Photograph by Ned Matura
By Paul Berman, OD, FAAO
Our culture is sports crazy. We all talk about sports, watch sports on TV and introduce our children to sports at an early age. According to a Harris Poll, 87 percent of parents of boys and 86 percent of parents of girls want their children to play organized sports.
What is our obligation as eyecare professionals to protect their eyes while playing sports? The risks are great—certainly larger than eye disease at young ages. According to the National Eye Institute, eye injuries are the leading cause of loss of vision in one eye (second for two eyes after cataracts) and 27 percent of all eye injuries are sports related. This increases to 40 percent for children between the ages of 11 to 15. Loss of vision at an early age can affect general performance, athletic performance and career options.
Eye injuries pose an even greater threat for patients with certain vision problems. People with one good eye (20/40 or worse in bad eye) are 150 times more likely to go blind and 50 percent of that is caused by trauma according to Paul Vinger, MD, a leading authority on sportsrelated eye injuries. Sports-related eye injuries occur frequently. According to Protect Blindness America, every 13 minutes a sports-related eye injury requires a visit to the emergency room. Considering the potential for eye injury, why isn’t protective eyewear required for all children who play sports?
The federal government feels so strongly about the need to increase the utilization of sports protective eyewear that they included it as one of the 10 vision objectives of Healthy People 2010. It reads, “Increase the use of appropriate personal protective eyewear in recreational activities and hazardous situations around the home.” The American Optometric Association has passed a resolution and the American Academy of Ophthalmology, the American Academy of Pediatrics, the World Eye Injury Registry and Prevent Blindness America have issued position papers in support of this topic as well. All of these organizations encourage eyecare professionals to prescribe sports protective eyewear for children.
How do we define sports protective eyewear? More than just a stylish sports frame with a UVblocking lens, sports protective eyewear must meet specific performance standards set by American Society for Testing and Materials (ASTM) and American National Standards Institute (ANSI). For example, sports frames must meet ASTM F803, which includes specific standards for squash, tennis, basketball, badminton and handball, as well as racquetball, paddleball and three levels of baseball (youth: 40 mph, mid: 55 mph and adult: 85 mph). All of these standards involve performance tests conducted on head forms with various balls being shot at specific speeds and angles. In order to pass, there cannot be any displacement of the lens from the frame, any displaced fragments or complete fracture of a frame or any touching of eye socket or face form. For basketball, there is an additional test called the finger poke test where a dowel of a specific width cannot fit anywhere between the head form and the frame.
CHOOSING A LENS
Lenses used in sports protective eyewear must meet the ANSI standards for impact resistance. Although there is no specific ANSI impact standard for sports lenses, the accepted process is to use the highest ANSI industrial safety standards. The ANSI standards are reviewed every five years and must be reviewed, reaffirmed or withdrawn by the 10th anniversary. Recent revisions to ANSI Z87.1 - 2003 have two impact standards—basic and high. The high standard, which is used for sports, states that lenses must be made of polycarbonate or PPG’s Trivex monomer, materials that are significantly more impact resistant than standard plastic or glass. The lenses must have a minimum 2mm thickness and be able to pass a ballistic test of a metal ball fired at 150 feet per second. In addition, both of these materials block UV, which is very important for young athletes who play sports.
In my optometric practice I have found photochromic lenses to be great for sports. As sports often occur indoors and outdoors, a lens that automatically adjusts to changing light conditions is an ideal choice. These lenses are made in both polycarbonate and Trivex. A photochromic lens can also enhance the look of the sports frames, making the eyewear more appealing to children.
There are other tints that some athletes prefer and you should discuss them with your patient athletes. My experience is that it often depends on the weather, with athletes preferring a lens that blocks short wave lengths and have an orange/brown color on cloudy days. For sunny days, I strongly recommend polarized lenses. Nike Max-Sight contact lenses by Bausch & Lomb in orange and gray also improve the contrast in different lighting situations.
Having been in private practice for over 30 years, I remember when I would recommend sports protective eyewear to a child and they would say, “I’m not going to wear that!” With new frame and lens styles now available this is no longer an issue.
Some of the new frame styles—both ASTM F803 approved and those that are not—have more of a “wrap” effect and require an eightbase lens. This lens, when properly fabricated, gives less peripheral distortion and is great for a person playing a sport where peripheral vision is required.
How do I get my patients, children and adults, to protect their eyes while playing sports? It starts with our “Welcome” and “Welcome Back” forms where we ask patients what sports they play.
We also have brochures in our waiting room about sports protective eyewear. Our dispensary is adjacent to our reception area and patients must pass by our optical Sports Center with sports protective eyewear prominently displayed. After pre-testing, I go over the initial form and ask every child, “Do you play sports?” and “What sports do you play?” These are good questions to develop rapport. Then I ask if they play on teams or with friends, and how serious they are about sports. Next I complete their visual and eye health exam.
After reviewing the findings, I analyze their refractive errors, the sports and even sometimes the position they play and make eyewear recommendations including sports protective eyewear. I strongly suggest that amblyopes or patients with decreased vision wear protective eyewear when they play sports.
In my office I have a buzzer that summons my staff to my office. When they arrive I do the hand-off, tell them what, if any, additional tests are needed and what my eyewear recommendations are including any sports protective eyewear, lens materials and if the lens should be photochromic. I have also found it helpful to write two prescriptions, one for dress eyewear and one for sports protective eyewear when indicated. My staff then escorts the child and his parents to our dispensary where they see a wide selection of sports protective eyewear.
When necessary they receive additional information in a manual, provided by the Coalition to Prevent Sports Eye Injuries (an organization of which I am chairman), which lists the risks of eye injury by age and sport. This information is available to members of the Coalition to Prevent Eye Injuries at our web site, www.sportseyeinjuries. com/. A media kit, fast facts and a practice locator are also available through the site. In addition, I have a decal on my door that identifies my practice as a Coalition Approved Sports Eye Injury Prevention Center. Membership in the group is free.
New Jersey recently passed legislation mandating that any child who wears corrective eyewear must wear sports protective eyewear while participating in certain organized community or scholastic sports. These sports are racquetball, squash, tennis, women’s lacrosse, basketball, women’s field hockey, badminton, paddleball, soccer, volleyball, baseball and softball. This effectively outlaws street eyewear on the playing fields of New Jersey.
On a nationwide basis, various groups are also campaigning for a public health mandate requiring people who have a significant prescription to wear contact lenses or sports protective eyewear when playing sports.
While protecting our patients is always a number one priority, research by Dr. Vinger has found that one in 12 with a serious eye injury will seek legal counsel and one in 20 with a less severe injury will seek legal counsel. By recommending protective eyewear we not only protect our patients but our businesses and families as well.
Seat belts, child seats, bike helmets and sports protective eyewear are items that protect people against permanent injury. It is time for us to proactively protect our patients, particularly the children, from this leading cause of lost vision. Follow the three “I”s: Inquire if your patient plays sports; Inform them about sports specific risks of eye injury; Introduce appropriate protective eyewear. We as eyecare professionals can reduce the needless loss of sight.
Paul Berman, OD, FAAO is chairman of the Coalition to Prevent Sports Injuries and director of professional relations and education for Liberty Sport.