Sports-related eye injury. A preventable problem

SURVEY OF OPHTHALMOLOGY

VOLUME 25

PERSPECTIVES

NUMBER 1 JULY-AUGUST

l

l

1980

IN REFRACTION

MELVIN L. RUBIN, EDITOR

Sports-Related

Eye Injury.

A Preventable

Problem

PAUL F. VINGER, M.D.

Lexington, Massachusetts Abstract. Sports-related eye injuries pose a substantial and preventable problem. Ophthalmologists, by educating their patients regarding the risks of eye injuries in various sports and the benefits and availability of protective equipment, have the potential to prevent injury to well over 100,000 eyes each year. General guidelines and recommended levels of eye protection for various sports are given. The appendix lists suppliers of protective equipment. (Surv Ophthalmol 2547-51, 1980) Key words.

protective equipment

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sports related eye injury

0

phthalmology, as a discipline, has neglected a major cause of blindness sports eye injuries. The average ophthalmologist sees over fifty patients with sports eye injuries for each new melanoma (see footnote on next page) yet the literature and funds research overwhelmingly emphasize the rarer diseases. Why? Perhaps because, as ophthalmologists, we are trained to treat disease, we feel more comfortable with diseased eyes than with healthy eyes that only have the potential of pathology. Somehow, the discussion of injury prevention makes many of us “surgeons and healers” feel like technicians. However, as primary eye care providers, our responsibility in this area cannot be denied. Table 1 hints at the magnitude of the problem of sports-related eye injuries. Truer estimates would be obtained by multiplying

* trauma

each of the figures in the table by 3-5, since

more patients present to private offices than to hospital emergency rooms. The National Society to Prevent Blindness estimates that 90% of the sports-related eye injuries are preventable. The widespread mandatory use of hockey face masks has prevented over 70,000 projected eye and face injuries in the 1,200,OOOprotected players at an estimated savings to society of over $lO,OOO,OOO last year alone. Ophthalmologists are urged to take a more active leadership role in injury prevention. Communities rightly expect their ophthalmologists to have answers to questions on injury prevention and, by educating our patients regarding the risks of eye injuries in various sports and the benefits and availability of protective equipment, we have the potential ability to prevent injury to well 47

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Surv Ophthalmol

25 (1) July-August 1980

VINGER

TABLE 1 Estimated Number of Product-related Eye Injuries Treated in Hospital Emergency Rooms for Selected Sports: U.S., 1973-l 978

Sport TOTAL Baseball Basketball Tennis, badminton, squash Football Bicycling Sportsball, not specified Gas, air, Spring operated guns Hockey, all kinds Volleyball : Soccer

Total 1973-1978

1973

1974

1975

1976

1977

1978

126,268

16,743

17,417

18,047

22,385

25,268

26,408

36,419 19,869 18,049 11,961 7,856 11,382

5,288 2,127 1,679 1,620 1,069 1,293

5,416 3,370 1,719 2,018 1,244 730

4,755 2,563 2,751 1,439 1,783 1,318

5,371 4,037 3,519 2,275 923 3,297

6,918 3,466 4,699 2,291 1,138 3,137

8,671 4,306 3,682 2,318 1,699 1,607

8,081 6,717 3,028 2,906

1,267 1,832 332 236

1,552 1,037 34 297

1,489 1,251 315 383

1,288 651 438 586

1,150 629 1,095 745

1,335 1,317 814 659

Observations

(1) Hockey injuries are decreasing as a result of protective facemasks. (2) Although hockey injuries have decreased dramatically to players wearing face protection, a significant injury problem remains for unprotected players. (3) There is an upward trend of injuries in baseball, basketball, and football. (4) Injuries from airguns and cycling continue at a steady rate. (5) There is steady increase in sports-related eye injuries. Source: Unpublished data from the Consumer Product Safety Commission provided to the Operational Research Department, National Society to Prevent Blindness, New York. *“.50 patients with sports eye injuries for each new melanoma.” (see page 47)

This statistic was gathered from two sources: (1) the relative incidence of sports eye injuries to melanomas that we see in a large private practice of fulltime ophthalmologists, and (2) extrapolation from national data as follows. The incidence of melanoma has been estimated at 0.6/100,000 or approximately 1200 new cases per year.’ The National Society for Prevention of Blindness estimates that over 100,000 eye injuries result from play or sports to school-age children alone. The totals from the Consumer Products Safety Commission of over 26,000 eye injuries from selected sports in 1978 probably reflects approximately 25% of the total eye injuries which actually occur. This low estimate of injuries by their data collecting system is due to the fact that they extrapolate data from visits to emergency rooms and do not gather data from visits to private offices. They also collect data concerning product-related injuries and might not necessarily collect all athletic injury data. If it is conservatively estimated that the actual athletic eye injury rate lies somewhere between the Consumer Product Safety Commission estimates and those of the National Society for Prevention, a reasonable figure of 60,000 eye injuries from sports could be presented. This figure is fifty times the incidence of new melanomas, and this is consistent with our office experience.

over 100,000 eyes each year.

General Guidelines Table 2 outlines the various recommended levels of protection, and the appendix provides a listing of manufacturers and suppliers of protective equipment. The following are general guidelines which cover most sports and most participants in these sports. Of course, these guidelines, as well as the recommended levels of protection, should be modified as new data and standards are developed. HELMETS Sports which involve high speed collisions with other players, sticks or immobile objects (football, hockey, lacrosse) require that eye protection be considered in the concept of

head protection. Absorbed energy must be transmitted through a facemask into a helmet specifically designed to dissipate the energy and prevent brain injury. Standards are available for motorcycle helmets, football helmets, hockey helmets and hockey facemasks, but are lacking in other important total

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TABLE 2 Recommended

Levels of Protection

COLLISION

SPORTS

Certified helmet plus: Safest

(I)

Hockey facemask, fine mesh, certified Hockey Equipment Certification Council (HECC), Canadian Standards Association (CSA), ASTM

Adeauate

i:l

Hockey facemask, large mesh, certified (HECC, ASTM) Football facemask OTHER

SPORTS

Safest (1) Polycarbonate (2)

industrial safety lenses (ANSI Z 87.1) mounted in industrial frame with clear sideshields or polycarbonate injection molded frame CR 39 industrial safety lenses (ANSI Z 87.1) mounted in frames described in (1) above

(3)

Piano injection molded polycarbonate

eye protector (Pro-Tee)

Adquate (4) Polycarbonate

(5)

industrial safety lenses (ANSI Z 87.1) mounted in industrial or sports frame without sideshield CR 39 industrial safety lenses (ANSI Z 87.1) in frames described in (4) above. (Note: Industrial glass safety lenses are usually too heavy for athletes.)

Adequate for tennis/badminton (6) Streetwear eyeglasses with plastic lenses Not recommended for athletes (7) Streetwear eyeglasses with glass lenses (These pose definite hazard of eye laceration if struck with

(8) (9)

force.) Contact lenses (These offer no protection.) Bare eyes

Note: Protective devices decrease but do not eliminate the chance of injury. The above recommendations are subject to change pending future data.

areas (football facemasks, horseback riding helmets, lacrosse helmets and facemasks, baseball helmets and most other “protective devices”). INDUSTRIAL SAFETY SPECTACLES

As a general rule, athletes participating in sports which involve a ball, racket, poking fingers, fists or elbows (basketball, racket sports, baseball, etc.) could obtain adequate protection with industrial safety spectacles (ANSI Z 87.1). Clear sideshields provide protection to the exposed lateral side of the eye. Plastic (polycarbonate or CR 39) are lighter and stronger than hardened glass. Players who ordinarily wear spectacles could have their prescriptions made in plastic industrial safety lenses and mounted in industrial safety frames (many suppliers),

sports frames (CRISS, American Optical) or injection molded polycarbonate frames (through opticians). Players who ordinarily do not wear spectacles could achieve protection with plano polycarbonate industrial lenses or injection molded piano’ polycarbonate eye protectors (Pro-Tee). For the racket sports, lensless eye protectors of polycarbonate (Pro-Tee) or wire (Champion) are available. STREETWEAR SPECTACLES

Streetwear spectacles with plastic lenses offer adequate but not complete protection for tennis and badminton, but not for squash and racketball which require the strength of the industrial ANSI Z 87.1 standard. Glass streetwear spectacles are not

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Surv Ophthalmol 25 (1) July-August

1980

recommended for athletes. They are heavier than plastic, shatter more easily and have lacerated several eyes, especially in squash players. Industrial strength glass lenses have a greater tendency to shatter than their plastic counterparts and are so heavy they tend to fly off the face with rapid starts and stops. OTHER CONSIDERATIONS

Contact lenses offer no eye protection whatsoever. A practitioner would be negligent to fit an athlete with contact lenses and not advise the athlete that there now exists a greater risk of injury. Contact lens wearers should have the same level of protection advised for players who ordinarily do not wear spectacles. Divers should have their spectacle prescriptions bonded to the inner surface of high quality diving masks. Contact lenses are not advised as loss of the lens under water (which happens easily if the mask leaks just a little) could result in loss of orientation for the highly myopic or hyperopic diver. One-eyed children should wear safety glasses at all times. They should not play contact or collision sports. If for psychiatric reasons, participation is required, then for hockey, football, field hockey, lacrosse, etc., safety glasses should be worn beneath the helmet-facemask combination. A fine mesh wire hockey face shield should be substituted for the bar type football facemask.

References 1. Pashby TJ: Eye injuries in Canadian hockey. Phase II. Can Med Assoc J 117:671-678, 1977 2. Pashby TJ: Eye injuries in Canadian hockey. Phase III. Can Med Assoc J 121:643-644, 1979 3. Pashby TJ, Pashby RC, Chishom LDJ, Crawford JS: Eye injuries in Canadian hockey. Can Med Assoc J 113:663-666, 674, 1975 4. Scoto J, Fraumeni JF, Lee JA: Melanomas of the eye and other non-cutaneous sites. J Nat Cant Inst 56:489, 1976 5. Vinger PF: A sporting chance with protective eyewear. Sight Sav Rev 49:3-9, 1979 6. Vinger PF, Hoerner E (eds): Sports Injuries: The Unthwarted Epidemic. Littleton MA, PSG, 1980

*Some manufacturers of good protective devices may have been inadvertently omitted.

VINGER

Appendix Protective Equipment Suppliers* I. Manufacturers

of hockey faceshields. Fine mesh, full-face wire shield recommended as the most durable, probably safest, design style available at this time. Form fitting goalie face masks are not recommended. Goalie should wear a helmet/full-face wire cage combination for best total head protection. Face shields should be certified either by the Hockey Equipment Certification Council (HECC) or the Canadian Standards Association (CSA).

CCM 2015 Lawrence Avenue West Weston, Ont. M9N lH6, Can. St. Lawrence Steel & Wire 81 Mill Street Gananoque, Ont. K7G 2L5, Can. Cooper 501 Alliance Avenue Toronto, Ont. M6N 253 Can. Jofa, Volvo of American Corp. Recreational Products Division 266 Union Street Northvale, NJ 07647 Northland Group, Inc. 124 Columbia Court Chaska, MN. 55318 Pro-Tee, Inc. 11108 Northrup Way Bellevue, WA. 98004 Safe-T-Guard P.O. Box 934 Madison, WI. 53701 Sherbrooke 60 Ellsworth Street Worcester, MA. 01813 Winn Well Limited 113 Sterling Road Toronto, Ont. M6R 2G9, Can. II. Manufacturers of protective eyewear for the racquet sports and other sports.

Ektelon 8929 Aero Drive San Diego, CA 92123 Pro-Tee 11108 Northrup Way Bellevue, WA. 98004

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III. Manufacturers

of athletic frames

American Optical Corp. Southbridge, MA. 01550 Criss Optical Mfg., Co., Inc. Augusta, KS. 67010 Cunningham Sales Corp. 166 1 Worcester Road Framingham, MA. 01701 Safety Plastics of New York L$ys;:x Q/its) EHs;meadow, NY 11554

IV. Custom Swim, Diving Goggles, Specialty Optical Work

SEE LAB William J. Wilber, Jr. 69 Pleasant Street Manchester-by-the-Sea, MA 01944

Reprint requests should be addressed to Paul F. Vinger, M.D., 99 Waltham Street, Lexington, MA 02173.