Ocular complications of boxing.

OBJECTIVES: To investigate the prevalence of ocular injuries in a large population of boxers over a period of 16 years, in particular, the most severe lesions that may be vision threatening. METHODS: Clinical records of the medical archive of the Italian Boxing Federation were analysed. A total of 1032 boxers were examined from February 1982 to October 1998. A complete ophthalmological history was available for 956, who formed the study population (a total of 10 697 examinations). The following data were collected: age when started boxing; duration of competitive boxing career (from the date of the first bout); weight category; a thorough ocular history. The following investigations were carried out: measurement of visual acuity and visual fields, anterior segment inspection, applanation tonometry, gonioscopy, and examination of ocular fundus. Eighty age matched healthy subjects, who had never boxed, formed the control group. RESULTS: Of the 956 boxers examined, 428 were amateur (44.8%) and 528 professional (55.2%). The median age at first examination was 23.1 (4.3) years (range 15-36). The prevalence of conjunctival, corneal, lenticular, vitreal, ocular papilla, and retinal alterations in the study population was 40.9% compared with 3.1% in the control group (p< or =0.0001). The prevalence of serious ocular findings (angle, lens, macula, and peripheral retina alterations) was 5.6% in boxers and 3.1% in controls (NS). CONCLUSIONS: Boxing does not result in a higher prevalence of severe ocular lesions than in the general population. However, the prevalence of milder lesions (in particular with regard to the conjunctiva and cornea) is noteworthy, justifying the need for adequate ophthalmological surveillance.

The mechanism and prevention of soccer eye injuries.

AIMS: To study the mechanism and the means of preventing soccer eye injuries. METHODS: Kicked soccer ball velocities were measured for a range of ages and experience. Soccer balls (sizes 3, 4, and 5), inflated to 3, 6, and 9 psi, were impacted onto an artificial orbit and the results analysed at 1000 frames per second. Protective eyewear was fitted to a headform then impacted and evaluated. RESULTS: The mean peak ball velocity was 20.4 (SD 6.2) m/s. Soccer balls at 18 m/s entered the orbit between 7.5 and 8.7 mm. There was no significant difference in orbital penetration as a result of ball size or pressure. The soccer ball stayed in the orbit approximately 10 ms and appeared to have a suction effect as it withdrew. Protective eyewear that complied with sports protective eyewear standard ASTM F803 prevented contact of the ball to the eye. CONCLUSIONS: The soccer ball causes eye injury by entering the orbit. Protectors that pass ASTM F803 would prevent orbital intrusion.

Prescription safety eyewear: impact studies of lens and frame failure.

OBJECTIVES: To determine if a plano lens could be the test lens for all prescription (Rx) lenses and to investigate why Rx lenses pop out of safety eyewear. DESIGN: Plano and Rx polycarbonate lenses (n = 641) with varying thickness and edge geometry, mounted on steel lens holders, and Rx safety eyewear (n = 128) placed on headforms were impacted with test objects of varying diameter and hardness. Impacts were studied with 500 to 2,000 frames-per-second motion analysis. RESULTS: Plano lenses were at least, or more, prone to failure (dislodgment, perforation, shatter, or crack) than -3.00 or +3.00 lenses of the same minimum thickness. More than 40% of safety frames with removable lenses broke or had lenses pop out when impacted with energies expected in industry and sports. CONCLUSIONS: Plano lenses can be used as the test lenses for all Rx lenses made of the same material with the same minimal thickness. The ANSI Z87.1-1989 industrial standard for Rx eyewear is inadequate for sports or other activities with high-impact potential. The best lens-retention system has, as a component, a frame with a bevel perpendicular to a frontal impact force.

A practical guide for sports eye protection.

Sports eye injuries can be serious but are preventable. Any sport that involves a stick or racket, a ball or other projectile, or body contact presents a risk of serious eye injury. Physicians have an obligation to warn players of potential risk and to recommend appropriate eye protection. Sports eye protection should be designed specifically for the activity or sport. Eye protection that bears the seal of sanctioned organizations should be mandated for high-risk sports.

Injury prevention: where do we go from here?

BACKGROUND: Most eye injuries are preventable. Military personnel, workers, athletes, and other spectacle wearers--especially children and the functionally one-eyed--who require protection from impact, should expect that safety eye-wear actually protects. PURPOSE: To present to eye care professionals the current state-of-the-art in eye injury prevention. METHODS: A review of the current eye protection standards, guidelines, and warnings for the activities of daily living, work, hobbies, education, and sports with emphasis on the importance of standards and the role of the recently organized Protective Eyewear Certification Council (PECC). CONCLUSIONS: The prescriber and dispenser are obliged to prescribe, fabricate, and dispense safe and effective eyewear. PECC will help the eye care professional fulfill this obligation.

Baseball hardness as a risk factor for eye injuries.

BACKGROUND: Baseball is the leading cause of sports-related eye injuries in young persons. It is known that softer baseballs reduce the potential for brain and cardiac injury, but it has been speculated that softer baseballs may increase eye injuries by intruding more into the orbit. It also has been claimed that softer baseballs would change the "feel" of the game. OBJECTIVES: To determine the orbital intrusion and eye injury potential of baseballs of varying hardness, and whether a player can feel the difference between these different baseballs. MAIN OUTCOME MEASURES: Orbital force and penetration of baseballs of various hardness into an artificial orbit. Ability of subjects of varying age and baseball experience to determine the hardness of baseballs. RESULTS: The peak orbital force and force onset rate from softer baseballs, at all impact velocities, were less than the force and force onset rate from baseballs that had hardness equal to, or greater than, major league baseballs. The softest (10% of major league hardness) baseballs intruded into the orbit significantly more than balls that were 15% of major league hardness or harder. Children younger than 14 years could not differentiate balls 15% of major league hardness or harder, and adults could not differentiate 20% of major league hardness or harder from each other or from major league balls. CONCLUSION: The potential for injury to the unprotected eye from soft baseballs is significant, but not greater than that from a major league baseball. Baseballs that are 15% to 20% of major league ball hardness are recommended for youth baseball because these balls feel like major league balls, reduce the potential for brain injury and commotio cordis, cause less pain on impact, and do not increase the potential for eye injury to the unprotected player. Eye injuries in youth baseball could be minimized by the use of protective eyewear that conforms to the standard specifications of the American Society of Testing and Materials (Philadelphia, Pa), standards F910 (for batters and baserunners) and F803 (for fielders).

Sports medicine and the eye care professional.

BACKGROUND: There are more than 40,000 eye injuries every year in the United States--many of which are sports-related. Sports injuries are a common cause of severe vision loss. Today, contact sports, racket sports, and other high-risk athletic activities are more popular on an organized and informal level. Those engaging in these activities should wear the proper eye and facial protection, so as to minimize the risk of severe injury and potential vision loss. CASE REPORTS: Case studies are used to illustrate examples of sports-related clinical experiences encountered in a primary care practice. A description of protective devices, a discussion of product liability, the standard of care, and the doctor's responsibility to the patient complement the case scenarios. Emphasis is placed on prevention and particular attention should be paid to the patient at high risk and to the one-eyed patient. CONCLUSION: Sports-related eye injuries have a high risk for ocular morbidity and subsequent severe vision loss. Many sports related injuries are preventable and the primary care practitioner can provide important information and education regarding protection and avoidance for those participating in high-risk activities. The provider should promote compliance and be adequately informed as to product liability, standards, manufacturers of the devices, and indications for the use of specific devices.

Shatter resistance of spectacle lenses.

OBJECTIVE: To evaluate the relative strength and shatter resistance of spectacle lenses currently used in sunglasses and dress, sports, and industrial eyewear. DESIGN: Seven lenses that met the US American National Standards Institute (ANSI) Z80 standards for dress glasses (made of high-index plastic, allyl resin plastic, heat tempered glass, chemically tempered glass, and polycarbonate, and with center thickness ranging from 1 mm to 2.2 mm) and 4 lenses that met ANSI Z87 standards for industrial safety eyewear (allyl resin plastic, heat-tempered glass, chemically tempered glass, and polycarbonate, all with 3.0-mm center thickness) were tested for impact resistance to 5 projectiles (air gun pellets, golf balls, tennis balls, lacrosse balls, and baseballs). MAIN OUTCOME MEASURES: Impact energy required to shatter spectacle lenses. RESULTS: Based on 348 lens impacts, dress and industrial lenses made from glass, allyl resin plastic, and high-index plastic shattered at impact energies less than those expected to be encountered from the test projectiles during their routine use. Polycarbonate lenses demonstrated resistance to impact for all tested projectiles exceeding the impact potential expected during routine use. CONCLUSIONS: Under the test conditions of this study, polycarbonate lenses demonstrated greater impact resistance than other commonly used spectacle lenses that conform to prevailing eyewear standards. These findings suggest that current ANSI Z80 and ANSI Z87 standards should be reevaluated.

Ruptured globes following radial and hexagonal keratotomy surgery.

OBJECTIVE: To ascertain if cases of radial keratotomy wound rupture were occurring and whether the globes ruptured through the corneal incisions. DESIGN: Cases of traumatic ruptured globe after incisional corneal refractive surgery were collected from ophthalmologists and from peer-reviewed and other ophthalmic literature. RESULTS: Twenty-eight human eyes (eight previously unreported) are known to have ruptured through refractive corneal incisions in activities of daily living (n = 12), assault (n = 7), motor vehicle accidents (n = 5), and sports (n = 4). Two patients died of their injuries. Of the remaining 26 ruptured eyes, eight (31%) recovered 20/40 or better visual acuity. Six eyes (23%) were totally blinded, six (23%) were legally blinded, and six (23%) had best corrected visual acuity of 20/40 to 20/100 despite multiple surgical procedures. CONCLUSIONS: As radial keratotomy becomes more popular the pool of patients who may experience traumatic ruptured globe will grow. Every patient who has had radial keratotomy should be aware that the surgery has weakened the eye(s).

Prescribing for contact sports.

Polycarbonate lenses should be prescribed for wear by participants of contact sports during athletic activities. Frames that meet the specifications of American Society for Testing and Materials F803-88a should be prescribed for sports in which there is a significant risk of eye injury. Because of the high-energy collisions in some sports, helmets are also essential for both face and eye protection. Functionally one-eyed athletes should not participate in sports in which adequate eye protection is not available. It is inadvisable to recommend radial keratotomy to athletes who will participate in contact sports.

Prevention of sports injuries.

The eye care professional has the responsibility to advise the patient of potential eye injuries in sports and the available methods of protection against injury. Polycarbonate is the lens material of choice, both plano and for prescription eye wear for athletes and other active people. Those who fabricate and dispense eye wear must be aware of the need for safety eye wear and advise patients appropriately. They should stock and distribute the material at reasonable prices.

The spectrum and burden of ocular injury.

The authors conducted a hospital-based study to ascertain basic, descriptive epidemiologic information about ocular trauma in an urban setting. Over a 6-month period, 3184 patients presenting to our emergency ward with ocular trauma were studied. Severe injuries totaled 5.1% (ruptured globe, intraocular foreign body, hyphema, orbital/facial fracture) and 94.9% were superficial injuries and contusions. A disproportionate burden of severe ocular injury was borne by those less than 15 years of age. The work place accounted for 48% of all injuries and 50% of ruptured globes. Automobile repair-related tasks were specifically associated with injury. Sports injuries, although accounting for 3.4% of all injuries, were responsible for 60% of hyphemas and 10% of ruptured globes. Annual direct and indirect costs for these ocular injuries are estimated conservatively at $5 million and a loss of 60 work years. A large burden of preventable eye trauma is borne by both patients and society.

How I Manage Corneal Abrasions and Lacerations.

In brief: The initial on-field examination of an athlete who has sustained an eye injury is crucial. Corneal abrasions usually heal rapidly with little lost playing time and rare complications, but a laceration can result in the loss of an eye if the injured athlete continues activity. Symptoms such as a cut in the eyelid or an object on the cornea may require immediate transfer of the injured athlete to a special facility for more thorough examination and treatment. The best treatment is prevention, which includes using protective eye wear that meets or exceeds safety standards.

Soccerball-induced eye injuries.

We report a series of 24 confusion eye injuries resulting from soccerball impact. Hyphema (50%), vitreous hemorrhage (29%), corneal abrasion (21%), angle recession (8%), and retinal tear (4%) were experienced. When compared with a combined hyphema series and with hockey and racquet sports, our group had fewer serious injuries and no permanent visual acuity loss resulted. Although the incidence of eye injuries is low and the use of eye protectors may be inconvenient, we strongly recommend protective eyewear be worn in competitive sports involving large and small projectiles.

Sports eye injuries a preventable disease.

Each year, sports are responsible for over 100.000 preventable eye injuries. A face-protector standard was developed for hockey. Certified protectors effectively eliminated eye and face injuries to 1,200,000 players averting a projected 70,000 injuries and saving over $10,000,000 in medical expenses annually. The principle of absorbing energy in a protective device before the eye is injured is applied to other sports (racket sports, baseball, basketball). Recommendations are made on eye protection for athletes. Better data collection and standards for sports and children's eyewear are encouraged.