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GAME FACE
Assessing Risk for the Child Athlete

By Danielle Crull, ABOM

Release Date: May 22, 2013

Expiration Date: January 1, 2016

Learning Objectives:
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:

  1. features of sport protective eyewear.
  2. Learn an effective approach to recommending sport eyewear.
  3. Identify who can benefit from sport eyewear.

Faculty/Editorial Board:
Mark Mattison-ShupnickDanielle 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.

Support:
This course is supported by an educational grant from LUXOTTICA.

Credit Statement:
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 common.

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 ASTM certification.

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.

figure1

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.

HOME PLATE

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 his sight.

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.

SPORT BANDS?

figure2The 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.

THREE-POINT PLAY

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 sport eyewear.

TextThis 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

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

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."

THE LAW

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.