiny. Thank you for your membership and support. Of course, I’m preaching to the choir since this newsletter only reaches our SDCOS members. I challenge each of you, though, to share this information with a non-member colleague and ask them what would happen if September 30 never took place? Who is going to look out for our interests? It’s time that we ALL take responsibility for the future of our chosen profession.
John Pack, O.D.
SDCOS President 20205
The joint initiative between the LOVC, Lions Club members, and the SDCOS kicked off in September and is now in full swing, helping students in the La Mesa Spring Valley School District receive the vision care they need.
Building on the success of last year’s project in the South Bay Union School District, Lions Club members are once again lending a hand with student vision screenings—this time across 21 schools in the La Mesa–Spring Valley district.
Volunteer SDCOS doctors will examine referred students on-site and prescribe eyewear as needed, while LOVC members will assist with frame selection and provide glasses at minimal cost. It’s a true team effort that continues to make a difference in our local communities.
Recently, Drs. John Pack and Bob Meisel performed exams for 28 students at Spring Valley Academy, helping ensure each child can see clearly and learn confidently.
If you’re interested in volunteering for upcoming school screenings or exams in the next six months, please reach out to Dr. Eric White or Dr. Bob Meisel for dates and locations.
rmeisel47@gmail.com
619-818-3031
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.
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, November 20
NEW LOCATION: WestPac Headquarters: 5280 Carroll Canyon Rd Suite 300, San Diego, CA 92121
https://www.westpacwealth.com/
Speaker: Dr. Mika Moy
Catering Theme: South of the Border
Retina Corner
Over-Easy Diagnosis: Spotting an Acquired Vitelliform Lesion
Dear SDCOS Friends,
I hope that everybody is doing well. It was wonderful seeing many of you at last week’s SDCOS continuing education event. For this month’s Retina Corner, I will be sharing an interesting case from my clinic
This week, I received an urgent referral from a local cataract surgeon for a longtime patient of hers who had developed a yellow-white spot in the right retina associated with blurred vision. The patient came in immediately, and I assessed an 84-year-old pseudophakic man with a history of dry age-related macular degeneration (AMD). He was 20/40 OD and 20/20 OS with normal IOP in each eye. He noted mild distortion on his amsler grid in the right eye. He denied sudden vision changes or vision loss.
His funduscopic images demonstrated a ¾ disc-diameter yellow subretinal lesion in the central macula OD and numerous scattered hard drusen OU (Figure 1A, B). He had healthy appearing optic nerves and symmetrically tortuous retinal vasculature with good perfusion OU.
OCT imaging demonstrated central elevation of the neurosensory retina with hyperreflective subretinal material and scattered fine drusenoid PEDs in the central OCT image of the right eye (Figure 2A). A cross-sectional OCT image through the middle of the yellow subretinal lesion (just below center) in the right eye demonstrated hyperreflective subretinal material overlying drusenoid PEDs (Figure 2B). The OCT of the left eye demonstrated few scattered small drusenoid PEDs (Figure 2C, scant drusen captured in the central cut).
Additional imaging was obtained to better characterize the lesion. Fundus autofluorescence (Figure 3A) demonstrated intrinsic hyperautofluorescence of the lesion. Fluorescein angiography demonstrated early hypofluorescence consistent with blockage (Figure 3B) and late hyperfluorescence consistent with staining of the lesion (Figure 3C).
Overall, the multimodal imaging evaluation was consistent with an acquired vitelliform lesion in the right eye. Acquired vitelliform lesions are subretinal, yellowish lesions typically located in the central macula, resembling the “egg-yolk” appearance of Best Disease, but occurring later in life and generally unilaterally without a hereditary component. They represent a degenerative change involving dysfunctional phagocytosis of photoreceptor outer segments by the retinal pigment epithelium. The accumulation of lipofuscin-like material between the RPE and photoreceptors leads to the characteristic vitelliform appearance.
Associated conditions include age-related macular degeneration such as in our patient, chronic central serous chorioretinopathy, and pattern dystrophies. The differential includes Best Disease and Adult-Onset foveomacular vitelliform dystrophy (AOFVD) which are hereditary conditions in which patients present with bilateral vitelliform lesions, as well as neovascular age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy (PCV) and other exudative conditions.
Classically, such as in our patient, multimodal imaging reveals a dome-shaped subretinal hyperreflective lesion that is hyperautofluorescent on fundus autofluorescence corresponding to lipofuscin accumulation. Fluorescein angiography or OCT angiography can be helpful in excluding the presence of choroidal neovascularization (CNV) in patients who have underlying age-related macular degeneration. The prognosis of a vitelliform lesion is generally favorable, with many patients maintaining driving vision, though gradual decline can occur, often associated with the development of atrophy. Generally, vitelliform lesions are observed unless CNV occurs, in which case they are treated aggressively with anti-VEGF injections.
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. I am also open to any requests, if there is a topic or case that you would like for me to discuss in this space.
Best wishes, and until next time,
Thomas
Thomas Lazzarini, MD
Retina Consultants San Diego
626-537-5857 (cell)
lazzarini@rcsd.com
Successful Planning Starts Much Earlier Than You Think
When is the right time to start planning? This article outlines three steps owners should consider taking as soon as possible. Many business owners believe they have plenty of time to create a successful plan for the future of their businesses. Most commonly, owners think that if they give themselves a few years, they can transform their businesses into whatever they need them to be: whether that means bigger, more valuable, or more easily sold/transferred. And while each business is different and each owner has different goals, one thing is clear: You likely need to start your planning earlier than you think. Beginning your planning long before you intend to leave your business often lets you choose the conditions of your exit. For example, let’s say that one day, you’d like to sell your business for as much money as possible. To do so, you must know what your current business value is. You must know which factors give your business its value. You must know what the market for a business like yours is and anticipate any flaws potential buyers might find during due diligence. The same concept is true if you hope to transfer your business to family members or employees. You’ll likely need to determine whether your targeted successors can successfully run the business, along with whether they are even interested in ownership. You may need to construct plans to keep key employees with the company as and after you exit it. You’ll probably want to determine how long it will take for your successors—who are unlikely to have much money—to cash you out for your share of ownership. If you wait only until you are ready to exit the business to figure these things out, you may not give yourself enough time to address any issues your business may have. This can prolong the time you’re in your business, which can lead to poor performances or burn out. There are many things to consider, but we recommend a three-step process to begin. 1. Set your goals Setting your goals long before you’re ready to implement plans gives you a target to aim at. The most important goal to set is achieving financial confidence. Unless you know what it will take for you to leave your business and never have to work again (unless you choose to), all of the other details surrounding your planning become moot. Once you’ve determined how much you’ll need to achieve financial confidence, you can decide when you’d like to leave the business, how much money you want (not need) after you leave, and to whom you’d like to leave it (e.g., an outside third party or an inside management team). 2. Account for your resources Knowing what you currently have makes it much easier to determine what you will eventually need. Consider accounting for all of your resources, including the value of your business and any non-business assets. Many owners have a general idea about the resources they have, but when planning for future success, general ideas often aren’t precise enough. Accounting for your resources with precision provides time for you to close any gaps between the resources you have and the resources you need. If you wait only until you’re ready to implement plans to start accounting for your resources, you may prolong the planning process beyond your wishes or find it difficult to achieve your goals at all. 3. Install Value Drivers Value Drivers are things that increase the value of your business to an objective buyer. For example, regardless of whether you intend to sell your business to a third party or transfer it to an insider (e.g., family), the new owner will likely expect your business to run smoothly without you. If it doesn’t, you may be expected to stay in your business until the business can run without you. One Value Driver that can address this threat is a next-level management team. A next-level management team, by definition, allows the business to run smoothly without its owner. Another important Value Driver is a documented process for sustaining cash flow. Documentation allows new owners, managers, and key employees to maintain the company’s profits after you’ve left. Without written and easily understood processes, cash flow can become a game of chance, and few buyers want to take chances when buying a business. If you’d like to talk about when the right time to start planning for you is, please contact us today. Based on your goals and resources, you can begin to create a road map for the business future you desire.
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 | 7919948.1 Exp. 05/27
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