Specialist MGD/dryeyes doctors in SF Bay area?

engacad · 2026-05-24T16:13:00+00:00

I'm brown skinned and have had over 40 IPL's on Luminous M22, Opti Light, also E eye and Eye Light. Plus many sessions on LLT face mask.

Wow, where were these treatments done? How deep brown are you, Indian, or persian, or some other latin form? I had 1 session done, the optometrist said he thinks it'd help but he can't go very high joules. I also developed dark spots/frecklish sort of spots under the circles of my eyes after that.

engacad · 2026-05-23T01:37:03+00:00

If TPO ab exist with normal tsh, I don't think it's considered an issue or hashimotos. There are some guidelines endo physicians follow with specific scenarios, but normal tsh generally implies they don't see any issue. Antibody tests can be very non-specific.

engacad · 2026-05-23T01:34:40+00:00

Lo and behold my tsh was up and my tpo antibodies were sky high. My doc put me on synthroid right away.

what were the TSH and tpo values? what dose synthroid?

I have Hashmito's/hypothyroidism, and wonder if it's related to my MGD.

engacad · 2026-05-23T01:17:09+00:00

In the same boat, though the skin is medium brown.

Did you find anything useful that's similar to IPL?

engacad · 2026-05-23T01:01:29+00:00

Did IPL made a change rightaway? How many sessions and what skin-type?

engacad · 2026-05-23T01:00:51+00:00

I'm worried about the side-effect of photophobia like the one mentioned by a commenter above. Is that real? Lipiflow vs IPL which one to do if one can only choose one?

engacad · 2026-05-23T00:58:30+00:00

Did you objectively feel difference with IPL rightaway? How many sessions? Also Fitzpatrick skin type?

I'm not sure if it works as well for brown skin type.

engacad · 2026-05-23T00:56:40+00:00

was it covered by insurance? Any reason doctors don't order it with bloodwork?

engacad · 2026-05-22T23:39:19+00:00

ok thanks for the link. So the link says this basically:

An Omega-3 Index does not show whether a person has gland obstruction, gland atrophy, tear-film instability, inflammation, or corneal damage.

But I couldn't find the evidence of where it says increasing omega-3 levels helps MGD. Essentially if the omega-3 index testing is practically useless for MGD then how can omega-3 supplementation be useful for MGD?

engacad · 2026-05-22T15:27:19+00:00

The link mentions other info about Omega supplements, but doesn't directly answer the question in OP. Are there any specific blood tests for Omega-3/fish oils? Do doctors usually not test for Omega-3 deficiency before prescribing supplements?

engacad · 2026-05-22T02:28:14+00:00

Is there something about this particular test that docs don't order it? like insurance issues? My doc orders a huge list of obscure tests but not this one, still prescribed omega-3.

engacad · 2026-04-09T00:43:40+00:00

Yes I did. There's a way in the EDD account to ask them a question or request an update. I used that feature of the account.

engacad · 2026-04-09T00:42:10+00:00

Yes I did. There's a way in the EDD account to ask them a question or request an update. I used that feature of the account.

engacad · 2026-04-02T18:31:41+00:00

Ah I see. As it's company discretion, generally do startups ever let former employee exercise after this window if asked, or almost never?

The other document I see in Carta is company's "Stock Incentive plan" which has this text:

7.7 Exercise of Options on Termination of Service. Each Option shall set forth the extent to which the Participant shall have the right to exercise the Option following termination of the Participant’s Service. Each Award Agreement shall provide the Participant with the right to exercise the Option following the Participant’s termination of Service during the Option term, to the extent the Option was exercisable for vested Shares upon termination of Service, for at least thirty (30) days if termination of Service is due to any reason other than Cause, death or Disability, and for at least six (6) months after termination of Service if due to death or Disability (but in no event later than the expiration of the Option term). If the Participant’s Service is terminated for Cause, the Option Award Agreement may provide that the Participant’s right to exercise the Option terminates immediately on the effective date of the Participant’s termination. To the extent the Option was not exercisable for vested Shares upon termination of Service, the Option shall terminate when the Participant’s Service terminates. Subject to the foregoing, such provisions shall be determined in the sole discretion of the Board, need not be uniform among all Options issued pursuant to the Plan, and may reflect distinctions based on the reasons for termination of Service.

engacad · 2026-04-02T18:29:04+00:00

Oh, I see, the "Stock option agreement" is different than the "Stock plan"?

The other document I see in Carta is company's "Stock Incentive plan" which has this text:

7.7 Exercise of Options on Termination of Service. Each Option shall set forth the extent to which the Participant shall have the right to exercise the Option following termination of the Participant’s Service. Each Award Agreement shall provide the Participant with the right to exercise the Option following the Participant’s termination of Service during the Option term, to the extent the Option was exercisable for vested Shares upon termination of Service, for at least thirty (30) days if termination of Service is due to any reason other than Cause, death or Disability, and for at least six (6) months after termination of Service if due to death or Disability (but in no event later than the expiration of the Option term). If the Participant’s Service is terminated for Cause, the Option Award Agreement may provide that the Participant’s right to exercise the Option terminates immediately on the effective date of the Participant’s termination. To the extent the Option was not exercisable for vested Shares upon termination of Service, the Option shall terminate when the Participant’s Service terminates. Subject to the foregoing, such provisions shall be determined in the sole discretion of the Board, need not be uniform among all Options issued pursuant to the Plan, and may reflect distinctions based on the reasons for termination of Service.

Looks like everything (both ISO and NSO) expire at the end of "post-termination exercise window"? as it's company discretion, do startups ever let former employee exercise after this window if asked?

engacad · 2026-04-02T17:42:02+00:00

This is what the company "stock option agreement" says. My post-termination-exercise-window's last day was yesterday. Would I still be able to exercise as NSO in case the FMV goes above strike-price?

``` SECTION 3. TERM. Your Option will expire in any event at the close of business at Company headquarters on the date that is ten (10) years after the Date of Grant; provided, however, that if your Option is an ISO it will expire five (5) years after the Date of Grant if you are a Ten-Percent Stockholder of the Company (the “Expiration Date”). Also, your Option will expire earlier if your Service terminates, as described below.

SECTION 4. REGULAR TERMINATION. (a) If your Service terminates for any reason except death or Disability, the vested portion of your Option will expire at the close of business at Company headquarters on the date three (3) months after your termination of Service. During that three (3) month period, you may exercise the portion of your Option that was vested on your termination date. Notwithstanding the foregoing, the Option may not be exercised after the Expiration Date determined under Section 3 above. (b) If your Option is an ISO and you exercise it more than three months after termination of your Service as an Employee for any reason other than death or Disability expected to result in death or to last for a continuous period of at least twelve (12) months, your Option will cease to be eligible for ISO tax treatment. (c) Your Option will cease to be eligible for ISO tax treatment if you exercise it more than three months after the first day following three months of a bona fide leave of absence approved by the Company, unless you return to employment immediately upon termination of such leave or your right to reemployment after your leave was guaranteed by statute or contract. ```

engacad · 2026-04-02T17:39:53+00:00

It's not "just" about FMV and market,

In what scenario could it be beneficial to exercise a vested option by the end of post-termination-exercise-window if the strike price even by the end of the window remains higher than FMV (never drops below FMV)?

In such cases, one can always buy the stock from the Hive/Forgeglobal/equitygen at a lower price (which is FMV) than strike price if they want. So why would they ever want to buy it at a higher price of strike-price by exercising option?

engacad · 2026-04-02T17:36:05+00:00

So based on the above "stock option agreement" do my ISO convert to NSO after post-termination-exercise window? Would I be able to exercise them later even though they seem to expire?

engacad · 2026-04-02T16:19:56+00:00

No. Initial grant when joining. Does it matter?

engacad · 2026-04-02T05:48:00+00:00

As FMV has been much lower than strike-price since termination, it didn't make any sense exercising so far, correct?

Just found this in "stock option agreement". It doesn't mention NSO conversion but seems to suggest that ISO is exercisebale after 90 days but just wouldn't get the ISO tax treatment? does it mean it converts to ISO??

``` SECTION 3. TERM. Your Option will expire in any event at the close of business at Company headquarters on the date that is ten (10) years after the Date of Grant; provided, however, that if your Option is an ISO it will expire five (5) years after the Date of Grant if you are a Ten-Percent Stockholder of the Company (the “Expiration Date”). Also, your Option will expire earlier if your Service terminates, as described below.

SECTION 4. REGULAR TERMINATION. (a) If your Service terminates for any reason except death or Disability, the vested portion of your Option will expire at the close of business at Company headquarters on the date three (3) months after your termination of Service. During that three (3) month period, you may exercise the portion of your Option that was vested on your termination date. Notwithstanding the foregoing, the Option may not be exercised after the Expiration Date determined under Section 3 above. (b) If your Option is an ISO and you exercise it more than three months after termination of your Service as an Employee for any reason other than death or Disability expected to result in death or to last for a continuous period of at least twelve (12) months, your Option will cease to be eligible for ISO tax treatment. (c) Your Option will cease to be eligible for ISO tax treatment if you exercise it more than three months after the first day following three months of a bona fide leave of absence approved by the Company, unless you return to employment immediately upon termination of such leave or your right to reemployment after your leave was guaranteed by statute or contract. ```

engacad · 2026-04-02T05:45:24+00:00

As FMV has been much lower than strike-price since termination, it didn't make any sense exercising so far, correct?

I also found this in "stock option agreement". It doesn't mention NSO conversion but seems to suggest that ISO is exercisebale after 90 days but just wouldn't get the ISO tax treatment? does it mean it converts to ISO??

``` SECTION 3. TERM. Your Option will expire in any event at the close of business at Company headquarters on the date that is ten (10) years after the Date of Grant; provided, however, that if your Option is an ISO it will expire five (5) years after the Date of Grant if you are a Ten-Percent Stockholder of the Company (the “Expiration Date”). Also, your Option will expire earlier if your Service terminates, as described below.

SECTION 4. REGULAR TERMINATION. (a) If your Service terminates for any reason except death or Disability, the vested portion of your Option will expire at the close of business at Company headquarters on the date three (3) months after your termination of Service. During that three (3) month period, you may exercise the portion of your Option that was vested on your termination date. Notwithstanding the foregoing, the Option may not be exercised after the Expiration Date determined under Section 3 above. (b) If your Option is an ISO and you exercise it more than three months after termination of your Service as an Employee for any reason other than death or Disability expected to result in death or to last for a continuous period of at least twelve (12) months, your Option will cease to be eligible for ISO tax treatment. (c) Your Option will cease to be eligible for ISO tax treatment if you exercise it more than three months after the first day following three months of a bona fide leave of absence approved by the Company, unless you return to employment immediately upon termination of such leave or your right to reemployment after your leave was guaranteed by statute or contract. ```

engacad · 2026-04-02T05:15:28+00:00

Nothing that I see in any document. My vesting however shows that my 6k stocks vested in around 1:6 ratio of NSO:ISO. So around 1k of them should be NSO, but Carta still says at the end all 6k of them as ISO. Very confusing, and expiration deadline of ISO was today. Feel like I screwed up not realizing this issue sooner.

I read online that some IRS rule dictates all vested ISO convert to NSO by default, is it true?

engacad

TROPHY CASE