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Preventive measures, in-depth testing benefit players
In addition to prescribing simple precautions such as protective goggles, physicians can monitor visual functioning that is important to athletic performance.
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Ophthalmologists play a key role in maintaining athletes’ vision, helping not only to protect their eyesight but also to improve their game.
According to the United States Eye Injury Registry, about 70% of eye injuries happen because no preventive measures are taken, and 8% of those injuries are sports-related. Moreover, studies show that more than 100,000 physician visits per year are related to eye injuries from sports, at a cost of more than $175 million.
“We still see a lot of injuries, and I would say that it’s probably not that frequent that people are protecting their eyes during sports events,” said Richard W. Yee, MD, member of the American Academy of Ophthalmology’s Committee on Eye Safety and Sports Ophthalmology.
Dr. Yee said ophthalmologists cannot prevent athletes from getting corneal abrasions or fractured eye sockets, but they can take steps to help athletes maintain healthy vision thereafter.
Keeping the eye protected
In 2004, the AAO and the American Academy of Pediatrics officially recommended protective eyewear for athletes. Many Little League teams require players to wear protective masks, according to Dr. Yee, who said eye protection is particularly important for children because their motor skills are not fully developed.
 Daniel M. Laby |
Polycarbonate facemasks and goggles are the best options for protecting the eye from sports injuries, according to sports ophthalmologist Daniel M. Laby, MD, FAAO, FAAP, assistant clinical professor of ophthalmology at Harvard Medical School.
“I tell ‘my kids’ to wear protective glasses, Rec Specs or something, to protect themselves when they are playing Little League baseball or high school baseball,” he said.
There are no regulations that require professional athletes to wear protective gear, so many forgo goggles or masks, according to Dr. Laby.
“The pros are hesitant. You don’t see many pros wearing any kind of protection around their eyes,” he said.
Vision maintenance
When treating child athletes, the primary concern for ophthalmologists is making sure vision has developed properly, according to Dr. Yee.
“In children, we always worry about things like whether they have stereopsis and whether they are using both of their eyes together, whether they have a strabismus problem and whether they have that depth of focus that they need to perform well in certain sports,” he said. “A routine eye health exam is real key for kids going into sports, just to make sure they are seeing well, especially the eye-to-hand coordination type sports.”
When an ophthalmologist is working with professional athletes, maintaining healthy vision becomes more complicated and involved.
For example, spring training is an important time for ophthalmologists who work with professional baseball teams. They perform numerous exams on the players to ensure maximum visual health, according to Dr. Laby, who has worked with the Los Angeles Dodgers since 1992 and the Boston Red Sox since 2004.
In lectures that Dr. Laby gives to teams during spring training, he refers to a “pyramid” that prioritizes the various levels of visual function that he keeps track of during exams and treatment.
“The pyramid starts out with the base, visual acuity, contrast sensitivity, the basic function, and you have to perfect that and you have to have that working 100%, if you are going to be able to get the higher functions above the pyramid,” he said.
The higher functions of the pyramid consist of stereovision and depth perception, followed by reaction time/hand-eye coordination and on-field performance.
“If you want to play well on the field, you better make sure the base of the pyramid is strong and healthy,” he said.
According to Dr. Laby, taking care of the base of the pyramid means normalizing his players to 20/12 vision, which he has found through studies to be about the average visual acuity for professional baseball players.
“20/20 is not seeing 20/20 as a baseball player. They’re not seeing as well as they need to play effective baseball, so we try to normalize them to 20/12,” he said.
Visual exams during spring training can last from 7 a.m. until to 2 p.m. or later, and include testing the visual acuity to a threshold of 20/8, according to Dr. Laby.
These exams are followed by others: two tests of distance stereo acuity; an eye dominance test; three contrast sensitivity tests including letter contrast, stripe contrast and contrast sensitivity with glare; measurements of higher-order aberrations; two tests of reaction time; two tests of hand-eye coordination; Goldmann applanation tonometry; and fundus photos, he said.
“Once you have their skills proper, then we try to go on from that to integrate the different parts of the vision together, like contrast, acuity, hand-eye coordination, reaction time, so they can train those together to be as efficient as possible,” he said.
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Images: Laby DM |
MD, OD relationship
Dr. Laby ensures he has an open line of communication with an optometrist when taking care of professional athletes to get two viewpoints.
“You have to look at both sides, the injury prevention, the injury correction and the increase in function of performance,” he said. “Each can bring to the table their different strengths, and I think you’re finding that pretty much all of the teams now are having some sort of formal eye exam by some eye care professional, whether it’s an OD or an MD.”
Ophthalmologists concentrate on things such as retinal exams and other aspect of the physical health of the eye, but Dr. Laby said that “doesn’t do a lot to help you hit the ball.”
“I have learned a lot of the things from my optometry colleagues that I have been able to incorporate … into the care,” he said. “I have the surgical background, the overall general health background, how the health of the body relates to the health of the eye. So those two together cover all the different aspects of what a player could end up having with their eyes.”
Maintaining a healthy fundus
Although athletes can experience immediate back-of-the-eye problems such as retinal contusions from blunt trauma, yearly examinations are key for catching the long-term effects of elbows or fingers to the eye.
 Henry Trattler |
Henry Trattler, MD, advisory board member of the Sports Ophthalmic Society of the Americas (See related article) and ophthalmologist to the Miami Heat basketball team for 19 years, said he is always looking for signs of trauma because of the nature of basketball. Corneal abrasions are common and easily treatable, but elbows to the eye can cause traumatic iritis, and in extreme cases, traumatic hyphema.
“When we see traumatic hyphemas, we start realizing that maybe 2% to 5% of these patients are going to get glaucoma secondary to this type of trauma, statistically,” he said.
According to Dr. Trattler, this means the athlete will require lifelong yearly checks to determine any long-term damage.
“We can see damage to the drainage angle not causing elevation of pressure at the time of injury, but later on, maybe a decade later,” he said. “If you already have damage to part of the drain, now you’ve got less drain to do the job, so this is why we’ll tell everybody who has traumatic hyphema, they must be looked at on a yearly basis.”
Enhancing athletes’ vision
Ophthalmologists who treat athletes agree that professional and amateur athletes can enhance their performance by reducing sun glare with specialized optics such as the tinted contact lens Maxsight (Nike) or by purchasing ultraviolet-light blocking sunglasses.
However, when it comes to refractive surgery to improve performance, ophthalmologists are not all in agreement.
Dr. Laby raised concerns about lost best corrected visual acuity, reductions in contrast sensitivity and unhealed flaps.
In order to determine the effects of LASIK surgery on the performance of professional baseball players, Dr. Laby and colleagues recently conducted a retrospective study that compared pre-LASIK and post-LASIK performance data for 12 professional baseball players. According to Dr. Laby’s findings, there was no significant improvement in on-base percentage, batting average, slugging percentage or on-base plus slugging.
 Daniel S. Durrie |
“The conclusion we came to is that unless you can prove or guarantee that they are not going to have any complications, you’re certainly not going to improve [their] play, and you are opening yourself up to more complications,” Dr. Laby said.
However, OSN Refractive Surgery Section Editor Daniel S. Durrie, MD, said refractive surgery for athletes is safe as long as they are getting high-quality treatment.
“If somebody isn’t doing the most advanced techniques and isn’t the best in town, I certainly wouldn’t think that you could go for the two-for-one special when you are an athlete,” he said. “If we look at the most advanced excimer laser systems that we can use, with the IntraLase, with the new sub-Bowman’s keratomileusis thinner flaps, the majority of patients — 70% to 80% — are 20/16 or better and 50% of them are 20/12, so that’s higher than the normal population.”
In order to avoid flap problems, Dr. Yee suggests surface ablation as another option for athletes who would like to enhance their vision.
“Certainly, a boxer would not be a good person to have LASIK surgery,” he said. “A basketball player, especially of a professional or collegiate caliber, should not have, whether it’s professionally or provisionally, a lamellar-type procedure. We strongly recommend surface ablation in those types of situations.”
For more information:
- Richard W. Yee, MD, can be reached at 6411 Fannin St., Jones Pavilion, 7th Floor, Houston, TX 77030; 713-704-1839; fax: 713-704-9002; e-mail: richard.w.yee@uth.tmc.edu.
- Daniel M. Laby, MD, FAAO, FAAP, can be reached at Village Shoppes, 95 Washington St., Suite 592, Canton, MA 02021; 781-769-4797; fax: 781-769-4794; e-mail: drlaby@drlaby.com.
- Henry Trattler, MD, can be reached at Baptist Medical Arts Building, East Tower, 8940 N. Kendall Drive, Suite 400-E, Miami, FL 33176; 305-598-2020; fax: 305-274-0426; e-mail: htrattler@hotmail.com.
- Daniel S. Durrie, MD, can be reached at Durrie Vision, 5520 College Blvd., Suite 200, Overland Park, KS 66211; 913-491-3330; fax: 913-491-9650; e-mail: ddurrie@durrievision.com.
- Rec Specs, maker of Rec Specs protective wear, can be reached at 107 Fairfield Road, Fairfield, NJ 07004; 973-882-0986; fax: 973-575-1274; Web site: www.libertyoptical.net.
References:
- Napier SM, Baker RS, et al. Eye injuries in athletics and recreation. Surv Ophthalmol. 1996;41:229-244.
- Laby DM, Kirschen DG, De Land P. The effect of laser refractive surgery on the on-field performance of professional baseball players. Optometry. 2005;76:647-652.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.