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Refraction, Correction & Protection

Joshua Watt, OD, FCOVDSports & Performance Vision Committee Member

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➢ 2.5 million Eye Injury cases per year in U.S.

➢ 40-45K cases of permanent visual impairment

➢ Accounts for 20% of unilateral blindness; 7% of bilateral

➢ Sports-related ocular trauma=600,000+ per year➢ “Sports injuries: an ounce of prevention and a pound of cure.” Eye Contact Lens. 2011

May; 37(3):160-3

Eye Injury Prevalence

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Many, if not most, sports-related eye injuries are preventable.

Unaddressed vision impairments decreases performance and increases risk of accidents/injury

Patients and athletes are unaware of the risk and how to properly protect their eyes.

Doctors of optometry are key to keeping our athletes safe

Preventable Injuries

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Activity Estimated Injuries Age 0-14 Age 15+

Water & Pool 6,351 2,686 3,665

Basketball 5,751 1,693 4,058

Guns, Darts, Arrows, Slingshots 2,946 1,936 1,010

Baseball, Softball 2,473 1,467 1,006

Bicycle 2,195 777 1,418

Soccer 1,745 447 1,298

Prevent Blindness America Study 2016

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https://www.preventblindness.org/sites/default/files/national/documents/fact_sheets/FS09_Sports_Injuries_by_Age_2017-2.pdf

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As primary eye care physicians, it is optometry's role to help patients and athletes understand the need to protect their eyes and ensure optimal vision while participating in sports.

Education is Key

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➢ Doctors of optometry can help patients• Protect their eyes

• Address vision impairments that affect their safety and performance

➢ As more patients and the public view understand our role in their eye safety, health, and performance, • More athletes of all ages will seek our services

• Other professions will regularly refer athletes to optometry practices

Important Part of Primary Eye Care

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Improper eye wear◦ Reduces performance

◦ Increases risk of accidents

◦ Leads to ocular injury

Untreated vision impairments ◦ Reduce Performance

◦ Increase risk of injury

Risks to Athlete

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➢ Contact Lenses

➢ Eyeglasses

➢ Surgery co-management

➢ Sports Safe Eyewear

Refraction, Correction, & Protection

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Refraction

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➢ Based on VA’s?

➢ Based on sport demand?

➢ Based on effort required to achieve clarity?

➢ Based on refractive error guidelines?

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➢ Myopia: beginning at -0.25D

➢ Hyperopia: beginning at +1.00D

➢ Astigmatism: beginning at -0.50D• WTR VS ATR VS OBLIQUE

➢ Anisometropia: beginning at 0.50D• Consider each meridian

Prescribing Guidelines

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Considerations for the Rx

➢ Timing of first prescription

➢ Value of over minusing

➢ Prescribing for twilight

➢ Prescribing for specific distances

➢ Prescribing modalities:• Contact Lenses

• Glasses

• Refractive Surgery

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Contact Lenses

Glasses

Refractive Correction

Correction

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Contact Lenses and Sports

➢ Contact lenses are vision correction of choice for most sports and athletes

➢ Easiest, quickest way to improve performance

➢ Optimize CL fit to activity and demands

• Silicone hydrogel CW

• Single-use daily disposable lenses

• Soft toric (stable designs)

➢ Gain is attributable to ECP

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CL vs. Spectacles - Benefits

➢ Natural, unrestricted field of vision

➢ Less aberrations, no minus/plus effect

➢ Potential for better eye teaming (depth)

➢ Don’t fog up, become soiled

➢ No displacement in collisions and under dynamic conditions

➢ Allow over-wear of goggles, sunglasses, protective eyewear

➢ More comfortable, natural vision correction

➢ Psychological - confidence inspiring

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Performance Contact Lenses

➢ Consider sport-specific demands

➢ Predict what difficulties contact lens wear may present and be able to prevent or address them

➢ Factors to consider:• Gaze positions (ex: up-gaze for cyclists)

• Speed of eye movements (re-orientation)

• Length of competition

• Environment (humidity, temperature, altitude, debris, wind, UV exposure)

• Replacement possibilities

• Tint possibilities

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It is not ideal for every athlete or sport

Considerations◦ Risk of a Surgery

◦ Exposure and Dryness

◦ Corneal Integrity (PRK vs Lasik)

◦ Spherical Aberrations

Educate the athlete

Refractive Surgery

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Sports goggles and frames must meet ASTM safety standards; ANSI standards do not apply to sport.• Street glasses should never be used during sports activities

• Polycarbonate or high-impact resistant lenses are a must

Practice Builder◦ Increases 2nd Pair Sales

◦ Education of safety and protection increase practice loyalty

Protection

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ASTM F803 standards

• Basketball, Baseball, Racquet Sports, Field Hockey, and Women’s Lacrosse

• ASTM F513: Ice hockey

• ASTM F1776: Paintball

• ASTM F2879: Airsoft

• ASTM F659: Skiing goggles/shields

ASTM Standards

19Dain, SJ; “Sports eyewear protective standards” Clinical and Experimental

Optometry. 2016 Jan;99(1):4-23.

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The SPVC and SPVAN are committed to ensuring:◦ Awareness: The public, policymakers, and other professions

understand that ALL athletes should be referred to and regularly visit a doctor of optometry to address their refraction, correction, & protection needs

◦ Policy: Local, state, and federal policies promote or require sports safe eyewear by athletes of all ages and levels

◦ Resources: Doctors of optometry understand how to identify patient athletes, address their refraction, correction, and protections needs, and refer patients to an SPV specialist if necessary.

Advocacy:

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AOA’s Refraction, Correction & Protection Webpage:◦ aoa.org/optometrists/tools-and-resources/sports-and-performance-

vision/refraction-correction-protection

Sports & Performance Vision Club Kit:◦ Ocular Injury

◦ Vision Correction

Resources

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AOA Brochure: ◦ Healthy Eyes for Peak Performance

EyeLearn Lectures◦ Sports-Related Ocular Trauma: Prevention, Identification &

Treatment

◦ 2015 Sports Vision Grand Rounds

Resources

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SPV Forum:◦ To register, contact

SPV@aoa.org

CE at OM:◦ Sports Vision: Grand Rounds

◦ Getting Started inSports Vision "Hands-On Workshop“

◦ Optometry's Role in Sports, From Youth to ProfessionalSports

2018 Optometry’s Meeting