Olympic Committee Targets Sports-Related Ophthalmic Issues

Vision accounts for about 80% of perceptual input in sports, making close cooperation among sports physicians and ophthalmologists a must. To that end, the International Olympic Committee (IOC) has published a consensus paper on sports-related ophthalmology issues in elite sports.¹

Covering everything from blunt trauma to ocular surface conditions, and published in BMJ Open Sports and Exercise Medicine, the statement mainly targets sports medicine practitioners, who are typically the first to see injured athletes. It includes basic information on ocular injury prevention, as well as ocular anatomy, diagnosis, and when to refer injuries and conditions to an ophthalmologist.

However, the relationship between sports and ophthalmology is reciprocal, so ophthalmologists can also learn from the paper—not only regarding physical sports but e-sports as well. Both are affected by vision and can affect vision, said Professor Christophe Baudouin, who contributed to the paper’s section on ocular surface issues.

Ocular surface issues are common

Dry eye or allergy may result from “exposure to light, UV, pollution, and other environmental challenges. It may directly influence comfort, causing more or less severe symptoms, and more importantly, influence visual capabilities: increased blinking rate and unstable tear film may decrease the quality of vision, which may be very important for high-level and visual-demanding sports,” Prof Baudouin said.

E-sports are a particular concern, especially since they are extremely popular and avid participants have a high incidence of dry eye and other vision strain-related conditions, he added. “The effects of screens on dry eye are well known, and again, dry eye may decrease performance, especially in those sports where visual performance must be very high, like speed, visual field, or reflexes.”

With worldwide e-sport participation in the billions, eye care practitioners have ample opportunities to educate gamers on proper digital hygiene, such as looking away from the screen for 20 seconds at an object 20 feet away every 20 minutes (20/20/20 rule); monitoring vision performance using technologies such as the vision performance index; and treating digital eyestrain, according to the paper.

Assessing ocular trauma

Eye trauma typically results from crashes or contact with an opponent or equipment, the paper says. It characterises sports eye injury risk as high, moderate, or low based on factors such as the use of bats or sticks and the type and intensity of body contact. But while sports-related ocular injuries are relatively rare and most have good visual out

comes, more severe injuries can involve orbital or intraocular injuries that require emergency attention as well as extensive follow-up and management. Ocular symptoms may also indicate a concussion or other neurologic injury.

The paper outlines sideline evaluation steps for trauma of the orbit, adnexa, and globe. These include noting any lacerations, abrasions, perforations, bleeding, iris damage, or lens displacement and checking visual acuity, pupillary shape, size, and red reflex; diplopia; orbital rim step-off or numbness over the cheek; ex- or enophthalmia; and bradycardia, syncope, or vomiting, which may be signs of extraocular muscle entrapment requiring early surgery. Other conditions requiring immediate referral include lacerations of the medial eyelid, open globe injuries, loss of vision, and lack of ocular motility. CT images indicating orbit fractures are also included, with a warning against MRI imaging due to the possible presence of metallic fragments.

History taking and physical examination are also outlined, as are equipment needed—including penlights, vision charts, direct ophthalmoscope, and hard-shell eye shields—and when and how to use them. Furthermore, it covers visual symptoms of traumatic brain injuries. Because about 90% of eye injuries can be prevented with suitable eye protection, the paper recommends counselling athletes on proper eyewear for their sports.

“In the event of an eye injury, sports medicine physicians must assess whether the athlete can return to the field of play, be substituted with another athlete, be referred to an ophthalmologist, or be immediately transported to the nearest hospital. This decision requires a good understanding of anatomy, common ocular conditions associated with high-level sports, and knowledge of proper examination techniques by the sports medicine physician. In addition, good eye health is crucial to prevent visual problems in athletes, while regular eye examinations using specialised techniques and equipment allow the early detection and management of visual impairments,” the paper concludes.

One weakness of the statement is the lack of prospective studies on the prevalence and severity of eye injuries in sports, the paper says. Until recently, even data collected by Olympic examiners did not distinguish eye injuries from other facial injuries, though it was added to reporting forms as a separate category in 2020. Better data and studies will help inform better prevention and treatment.

Christophe Baudouin MD, PhD, FARVO is professor at Versailles Saint-Quentin en Yvelines University, Versailles, France, chairman of Quinze-Vingts National Ophthalmology Hospital, Paris, and a founder and president of the European Dry Eye Society (EuDES).

1. BMJ Open Sport Exerc Med, 2023; 9(3): e001644. DOI: 10.1136/ bmjsem-2023-001644.