Issue Cover, Paediatric, Global Ophthalmology, Paediatric Ophthalmology

Rule Number One: Protect the Eyes

Ophthalmologists hold a key role in athlete eye care for all ages and abilities.

Laura Gaspari

Published: Monday, July 1, 2024

“ It’s essential for families to see that and recognise their child is differently abled, not disabled. “

Visually impaired individuals can participate in almost any sport, but wearing protective gear for the eyes is crucial to avoid trauma and damage, according to David B Granet MD. This summer, the Paralympic Games in Paris will showcase an astonishing number of athletes with visual impairments and blindness competing in various disciplines, from athletics to football, swimming, and martial arts like judo. Athletes are categorised based on their level of visual impairment, and in some competitions, such as blind football or goalball, wearing eye shades to cover their eyes fully is mandatory to ensure equality in the competition.

Sometimes, these athletes have been visually impaired from a very early age or have lost their sight due to accidents or trauma. Losing sight—or a lack of sight—might seem an obstacle, discouraging participation in activities like sports. In the case of children, ophthalmologists should encourage their parents to let them participate in sports, Dr Granet said. “It’s easy for families with visually impaired children to say no,” he noted. However, the Paralympics demonstrate that everyone can be an athlete, learning resilience, the value of practice, teamwork, and belief in their ability.

“It’s essential for families to see that and recognise their child is differently abled, not disabled,” Dr Granet emphasised.

Security comes first

Protecting one’s eyes is crucial, especially for individuals with visual impairments who engage in sports. They are less able to shield themselves and thus more vulnerable to injuries; sometimes, one eye is in better shape than the other, making it essential to guard the healthier eye.

“In this setting, I always tell families that rule number one is to protect the better-seeing eye,” Dr Granet advised. “Protecting the normal eye is vital to maintain daily activities in life.”

Protective eyeglasses and goggles are made of resistant materials like polycarbonate and must meet international and national standards, such as ISO certification or CE marking in European countries. Scientific societies like the American Academy of Ophthalmology also provide guidelines for this gear (available to everyone) and should be recommended by the ophthalmologist.

However, Dr Granet stressed that not only visually impaired individuals but everyone should wear eye protection during sports, as eye trauma can lead to blindness and disability.

“There is damage occurring after direct contact, called a coup injury, and then there are contrecoup injuries, where the eye bounces around inside the orbit. These are terms borrowed from brain injuries, but the same happens to eyes,” Dr Granet explained. Eye trauma varies from ruptured globes to corneal abrasions and retinal detachments. It is even more crucial when a person has pre-existing conditions like high myopia or previous surgery that can pose an increased risk of visual impairment in case of injury.

Raising Awareness

Unfortunately, eye protection in sports is not yet widespread, although Dr Granet observed things are improving. Some sports, such as football, rugby, boxing, water polo, and baseball, do not require their athletes to wear protective gear and eye injuries—and concussions—are a real concern. Convincing people to wear protection can be challenging, and the only way to raise awareness is to make it mandatory, encourage athletes to wear protection, and have them hear it directly from their ophthalmologist.

“We need to change the attitude that wearing protection is a negative; it doesn’t make you weak or less of an athlete,” he asserted. Fortunately, more professional athletes, sports leagues, and clubs are becoming aware of the issue, introducing more protective gear, especially helmets for the head and goggles for the eyes.

Inclusion and Security

As long as security is taken into account, everyone can participate in sports, even with visual disabilities. Dr Granet recalled some of his patients with visual impairments or blindness could ski in different ways, like using a rope attachment, holding on to someone, and even skiing independently. “There are programmes just for the visually impaired at many mountains,” he said. “Here in California, there’s even a programme for the visually impaired to learn to surf.”

One of his patients competed in the Paralympics in London in 2012 as a rower. “She developed Stargardt’s, which took her vision away as a child, but she did not let it stop her—in sports or in life.”

Visual abilities do not limit athletic capability, but athletic activity can impact vision—making sight important to protect. Ophthalmologists play a key role in preventing damage at every level.

“It should be standard and start from the very beginning with kids participating in sportswear protection. If you are wearing other protective gear anywhere else in your body, you should be thinking about protecting your eyes,” Dr Granet concluded. “With proper protection, everyone can participate in and grow from the joy and value of sport safely.”

David B Granet MD, MHCM, FACS, FAAO, FAAP is Professor of Ophthalmology & Pediatrics; Vice Chair of the Viterbi Family Department of Ophthalmology; Anne Ratner Chair of Pediatric Ophthalmology; Director, Anne F and Abraham Ratner Children’s Eye Center; and Director, Division of Pediatric Ophthalmology & Eye Alignment Disorders of the Shiley Eye Institute, UC San Diego, US. dgranet@ucsd.edu