Protective Eyewear for Young Athletes

A Joint Statement of the American Academy of Pediatrics and American Academy of Ophthalmology*

Source

American Academy of Ophthalmology

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Policy

The American Academy of Pediatrics and the American Academy of Ophthalmology recommend mandatory protective eyewear for all functionally one-eyed individuals; and for athletes who have had eye surgery or trauma and whose ophthalmologists recommend eye protection. Protective eyewear is also strongly recommended for all other athletes.

Background

Over 41,000 sports-related and recreational eye injuries were treated in hospital emergency departments in 1993.(reference 1) Seventy-one percent of the injuries occurred in individuals under 25 years of age, 41% occurred in individuals under 15 years of age, and 6% occurred in children under 5 years of age. Children and adolescents are particularly susceptible to injuries because of their fearless manner of play and their athletic immaturity. (references 2-4)

Ten sports or sports groupings are highlighted in this statement based on their popularity and the high incidence of eye injuries (see Table 1).(reference 1) Baseball and basketball are associated with the most eye injuries in athletes 5 to 24 years old.(reference 5) Participation rates and information on the severity of the injuries are unavailable, however, and so the relative risk of significant injuries cannot be determined for various sports.

The high frequency of sports-related eye injuries in young athletes indicates the need for an awareness among athletes and their parents of the risks of participation and of the availability of a variety of approved sports eye protectors. When properly fitted, appropriate eye protectors have been found to reduce the risk of significant eye injury by at least 90% (references 4,6,7)

Evaluation

It would be ideal if all children and adolescents wore appropriate eye protection for all sports and recreational activities. All youth involved in organized sports should be encouraged to wear appropriate eye protection.

Physicians must strongly recommend that athletes who are functionally one-eyed wear appropriate eye protection during all sports and recreational activities. (Functionally one-eyed athletes are those with a best corrected visual acuity of worse than 20/40 in the poorer-seeing eye, assuming that adequate amblyopia [lazy eye] therapy has been accomplished). (references 4,5,8)

Athletes who have had eye surgery or trauma to the eye may have weakened eye tissue that is more susceptible to injury. (reference 10) These athletes may need eye protection and should be evaluated and counseled by an ophthalmologist.

Various kinds of eye protection are described below and in the Glossary. Different brands of sports goggles vary significantly in the way they fit. An experienced ophthalmologist, optometrist, or optician can help an athlete select appropriate goggles that fit well.

Indigent athletes may have trouble affording eye evaluations or protective eyewear. Sports programs may have to assist these athletes in the evaluation process and in obtaining protective eyewear.

*This statement has been approved by the Council on Child and Adolescent Health. The recommendations in this policy statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Table 1 : Estimated Sports and Recreational Eye Injuries: 1993

Recommendations

To implement the policy, we recommend the following specific interventions:

1. Appropriate protective eyewear for low-eye-risk (LER) sports (see Table 2) consists of an approved street-wear frame that meets American National Standards Institute (ANSI) Standard No. Z87.1, with polycarbonate or CR-39 lenses. A strap must secure the frame to the head. These glasses must be fitted by an experienced ophthalmologist, optometrist, or optician.

2. Appropriate protective eyewear for high-eye-risk sports is itemized in Table 2. The sports goggles must have lenses made of polycarbonate, which is stronger than CR-39 plastic. An experienced ophthalmologist, optometrist, or optician must fit these goggles.

   Because some children have narrow facial features, they may be unable to wear even the smallest sports goggles. These children must be fitted with the approved street-wear frames described for low-eye-risk sports.

   Athletes with a high range of refractive error cannot use lenses made of polycarbonate. They may wear contact lenses (high power) protected by sports goggles with polycarbonate plano (nonprescription) lenses.

   For sports in which a face mask or helmet with an eye protector or shield must be worn, we strongly recommend that functionally one-eyed athletes also wear sports goggles with polycarbonate lenses to ensure protection. The helmet must fit properly and have a chin strap for optimal protection.

3. Contact lenses offer no protection; therefore, we strongly recommend that athletes who wear contact lenses also wear appropriate polycarbonate eye protection over the lenses. Polycarbonate (plano) nonprescription lenses should be used in street-wear frames for low-eye-risk sports or in sports goggles for high-eye-risk sports.

4. Athletes must replace sports eye protectors that are damaged or yellowed with age, because they may have become weakened.

5. Functionally one-eyed athletes and those who have had an eye injury or surgery must not participate in boxing, wrestling, and full-contact martial arts. Eye protection is not practical in boxing or wrestling and is not allowed in full-contact martial arts.

Table 2: Sports With High Risk of Eye Injury With Appropriate Eye Protectors

* LER = Low Eye Risk

** Goggles without lenses are not effective.

+ For sports in which a face mask or helmet with eye protector is worn, functionally one-eyed athletes, and those with previous eye trauma or surgery for whom their ophthalmologists recommend eye protection, must also wear sports goggles with polycarbonate lenses to ensure protection.

++ A street hockey ball can penetrate a molded goalie mask and injure an eye.

References

1. Prevent Blindness America (formerly National Society to Prevent Blindness): 1993 Sports and Recreational Eye Injuries. Schaumburg, IL: Prevent Blindness America; 1994.

2. Nelson LB, Wilson TW, Jeffers JB. Eye injuries in childhood: demography, etiology, and prevention. Pediatrics 1989;84:438-441.

3. Grin TR, Nelson LB, Jeffers JB. Eye injuries in childhood. Pediatrics 1987;80:13-17.

4. Jeffers JB. An on-going tragedy: pediatric sports-related eye injuries. Semin Ophthalmol 1990;5:216-223.

5. Erie JC. Eye injuries: prevention, evaluation, and treatment. Phys Sports Med 1991;19:108-122.

6. Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sport- related ocular trauma. Ophthalmol 1990;97:1265- 269.

7. Strahlman E, Sommer A. The epidemiology of sports related ocular trauma. /Int Ophthalmol Clin 1988;28:: 199202.

8. Wichmann S,, Martin DR. Single-organ patients: balancing sports with safety. Phys Sports Med 1992;20:176-182.

9. Federal Highway Administration. Manual on Uniform Traffic Control Devices for Streets and Highways. Washington, DC: Department of Transportation; 1988.

10. Vinier PF. The eye and sports medicine. In: Tasman W,, ed. Duane 's Clinical Ophthalmology 1994;5:chap 45.

Glossary

CR-39 lenses: Lenses made of an allyl/resin plastic ("CR-39" is a registered trademark of PPC Industrial) with a center thickness of 3 mm that meet or exceed ANSI Standard No. Z87.1. Used for strong prescriptions (above - 8.00 sphere and - 4.00 cylinder) for which polycarbonate is not suitable. Lenses made from this plastic are not as strong as those made with polycarbonate and should not be used in sports goggles for high-eye-risk sports.

Polycarbonate lenses: Prescription or nonprescription lenses made of polycarbonate material with a center thickness of at least 2 mm that meet or exceed ANSI Standard No. Z87.1. These are designed to fit in street-wear frames as well as sports goggles.

Polycarbonate shield/face guard: Molded protective shields or face guards designed to be a part of, or to be attached to, various sports helmets.

Sports goggles: Unhinged protective eyewear with a molded frame and temple with prescription or nonprescription polycarbonate lenses with a center thickness of 3 mm. An elastic band secures the goggles to the athlete's head.

Street-wear frames: Sturdy daily-wear frames with a posterior lip to prevent inward displacement of the lenses. They should meet ANSI Standard No. Z87.1.

Resources

1. American Academy of Ophthalmology, Dept ESC. Attention: Inquiry Clerk, PO Box 7424, San Francisco, CA 94120- 7424. Eye Safety for Children (brochure). (Include a self- addressed, stamped' legal size envelope with each request.)

2. Prevent Blindness America (formerly National Society to Prevent Blindness), 500 E. Remington Road, Schaumburg, IL 60173.

3. Standards:
   • American National Standards Institute, 11 West 42nd St, New York, NY 10036: Practice for Occupational and Educational Eye Face Protection (ANSI Standard No. Z87.1).

   • American Society for Testing and Materials, 100 Barr Harbour Drive, West Conshohoken, PA 19428: Face Guards for Youth (ASTM Standard No. F910-86).

   • American Society for Testing and Materials, 100 Barr Harbour Drive, West Conshohoken, PA 19428: Specifications for Eye Protectors for Use by Players of Racquet Sports (ASTM Standard No. F803-88).

   • American Hockey Association of the United States; Canadian Amateur Hockey Association; Canadian Standards Association: Hockey Helmets and Face Guards.

Approved by:

American Academy of Pediatrics Board of Directors, February 1996

American Academy of Ophthalmology Board of Trustees, February 1995

Credits

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
425.561.8500