Assessing Risk for the Child Athlete
By Danielle Crull, ABOM
Release Date: May 22, 2013
Expiration Date: January 1, 2016
Protecting children's eyes has always been important for the ECP. In the three-part CE series "Protect, Prescribe and Present" and "A Focus on Kid's Eye Health," Luxottica educational grants bring focus to a critical part of the optician's education. This Luxottica educational grant discusses the sport eyewear needed to protect and prevent children's eye injuries.
Upon completion of this program, the participant
should be able to:
- features of sport protective eyewear.
- Learn an effective approach to recommending sport eyewear.
- Identify who can benefit from sport eyewear.
Danielle Crull, ABOM, owns A Child's Eyes, an independent optical store specializing in pediatrics in south central Pennsylvania. She became a Master Certified Optician in 1997, and her thesis topic concerned the differences between dispensing to children and adults. She lives in Dillsburg, Pa., with her husband and three children, all of whom work in her business.
This course is supported by an educational grant from LUXOTTICA.
This course is approved for one (1) hour of CE credit by the American Board of Opticianry (ABO). Course SJHI276
When it comes to putting on
your best game face, there is
a lot of debate about how
that should look. For years, organizations,
parents, athletes and congressmen have
all debated this issue. It's no secret that
when it comes to sports, eye injuries are
We've all heard the statistic compiled
by Prevent Blindness of America in 2001
that 38,000 people suffered a sports eye
injury serious enough to require treatment in an emergency room. Even more
sobering is that this number does not
take into account the number of people
suffering injuries who sought treatment
in a primary care doctor's or eye doctor's
office, or just at home.
What about the injury that you can't
see from ultraviolet radiation during long
hours outdoors in the sun? Injury also
means sunburn and the accumulation
of UV in eye structures and the skin
surrounding the eye.
We know eye injuries and sports go
together like a ball and a glove, but what
can we do about the problem? Probably
the most startling statistic of all is that
simply wearing the proper protective
eyewear such as sport glasses can prevent
90 percent of these eye injuries. If we
could reduce a risk by 90 percent in other
medical disciplines, we would consider it
a cure or even a miracle. While coaches
and congressmen fight it out, we as opticians play a crucial role in educating and
encouraging our customers with regard
to sport eyewear.
ASTM 867-5309… WHAT?
When it comes to sport eyewear, we must
consult the American Society for Testing
and Materials. Founded in 1898, the
ASTM is responsible for testing and
developing safety standards for numerous product groups, including sport and
safety eyewear. The standard that specifically relates to eye protection for most
sports is ASTM F803. Sports that fall
under this standard are baseball, softball,
basketball, field hockey, women's lacrosse,
squash, racquetball, soccer, tennis, volleyball and badminton. Other applicable
standards include the ASTM F1776,
which covers the sport of paintball.
The ASTM standard specifies what
level of impact resistance that eyewear has
to surpass in order to be certified as safety eyewear for each sport. The primary
requirement for safety eyewear of all
kinds is that it be fit with polycarbonate
lenses. As you would expect, the ASTM
F803 standard covers impact resistance,
but it also sets standards for cleanability,
optical clarity and peripheral vision. It
even specifies the frame material's resistance to sweat and oils, which could
compromise the materials over time.
Each frame to be tested is mounted on
a head form to simulate the athlete. A
thin layer of pressure-sensitive paste
is applied to the eyes and upper and
lower eyelids. A ball from each sport is
propelled at varying velocities at the
head form, which is then rotated to test
impacts at six different angles, headon, side impacts at 90 degrees and at
45 degrees. For example, the testing
requires a baseball (for ages 9 to 14 years
old) to be accelerated to 55 mph and a
racquetball at 90 mph. After each test,
the frame is examined for breakdowns
in the materials as well as inspecting the
paste for signs of impact. A frame that
passes all the requirements of the ASTM
F803 standard can be marked with the
When looking for protective eyewear
for particular sports, they should specifically say they meet or exceed this
standard. It's best to let the moms and
dads know when they do or do not.
FITS LIKE A GLOVE
Manufacturing to standards is not the only
thing that insures protective sport eyewear
will work properly. It is important that
the eyewear fits properly. When looking
to protect an eye from impact injury, there
are four areas to consider: 1.When there
is direct contact with the eyeball, such
as corneal abrasions from finger pokes. 2.Contact between the eyes. 3.Contact at
the cheekbone, and 4.Contact at the sides
of the head near the temples.
Protecting the eye means the frame must
fit securely around the natural protective
home of the eye, the bony orbit. The bony
orbit consists of seven bones: frontal, zygoma, maxilla, lacrimal, ethmoid, sphenoid
and palatine. A direct impact can fracture
any one of these bones surrounding the
eye, causing a blowout fracture. This severe
type of injury can cause the muscles of the
eye to become entrapped in the bone, which
often leads to serious and sometimes permanent vision loss. Therefore, when you put
the sport eyewear on your patient, look at
not just the front, but also the sides. A well-fitting pair of sport eyewear should cover
the entire bony orbit, above the eyebrows,
down over the cheekbones and fit securely
around the sides of the head.
It is important to look closely at the frame
during the initial fitting. Do you see areas
where fingers can get in? Is there space
between the frame and the sides of the
head? If so, the frame is too large. Does the
frame cover the brow bone (the frontal
bone) and rest securely back on the nose? If
not, then you need to consider adjusting or
even trying a completely different style.
Sport eyewear should also be comfortable, so don't be afraid to ask, "How do they feel?"
Testing them out promotes confidence right
away. We have a portable basketball net right
in the parking lot outside our office and
encourage our little patients to try them out.
Basically, the glasses should feel like they are
a part of them—they should fit like a glove.
Probably the toughest part of our job is
communicating the importance of the right
outdoor eyewear and sport eyewear to parents. Fitting children offers a unique sales
problem. We can't lose sight of the fact that
even though the child is our patient, he or
she is not our customer. In most sales situations, the patient and customer are the same
person, but our real customer is the parent
and most often Mom. We have to convince
Mom that sport eyewear is worth the price
by explaining what they are actually doing.
Nearly every parent who walks into my
office is worried about little Johnny ruining his glasses when he's playing sports in
his fashion eyewear. The frames could be
broken by being knocked to the ground
and stepped on. They never recognize the
fact that ruining his glasses is inconsequential to the risk of ruining his eyes when he's
playing sports. It's hopeless trying to justify
the purchase of a $250 pair of sport goggles
to protect a $250 pair of street eyewear.
However, the balance changes dramatically
when you point out that sport
eyewear isn't designed to save his
glasses, they are designed to save
I often remind parents and kid
how they are required to wear
mouth guards, even though, honestly, false teeth could work as well as real
teeth. If we are so focused on protecting our
teeth, what about protecting our eyes? "False
eyes don't work nearly as well as false teeth."
When you frame things in that light, parents
will find it hard not to place a high value on
the only two eyes their child will ever have.
The other request often asked is,
"Couldn't my child just use an
elastic sport band that would hold
the glasses on more securely?" This is something that greatly
distresses me. A sport band is a
group of people marching on the
field at halftime, blowing their
trumpets and beating drums. When we put an elastic strap on
the back of metal or plastic glasses, we increase the tension on the
bridge of a frame that probably already
isn't strong enough to withstand an impact.
If the bridge breaks with the sport band
pulling back on the temples, it will pull the
frame directly into the face. When that
happens, the patient is likely to sustain
some kind of eye injury or, at the very least,
abrasions on the face. So let's leave the
band to the sidelines.
Did you notice the great parental misconception above? The family wanted to purchase sport frames and sport bands to save
their child's fashion eyewear. This assumes
that sport eyewear's main purpose is to
replace existing glasses, which is inaccurate.
Their main purpose is to protect eyes that
are at risk during dangerous activities.
Once the optician's mindset switches over
from replacement to risk mitigation, we
begin to see that many more young patients
will benefit from wearing sport frames.
When assessing risk, we need to evaluate
the type of sport, the kind of play and the
skill (or lack of skill) of the players. Every
family with children in contact sports
should be encouraged to consider sport
eyewear. This includes not only those with
corrective eyewear, but also those wearing
contact lenses and even those who do not
wear corrective lenses at all.
What is a contact sport? A contact sport
is technically defined as any sport where
there is the potential for physical contact
between players or a sport that has moving
projectiles, like baseballs, hockey pucks
and paintballs. Contact may be between
players or with inanimate objects.
The first category of athlete in the chart
(Fig. 2), those wearing corrective eyewear,
enjoy clear benefit from sport eyewear.
Consider this: In a contact sport, glasses
are just another potential projectile, but one
that is positioned a quarter-inch away from
the player's eyes. All players have an equal
risk with unprotected eyes, which is bad. But a competitor wearing glasses has
the added risk that their eyewear
becomes a secondary projectile
resulting from the original collision.
What if we take away the glasses
entirely? I have many young children
who grow into their teens and naturally move on to contact lenses. Contact
lenses have advantages over glasses because
they have a wider field of vision, and I
understand the freedom that the athlete
experiences when wearing them. It may
also have a small advantage that it provides
a tough membrane over the cornea, which could prevent abrasion during direct
contact. However, in the long run, there is
an increased risk of corneal abrasions
from dirt and other debris getting under
the contact lenses during play. Obviously,
the child has no protection from impact
during play. This type of protection will
only be afforded by wearing the proper
This brings us to the last category regarding the frame, i.e., athletes who do not wear
any type of corrective lenses at all. Although
wearing glasses or contact lenses doesn't
increase their risk, clearly their risk has not
been decreased at all. Anyone engaging in
sports, particularly contact sports, is at risk.
When families come in and only one of
their children wears glasses, I am quick to
let them know that their other children are
at risk too when they play without sport
eyewear. It's our duty to inform and help
patients and parents make educated decisions. It's up to them should they choose
not to, but if we choose not to tell them,
then we have not done our duty. Most parents don't want to send one kid on the field
with a risk reduced by 90 percent and send
the other out without any protection at all.
IN THE HUDDLE
Mom and Dad understand the benefits of
sport eyewear; little Johnny is confident
going out on the field because he knows he
is well-protected. Now we can "spread out
the defense" by finding other ways to use
the sport glasses. Sport and protective eyewear can be worn in many other places
than just traditional sport venues. Don't be
afraid to let them know that they can be
worn for riding a bike, on the playground
and at recess, sledding, even on roller coasters. Their new sport eyewear can also serve
as a backup pair of glasses, and if they
decide to use photochromic lenses, this can
also be helpful until the budget allows a
quality, great pair of sunglasses.
Once parents are on board, it's crucial the
child understands all the benefits
to wearing sport eyewear. After
all, the glasses are only good if the
child will wear them. Fortunately,
goggles are not what they used to be.
In fact, I make it a rule to never even
call them goggles. "Goggles" sounds
silly and ridiculous, who could ever
take that word seriously? Gargle,
giggle, goggles. In my office, we call it
sport eyewear or sport glasses.
On a cosmetic level, we can now
offer some pretty sweet-looking sport
eyewear. Liberty Optical's line of
RecSpecs come complete with a variety of
colors, even team colors. You can also find a
wide variety of Leader brand sport eyewear
by Hilco. On the other hand, we don't want
the kids to just look good—we want them
to feel good about wearing them.
This is when it's time to huddle up and
really show off the features. Let your little
friend know just how protected his or her
eyes are in this new high-tech sport eyewear.
Tell them that the sport eyewear absorbs
the impact and keeps that impact from
transferring to the head and eyes to make it
a less painful experience. Most kids will
identify with getting hit or knocked down
while playing. Let them know they can feel
safe and are safer than the other players on
the field who aren't wearing sport eyewear.
I have found that kids who normally would
shy away from getting hurt or breaking
their regular glasses now enjoy a freedom
that allows them to play more competitively.
What competitive kid doesn't want to know
he or she has an advantage on the field
over other players?
Brands also influence children and their
parent's decisions. For non-contact sports
that do not require ASTM-certified frames,
the driving force is appeal. Brands make a
difference—use them in your practice. Kids
will want to wear the glasses that their older
siblings like so use junior versions of the
popular aviator and Wayfarer styles.
Lenses are the other half of sport eyewear
protection. Lenses must be polycarbonate
for ASTM impact compliance and therefore will also be 100 percent UV-absorbing. For other non-ASTM covered sports,
polycarbonate and Trivex material are the
material choices. Remember that the
child's eye is more transparent to UV radiation so quality outdoor lenses like photochromics and polarized lenses make a real
difference. For more background about
UV and children, visit 2020mag.com/CE
for the CE "A Focus on Kid's Eye Health."
States are slowly taking up legislation about
sport eyewear and a few, like New Jersey
and Florida, are passing non-penalty laws
requiring sport eyewear. There is no good
reason for opticians to be waiting for governmental involvement. As an industry, we
have accepted that polycarbonate or Trivex
lenses are the preferred material for children's eyewear because they are the safest
lenses available. Clearly, we already recognize that children are inherently at a greater
risk. It is only a natural extension of this to
recommend sport eyewear for all children
engaging in sports.