joint policy statement - American Academy of Ophthalmology

joint policy statement - American Academy of Ophthalmology
JOINT POLICY STATEMENT
Protective Eyewear for Young Athletes
A joint statement of the American Academy of Pediatrics and the American Academy
of Ophthalmology
The American Academy of Pediatrics and the American Academy of Ophthalmology
strongly recommend protective eyewear for all participants in sports in which there is
risk of eye injury. Protective eyewear should be mandatory for athletes who are
functionally one-eyed and for athletes whose ophthalmologists recommend eye
protection after eye surgery or trauma.
BACKGROUND
More than 42,000 sports and recreation-related eye injuries were reported in 2000.1
Seventy-two percent of the injuries occurred in individuals younger than 25 years,
43% occurred in individuals younger than 15 years, and 8% occurred in children
younger than 5 years.1 Children and adolescents may be particularly susceptible to
injuries because of their aggressive play, athletic maturity,2-4 and poor supervision in
some recreational situations.
The sports highlighted in this statement were chosen on the basis of their popularity
and/or the high incidence of eye injuries in that sport. Participation rates and
information on the severity of the injuries are unavailable; therefore, the relative risk
of significant injuries cannot be determined for various sports. Baseball and
basketball are associated with the most eye injuries in athletes 5 to 24 years old.1
The eye-injury risk of a sport is proportional to the chance of the eye being impacted
with sufficient energy to cause injury. The risk is not correlated with the classification
of sports into collision, contact, and noncontact categories. Instead, the risk of eye
injury to the unprotected player is roughly categorized as high risk, moderate risk,
low risk, and eye safe. The sports included in each of these categories are listed in
Table 1.
Table 1: Categories of Sports Eye-Injury Risk to the Unprotected Player5
HIGH RISK
MODERATE RISK
LOW RISK
Small, fast projectiles
Tennis
Swimming
Air rifle
Badminton
BB gun
Soccer
Paintball
Volleyball
Diving
Skiing (snow and
water)
Noncontact martial
arts
Hard projectiles, “sticks,” close
contact
Basketball
Baseball / softball
Cricket
Water polo
Wrestling
Football
Fishing
Bicycling
Golf
EYE SAFE
Track and
field*
Gymnastics
Lacrosse (men and women)
Hockey (field and ice)
Squash
Racquetball
Fencing
Intentional injury
Boxing
Full-contact martial arts
*Javelin and discus have a small but definite potential for injury. However, good field
supervision can reduce the extremely low risk injury to near-negligible.
EVALUATION
All athletes and their parents should be made aware of the risks associated with
participation in sports and the availability of a variety of certified sports eye
protectors. Although eye protectors cannot eliminate the risk of injury, appropriate
eye protectors have been found to reduce the risk of significant eye injury by at least
90% when properly fitted.4,6,7 It would be ideal if all children and adolescents wore
appropriate eye protection for all eye-risk sports and recreational activities.
Physicians should strongly recommend that athletes who are functionally one-eyed
wear appropriate eye protection during all sports, recreational, and work-related
activities. Functionally one-eyed athletes are those who have a best corrected visual
acuity of worse than 20/40 in the poorer-seeing eye.1,4,8 If the better eye is injured,
functionally one-eyed athletes may be severely handicapped and unable to obtain a
driver's license in many states.9
Athletes who have had eye surgery or trauma to the eye may have weakened eye
tissue that is more susceptible to injury;10 such athletes may also need additional
eye protection or may need to be restricted from certain sports. They should be
evaluated and counseled by an ophthalmologist prior to sports participation.
PROTECTIVE EYEWEAR OPTIONS
Eye protection and different brands of sports goggles vary significantly both in the
way they fit and in their capacity to protect the eye from injury. An experienced
ophthalmologist, optometrist, optician, physician or athletic trainer can help an
athlete select appropriate protective gear that fits well and provides the maximum
amount of protection. Sports programs should assist indigent athletes in evaluating
and obtaining protective eyewear.
There are four basic types of eyewear. The two types that are satisfactory for eyeinjury risk sports include:
1. Safety sports eyewear that conforms to the requirements of the American
Society for Testing and Materials (ASTM) Standard F803 for selected sports
(racket sports, baseball fielders, basketball, women’s lacrosse, and field
hockey).
2. Sports eyewear that is attached to a helmet or for sports in which ASTM F803
eyewear is inadequate. Those for which there are standard specifications
include youth baseball batters and base runners (ASTM F910), paintball
(ASTM 1776), skiing (ASTM 659), and ice hockey (ASTM F513). Other
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protectors with specific standards are available for football and men’s
lacrosse.
The two types of eyewear that are not satisfactory for eye-injury risk sports
include:
1. Streetwear (fashion) spectacles that conform to the requirements of
American National Standards Institute (ANSI) Standard Z80.3.
2. Safety eyewear that conforms to the requirements of ANSI Z87.1 that is
mandated by the Occupational Safety and Health Administration (OSHA) for
industrial and educational safety eyewear.
Prescription or nonprescription (plano) lenses may be fabricated from any of
several types of clear material, including polycarbonate. Polycarbonate is the most
shatter-resistant clear lens material and should be used for all safety eyewear. 11
PROTECTIVE EYEWEAR CERTIFICATION
Protectors that have been tested to an appropriate standard by an independent
testing laboratory are often certified and should afford reasonable protection. The
Protective Eyewear Certification Council (PECC) has begun certifying protectors
that comply with the ASTM F803 (racket sports, basketball, baseball, women’s
lacrosse, and field hockey), ASTM F117 (paintball), and ASTM F910 (youth baseball
batters and base runners). The Canadian Standards Association (CSA) certifies
products that comply with the Canadian racket-sport standard, which is similar to
the ASTM standard. The Hockey Equipment Certification Council (HECC) certifies
ice hockey equipment, including helmets and face shields. The National Operating
Committee on Standards in Athletic Equipment certifies baseball and football
helmets as well as the face protectors for men’s lacrosse and football. For those
sports with certified protectors, it is recommended that products bearing the PECC,
CSA, HECC, or National Operating Committee on Standards for Athletic Equipment
(NOCSAE) seals be used when available.
RECOMMENDATIONS
1. All youth involved in organized sports should be encouraged to wear
appropriate eye protection.
2. The recommended sports-protective eyewear as listed in Table 2 should be
prescribed. Proper fit is essential. Because some children have narrow facial
features, they may be unable to wear even the smallest sports goggles. These
children may be fitted with 3-mm polycarbonate lenses in ANSI Z87.1 frames
designed for children. The parents should be informed that this protection is
not optimal, and the choice of eye-safe sports should be discussed.
3. Because contact lenses offer no protection, it is strongly recommended that
athletes who wear contact lenses also wear the appropriate eye protection
listed in Table 2.
4. An athlete who requires prescription spectacles has three options for eye
protection: (a) polycarbonate lenses in a sports frame that passes ASTM F803
for the specific sport, (b) contact lenses plus an appropriate protector listed in
Table 2, or (c) an over-the-glasses eye guard that conforms to the
specifications of ASTM F803 for sports in which an ASTM F803 protector is
sufficient.
5. All functionally one-eyed athletes should wear appropriate eye protection for
all sports.
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6. Functionally one-eyed athletes and those who have had an eye injury or
surgery must not participate in boxing or full-contact martial arts. (Eye
protection is not practical in boxing or wrestling and is not allowed in fullcontact martial arts.) Wrestling has a low incidence of eye injury. Although no
standards exist, eye protectors that are firmly fixed to the head have been
custom made. The wrestler who has a custom eye protector made must be
aware that the protector design may be insufficient to prevent injury.
7. For sports in which a facemask or helmet with an eye protector or shield must
be worn, it is strongly recommended that functionally one-eyed athletes also
wear sports goggles that conform to the requirements of ASTM F803 (for any
selected sport). This is to maintain some level of protection if the face guard
is elevated or removed, such as for hockey or football players on the bench.
The helmet must fit properly and have a chinstrap for optimal protection.
8. Athletes should replace sports eye protectors that are damaged or yellowed
with age, because they may have become weakened and are therefore no
longer protective.
Table 2: Recommended Eye Protectors for Selected Sports
SPORT
MINIMAL EYE PROTECTOR
Baseball / softball
(youth batter and base
ASTM F910
runner)
Baseball / softball
ASTM F803 for baseball
(fielder)
Face guard attached to
helmet
Basketball
ASTM F803 for basketball
ASTM specifies age ranges
Bicycling
Helmet plus streetwear /
fashion eyewear
Boxing
None available; not
permitted in sport
Fencing
Protector with neck bib
Field hockey (men and
women)
Football
Full-contact martial arts
Ice hockey
Lacrosse (men)
Lacrosse (women)
Paintball
ASTM F803 for women’s
lacrosse
Goalie full face mask
Polycarbonate eye shield
attached to helmet-mounted
wire face mask
None available; not
permitted in sport
ASTM F513 face mask on
helmet
Goaltenders ASTM F1587
Face mask attached to
lacrosse helmet
ASTM F803 for women’s
lacrosse
ASTM F1776 for paintball
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COMMENT
ASTM specifies age ranges
Contraindicated for
functionally one-eyed
athletes
Protectors that pass for
women’s lacrosse also pass
for field hockey
Contraindicated for
functionally one-eyed
athletes
HECC or CSA certified
full-face shield
Optional helmet
Racquet sports (badminton,
tennis, paddle tennis,
handball, squash and
racquetball)
ASTM F803 for selected sport
Soccer
ASTM F803 for selected sport
Street hockey
Track and field
Water polo / swimming
ASTM 513 face mask on
helmet
Streetwear with
polycarbonate lenses /
fashion eyewear*
Swim goggles with
polycarbonate lenses
Must be HECC or CSA
certified
Optional custom protective
eyewear
* Eyewear that passes ASTM F803 is safer than streetwear eyewear for all sports
activities with impact potential.
Wrestling
No standard available
REFERENCES:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
US Consumer Product Safety Commission. 2000 Sports and Recreational Eye
Injuries.
Nelson LB, Wilson TW, Jeffers JB. Eye injuries in childhood: demography,
etiology, and prevention. Pediatrics. 1989;84:438-441
Grin TR, Nelson LB, Jeffers JB. Eye injuries in childhood. Pediatrics.
1987;80:13-17
Jeffers JB. An on-going tragedy: pediatric sports-related eye injuries. Semin
Ophthalmol. 1990;5:216-223
Vinger PF. A Practical Guide for Sports Eye Protection. The Physicians and
Sportsmedicine. June 2000;28(6)
Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sports-related ocular
trauma. Ophthalmology. 1990;97:1265-1269
Strahlman E, Sommer A. The epidemiology of sports-related ocular trauma.
Int Ophthalmology Clin. 1988;28:199-202
Wichmann S, Martin DR. Single-organ patients: balancing sports with safety.
Phys Sports Med. 1992;20:176-182
Federal Highway Administration. Manual on Uniform Traffic Control Devices
for Streets and Highways. Washington, DC: US Department of Transportation;
1988
Vinger PF. The eye and sports medicine. In: Tasman W, ed. Duane’s Clinical
Ophthalmology. Philadelphia, PA: JB Lippincott; 1994;chap 45.
Vinger PF, Parver L, Alfaro D III, Woods T, Abrams BS. Shatter resistance of
spectacle lenses. JAMA. 1997;277:142-144
RESOURCES
American Academy of Ophthalmology, Communications Department, PO Box 7424,
San Francisco, CA 94120-7424
Prevent Blindness America (formerly National Society to Prevent Blindness), 500 E.
Remington Road, Schaumburg, IL 60173
Approved by:
American Academy of Pediatrics, Board of Directors, February 1996
American Academy of Ophthalmology, Board of Trustees, February 1995
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Revised and Approved by:
American Academy of Pediatrics, Board of Directors, October 2003
American Academy of Ophthalmology, Board of Trustees, November 2003
American Academy of Pediatrics, Board of Directors, June 2011
American Academy of Ophthalmology, Board of Trustees, 2013
©2013 American Academy of Ophthalmology®
P.O. Box 7424 / San Francisco, CA 94120-7424 / 415.561.8500
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