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Soccer eye injuries are a global concern
The worldwide popularity of soccer makes the risk for injury a public health issue, a study says.
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Edgar Davids, a midfielder for the Netherlands national team, recently began using a new model of eyewear from Nike that shows the latest technology in sport vision, Dr. Capão said. (All images courtesy of João A. Capão Filipe, MD, PhD.) |
Severe ocular injuries with potential long-term effects can be sustained on the soccer field, according to an analysis of soccer-related eye injuries at the São João Hospital in Portugal. Researchers recommend the use of protective eye wear for prevention.
“Soccer ocular injury is an important eye health problem in Europe and probably worldwide,” said João A. Capão Filipe, MD, PhD. Reducing the number of injuries by encouraging players to use readily available protective eyewear that conforms to American Society for Testing and Materials (ASTM) Standard F803-03 would be in the best interests of public health.”
Dr. Capão and colleagues at the sports ophthalmology unit at the University of Porto School of Medicine conducted a retrospective study on 163 ocular injuries from soccer between April 1992 and March 2000.
The researchers collected data on the types of injuries, patient demographics, position played, the place on the field where the injury occurred and the mechanism of injury. After injury, patients’ best corrected visual acuity, IOP and the condition of anterior and posterior segments were noted.
On initial diagnosis, the researchers found that many of the injuries involved the anterior chamber and the eyelids or orbit resulting from blunt trauma from the ball. Due to the nature of the game, the ball frequently comes from below and strikes the eye at the inferior orbital rim. For this reason, hyphema and vitreoretinal (VR) lesions are the most common injuries, Dr. Capão said.
Patients were evaluated up to 1 year. Follow-up examination included BCVA, late diagnosis or surgery. Severe injuries were considered those that required hospitalization or follow-up for hyphema or VR lesions, he said.
As a result of this study, the researchers said soccer players should be educated about the potential for ocular injuries. They do not recommend any specific type of protective eyewear, only that it be approved by ASTM F803-03 and have polycarbonate or Trivex lenses, Dr. Capão said.
“In a new study that will be published, we concluded that protectors that pass ASTM F803-03 would prevent orbital intrusion,” he said.
Most common injuries
Initial clinical diagnosis showed eyelid or orbital contusion and hyphema. Retinal hemorrhages, vitreous hemorrhage and uveitis were other frequent injuries. Glaucoma and angle regression were also observed. The injuries were indiscriminate of patient demographic, including the level of expertise. The most common mechanism of injury was from the soccer ball (n = 129, or 79.1%), Dr. Capão said.
He also observed that most of the injuries occurred near the goalpost (60.1%) and were made by impact from the ball kicked by an opposing player, or by rebounds of the ball. More injuries occurred in indoor soccer than in outdoor soccer.
Thirty-five patients played with a visual handicap; 30 wore glasses but did not use them during sports practice, he said. Initial visual acuity was 20/40 or better in 116 patients; 7 patients had light perception, he said.
Glaucoma was of concern in patients with hyphema, and because symptoms may not be initially present, as with VR injuries, Dr. Capão advised athletes to be examined periodically. Forty-three patients had elevated IOP higher than 21 mm Hg. Acute-angle glaucoma was present in 41 patients who had hyphema, he said.
Peripheral VR lesions were seen in the superotemporal quadrant in 94 patients, and in the superonasal quadrant in 39 patients, Dr. Capão said.
Twenty-two patients needed 42 surgical procedures; all of the patients that had retinal detachment were successfully reattached, but three cases remained worse than 20/200 due to severe traumatic maculopathy. Twenty patients required hospitalization, he said.
Eyewear protection necessary in soccer |
“The need for protective eyewear in soccer has remained far less clear than for other sports, such as hockey or racket sports. Its use by children or adolescents with underdeveloped orbital structures has been already considered,” said João A. Capão Filipe, MD, PhD. “We strongly recommend that protective eyewear in soccer be worn by adults, particularly by patients who require prescription lenses, have one functional eye or have had refractive surgical procedures that weaken the eye. Dress-wear glasses are never recommended in any circumstances during soccer. “There is no specific standard for soccer. At this time, eye protectors that comply with the requirements of American Society for Testing and Materials (ASTM) Standard F803-03 and have polycarbonate or Trivex lenses are recommended,” he said. |
More severe injuries
Dr. Capão said the findings are consistent with previous studies that compared soccer injuries to other sport injuries. His study showed that 75.5% of eye injuries were considered severe.
“One of the most surprising results of our data was that the age, sex, type of soccer, level of athletic expertise and player position did not relate to the severity of ocular injury, despite the inherent differences,” he said. “Beyond an unknown ball velocity limit, which needs to be determined, injury can occur independent of all these differences.”
For this reason, education is necessary for the public and for eye care professionals. Direct trauma to the globe is possible because of the angle of the ball being kicked from the ground, he said.
“The flatter inferior orbital rim affords less protection to the globe from a projectile coming at this angle. … [The] force of the impact is strong enough to deform the intraocular structures without exceeding the tensile strength of the eyewall,” he said.
Frequent hyphema and peripheral VR lesions were seen as a result from impact, he said. Previous studies have shown that children and teenagers may be more susceptible to these injuries, but Dr. Capão’s study showed that adults were equally vulnerable.
Another important finding was that retinal holes were more frequent than retinal tears. Dr. Capão believes this indicates there are small holes at the posterior border of the vitreous base and equatorial holes that can occur without VR attachment and secondary to retinal necrosis. He cited a need for experiments to reveal the pathogenesis of soccer eye contusion.
Though protective eyewear is not mandatory, Dr. Capão and colleagues recommend adequate eyewear for all athletes, especially those with visual impairments or who are dependent on one eye.
For Your Information:References:
- João A. Capão Filipe, MD, PhD, can be reached at the University of Porto School of Medicine, S João Hospital, 4200-319 Porto, Portugal; 351-2-26-10-71-55; fax: 351-2-34-37-13-46; e-mail: jacapaofilipe@netcabo.pt.
- Capão Filipe Ja, Fernandes VL, et al. Soccer-related ocular injuries. Arch Ophthalmol. 2003;121:687-694.
- ASTM F803-03. Standard Specification for Eye Protectors for Selected Sports. ASTM International; Web site: www.astm.org.