kate

/Kate Gifford
Kate Gifford

About Kate Gifford

Kate Gifford is a clinical optometrist, researcher, educator and professional leader. She is also a mediocre runner, voracious reader, decaf coffee addict, experimental paleo chef, fledgling blogger and interstate stepmum.

Kate’s Running Balls

One of my favourite past-times is baking sweet treats which are coeliac, diabetic and paleo friendly, and testing them out on the GJO team – thankfully most are met with resounding success! The reason I want to share these recipes with you is that Diabetes is a big enemy of healthy eyes and is frequently first diagnosed in adults when small changes are seen in the retinal blood vessels during a routine eye exam. There’s mounting evidence of the link between sugar consumption and diabetes across populations (Basu S et al, PLOS ONE 2013), so while we each have different tolerances, it makes sense to reduce sugar consumption. But thankfully your taste buds don’t have to miss out – give this recipe a try!

If you’ve been into my consultation room lately you’ll probably remember seeing my running event medals hanging in amongst my ‘wall of nerd’ framed academic certificates. I like to think that these medals make me appear to be a well rounded person, not just a nerd, but the truth is I’m quite a mediocre runner, a plodder, but I really enjoy it and I love the chance to finish an event where I’m rewarded with a medal. Pictured above are Paul and I with our spoils after the 14km Brisbane City2South in June this year, where Paul scored a massive PB (on his birthday!), and then had to wait another 18 minutes for me to finish! If you look closely at the ‘RUN’ sign, taken in Olympic Park in London on a visit in 2013, you’ll see examples of some terrible running form. The bottom right picture is the result of this recipe!

Paul and I are now training for the New York Marathon on 1st November 2015. The last time we trained for a marathon, two years ago, we were necking high sugar energy gels on our long runs, but neither of us tolerated them well. This time I was keen to find an alternative made from real food – my ‘running balls’ are an adaptation of a rum ball recipe I first tried at Christmas and can be made into the latter through the addition of 1 tbsp of rum – I used the delicious Bundaberg Royal Liquer (chocolate and coffee flavour) for mine. Roll them in dessicated coconut once you’ve formed them for extra Christmas cheer.

These running balls are gluten, grain and dairy free and low-ish in sugar. They’re packed full of good fats with the macadamia nuts and coconut oil for slow burn energy. If you’re more tolerant of sugar than me (which is probably most people), you’ll like them as a snack with your morning coffee. I munch on one of these before a long run and have another every 7-8km along the way, instead of the energy gels I used to eat. By the time I get to the third one, though, they’re getting pretty mushy in the Brisbane heat!

 

Ingredients

1 cup macadamia

1 cup pitted dates

2 cups shredded coconut

1 heaped tbsp cacao powder

50g melted coconut oil

Stevia to taste (I use 1-2 tbsp as the dates are sweet enough)

Throw everything into your food processor and process until well combined. Spoon out a dessert spoon sized volume of the mixture into your hands and form into tight balls with some decent squeeze pressure – you should make around 16. Pop into the fridge when you’re done.
These will get melty and soft if out of the fridge for longer than an hour, depending on the temperature, so could work as a morning tea lunchbox treat. I’m happy to report that they are teenager approved as well.

By | 2018-06-28T07:03:01+00:00 27th September 2015|Just for fun|1 Comment

Three 8 year old Vietnamese kids and OrthoK

In February 2015 Paul and I volunteered a week at the Vietnam National Institute of Ophthalmology in Hanoi, teaching OrthoK fitting to the staff of the Refractive Department. The VNIO is a specialty eye hospital, employing about 500 staff and seeing around 2000 patients per day. I was also there in March 2014 teaching the fundamentals of rigid contact lens fitting, and was greeted with squeezy hugs from Minh Anh (Hanoi’s only qualified optometrist) and Dr Huong (Hanoi’s nicest and most cuddly ophthalmologist) whom I’d worked closely with in 2014 and had kept in touch with since. If you’re wondering why there’s only one qualified optometrist in Hanoi, and indeed only a total of three in a country of 90 million people, read on.

Hanoi had just entered a cold snap as we have arrived, so Minh Anh and Dr Huong brought scarves and extra layers for us today, because they’re so lovely. After three months of relentless 30+ degree heat in Brisbane, though, Paul and I were really enjoying mid-teens temperatures even though the locals were all rugged up! Each morning Paul or I gave lectures to the staff, and then were treated to a tasty lunch at a local street eatery, usually washed down with cinnamon tea. We would then see patients in the afternoon.

On this initial day, our first three patients are all 8 years of age, and all around -5.00. This is generally considered a high level of myopia (shortsightedness), meaning that anything further away than 20cm from their nose is blurred. The younger you are when you become myopic, generally the faster you progress (1) so parents looking to do something to slow down this worsening are wise for two reasons: higher levels of myopia are strongly associated with higher levels of eye diseases like glaucoma, macular degeneration and retinal detachment in adulthood (2) and because very high spectacle prescriptions have been shown to affect quality of life.(3)

Vietnam kids 1 websizee

 

Twin sisters came first – little M only got her last pair of glasses at the end of 2014 and has progressed two more steps of myopia in two months. Her mother said M’s first pair of glasses were only a year ago, and were less than half of the current strength. Her twin sister P has a similar story. After measurement including corneal topography, or mapping of the eye surface to select the best fitting lens, M&P then sat in the waiting room with trial OrthoK lenses on their eyes.

M was reclining in her Dad’s arms with her eyes closed enjoying a toasty winter’s day cuddle. Their mother discussed OrthoK with me through Minh Anh, reassured her daughters and took photos of the two overseas experts discussing trial lens selection with their eye doctors. Mum said she was only -1.00 and her husband is -4.00 – both girls have surpassed their parents’ myopia by only age 8.

Our third patient, a little boy of the same age who soon becomes nicknamed ‘Little Champ’, was lead out of the room with his eyes closed for a similar waiting room nap. We then brought M&P back in to check their lens fitting. M had a reduction in her myopia of nearly half in her 30 minute nap; P a little less. They were shown lens handling along with their mum and dad, and we planned to see them back in the morning. Paul and I gave M&P a koala toy to take home with them which they both seem quite taken with, although their unruffle-able demeanour wouldn’t give it away – they were entirely quiet and calm throughout having eye drops and contact lenses popped onto their eyes.

Vietnam kids 2 websize

 

Around the world there is an increase in children of all ethnicities becoming myopic (4), and the reasons are multifactorial. Minimal time spent outside and high educational demands are key factors. I had an interesting conversation with one of the VNIO ophthalmologists at a dinner held in our honour later in the week. He said his children were myopic, and were getting worse, when they lived in an apartment with no significant outside view. Since they had moved to a higher apartment and could see further from the windows, their eyes had stopped worsening! While there’s probably a bit more to it such as the children getting older, where generally progression will slow down (1), there’s some truth to this observation!

Optometry isn’t a regulated profession in Vietnam, meaning that anyone can set up an optical shop with an automatic refraction machine (which takes an average reading of a spectacle prescription) and call themselves an optometrist or optician. Across the road from VNIO, the street is lined with these optical shops. Unfortunately for a lot of these myopic kids, this means that their glasses aren’t accurate, and whether they are over- or under-corrected, both can lead to worsening of myopia.(5,6)

Little Champ returned and his lenses look good for proceeding to an overnight trial. Mum was then  instructed on lens handling and was struggling a bit, which gave Little Champ the giggles – no sight of tears or even a frowny face! While Dr Huong finished lens care discussions with his mum, Little Champ was folding up a paper plane out of a tissue I gave him earlier and flying it towards his toy koala. We saw him the next morning too.

Our three 5D myopic kids have done brilliantly after their first night in OrthoK. Twin girls M&P both crack smiles when their lenses are taken off, experiencing clearer vision with over half of their myopia being reduced in one night. Little Champ arrives at 9am and peeks in through the glass windowed door, looking a bit squinty as is normal on the first morning when the lenses are worn in for fitting assessment. He stands up in front of the microscope, rather than sitting down, because it’s at the perfect level for his 3 and a half feet of height. He’s been lucky enough to undergo even more overnight myopia reduction than our twin girls, and happily departs with all three due for follow up in another week

 

REFERENCES

  1. Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith III EL, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci 2012;89:27-32.
  2. Flitcroft DI. The complex interactions of reintal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res 2012;31:622-60.
  3. Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, Tullo A. Quality of life in myopia. Br J Ophthalmol 2000;84:1031-4.
  4. Dolgin E. The myopia boom. Nature 2015;519:276-8.
  5. Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vis Res 2002;42:2555-9.
  6. Gwiazda JE, Hyman L, Norton TT, Hussein ME, Marsh-Tootle W, Manny R, Wang Y, Everett D; COMET Group. Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Invest Ophthalmol Vis Sci. 2004 Jul;45:2143-51.

 

By | 2018-06-28T07:03:01+00:00 22nd September 2015|Contact Lenses, Eye conditions|0 Comments

Horsing Around

It was a sunny, slightly chilly Sunday morning at my parents’ place at Swanfels, outside of Warwick, when I decided to wander out to see what Dad was up to in his shed, and say hi to his two horses Kinsman and Pepper. Pepper can be a tetchy horse, and after I fell off him on Christmas Day 2006 my horse riding days have concluded, but on Sunday he was lapping up the attention I was giving him, enjoying the head and neck rubs and not wanting them to end. I spent quite a bit of time looking at his fascinating dark eyes, and wondered what he could see. So I asked Dr Google (veterinarian version).

It turns out that there’s quite a few scientific articles on horse vision, including one review comparing horse and human vision published in the International Journal of Zoology a few years ago.(1) Generally, a horse doesn’t see as well as we do in terms of clarity of vision but sees better than a dog or a cat. Pepper can’t focus well up close to see detail, but as he doesn’t read very much, this doesn’t matter to him. Horses have dichromatic vision, which means Pepper isn’t colour blind but only sees shades of blue and green, and cannot detect red, similar to the experience of some people with colour vision deficiency. Below is an image I found hilarious, from the website of the Equine Research foundation (www.equineresearch.org) of a horse undergoing colour vision testing. He’s doing it wrong! Hahaha!

Horsing around in text image

A horse’s field of vision is designed to allow them to keep ‘half an eye’ on everything. If you could see around your whole head, you would have a field of vision of 360 degrees, and horses almost can. A human with normal vision will be able to see a field of vision of almost 180 degrees out to either side horizontally, with about 120 degrees of this being binocular, meaning we use two eyes and can better appreciate depth. By comparison, with its eyes set on the side of its head, a horse’s field of vision is about 350 degrees – most of this is monocular vision, meaning the right eye sees things on the horse’s right side and the same for the left eye. The horse only has about 65 degrees of binocular vision, which he will use to spot distant objects when his head is raised. When he holds his muzzle down and his head is vertical, he will have depth perception to see objects in front of him on the ground. Apparently pulling a horse’s head down as occurs in particular equestrian disciplines shortens his field of view even more to what’s right in front of him.

But despite this, the horse has hardly any blind spot, fitting its general characteristics as a ‘flight’ type of animal, being a herbivorous prey species in the wild.

The equine eye is the largest of any land mammal, being around 40mm (2) compared to the human average of around 24mm. I researched the size of an elephant eye just to check this claim, but it turns out their eyes are around 34mm long.(3) On my interesting travels down the Google rabbit hole (I know you’ve been there too!) I even read an article equating eye size in land mammals to their speed. Apparently the fastest runners in the animal kingdom generally have the biggest eyes when compared to their body size, improving sensitivity of vision which is helpful when you’re moving quickly through the environment. Even after adjusting for body size, researchers found that nearly 90% of the variation in eye size amongst mammals related to maximum running speed.(4) There’s even evidence that male horses have exhibited superior visuospatial ability compared to females, again likely linked to speed, and possibly contributing to the relative success of male over female horses at high levels of equestrian competition.(1)

We take for granted that humans will have variation in our visual ability from person to person. This is also the case for horses, and could influence their performance, especially in equine sports where assessing vision could predict how well a particular horse may perform. The horse has a unique relationship with the human, where two very different visual systems have to work together to control what is essentially one pattern of movement.(1)

So it turns out that my friend Pepper can’t see clarity, colour or close objects as well as me, but has bigger eyes and an almost 360 degree field of view. He also tolerates the chilly weather much better than me, so after an extended pat session I left him to his Sunday morning and headed inside for a cup of tea.

 

REFERENCES

  1. Murphy J, Hall C, Arkins S. What horses and humans see: a comparative review. Int J of Zoology 2009, Article ID 721798.
  2. McMullen RJ, Gilger BC. Keratometry, biometry and prediction of intraocular lens power in the equine eye. Vet Ophthalmol 2006;9(5)357-60.
  3. Bapodra P, Bouts T, Mahoney P, Turner S, Silva-Fletcher A, Waters M. Ultrasonographic anatomy of the Asian elephant (Elephas maximus) eye. J Zoo Wildl Med 2010;41(3):409-17.
  4. Heard-Booth AN, Kirk EC. The influence of maxiumum running speed on eye size: a test of Leuckart’s Law in mammals. The Anat Record 2012;295:1053-62.


By | 2018-06-28T07:03:01+00:00 17th September 2015|Just for fun|0 Comments

Changes to Medicare for optometrist consultations

The 2014 federal government budget announced wide sweeping changes across Medicare, and although it went largely unreported in the news, optometry has also been affected. As 2015 began, three major changes to Medicare funding for optometry services have occurred.

Firstly the Medicare scheduled fee and rebate for optometry services have both been cut by 5%. Since the late 1990’s, the scheduled fee has increased at a rate below CPI, or since 2012, not at all.  Now it has been cut and will be frozen again until mid 2018. These changes see the government rebate fall further behind the true cost of providing quality eye care.

Secondly, there have been changes to eligibility of patients for a full comprehensive eye examination rebate. Prior to 1st January 2015, if you were without symptoms, Medicare patients were eligible to receive the full rebate for a comprehensive eye examination once every two years. From 1st January 2015 patients aged 65 years and over are now eligible for the full rebate for a comprehensive eye examination every year, but patients under 65 years are now only eligible for the same every three years. This is a positive change for older Australians, but for those under 65, this is not a positive move in ensuring the nation’s eye health and it is unfortunately not evidence based.

It’s important to note that if you are symptomatic, you should present to your optometrist at any time as the full rebate may apply in your instance, even if it falls within the one- or three-year interval.

Finally, prior to 1st January 2015 the Medicare fee schedule for optometrists was capped. This means that unlike most other healthcare providers, optometrists were unable to charge for their professional services beyond the scheduled fee.  Any fees billed above the scheduled fee became ineligible for patients to claim a Medicare rebate.

Optometry was the only health profession to be subject to government set capping, in place since the profession became included in Medicare in 1975. Now optometrists may set their own fees for clinical services under Medicare. This means that, in line with other healthcare providers, optometrists can charge above the Medicare scheduled fee without impacting the patient’s ability to claim the Medicare rebate.

What does this mean for you, as a patient of Gerry & Johnson Optometrists?

  1. Our professional consultation fees at GJO will now be standardised, instead of varying up and down dependent on the Medicare rebate as they have previously. Click here for information on our professional fees schedule, which we have adopted in line with the recommendations of Optometry Australia.
  2. We will still use the Easyclaim system we have been using since early 2009, where we claim your Medicare rebate for you on the spot and it is paid back onto your cheque or savings card. Your Medicare rebate will unfortunately reduce, however people over 65 may see an increase in their overall rebate amount over the course of their clinical care.
  3. We are no longer able to bulk bill concession card holders and patients over 65 as we have previously, but have introduced a discount on optical products to assist with balancing costs.
  4. We are now able to include use of our cutting edge diagnostic technology in all consultations without additional charge, or at a reduced fee. This will be explained to you where relevant to your clinical care.

Our focus still remains entirely on providing you with the pinnacle of professional care for your vision and your eye health.

By | 2018-06-28T07:03:02+00:00 30th January 2015|Eyesight and Health, In the news|0 Comments