Printer Friendly

Contact lenses and sport.

Introduction

Participation in sport, games and physical activity generally decreases with age and the wearing of spectacles increases. (1) Up to 50% of the UK population participate actively in sport (2) with many of these activities hindered by wearing spectacles.

Replacing spectacles with contact lenses can revolutionise sports participation for patients with refractive error. (3) A quarter of contact lens wearers identify sport as being a major reason for choosing contact lenses; 45% of female and 65% of male contact lens wearers participate in sports with 94% wearing them for these activities. (1)

Importance of clear vision

Sport is a social activity, and whether in the swimming pool or on the athletics track, it is important to be able to see fellow competitors. In competition, it is vital to be able to read body language and expression in one's competitors; lack of this information can have a material effect on the result of the race, as reported by Olympians. (4) Using contact lenses as an alternative to spectacle correction offers numerous advantages to patients undertaking sporting activities at all levels (see Table 1).

Swimming and watersports

Ten million people swim in the UK and good vision in the swimming pool has many advantages. Swimmers need accurate binocular vision to judge turns and the timing of the touch. In backstroke, a clear view of features on the ceiling helps maintains lane position. Generally, practitioners do not recommend contact lens wear for water sports. Nevertheless, the reality is that many people do wear contact lenses and practitioners need to be able to give pragmatic advice. Chlorine and pool contaminants may remain in contact lenses. Chemical conjunctivitis, microbial keratitis and fungal infections as well as loss of lenses are all risks in water sports.

In sports such as canoe slalom and water polo, where aiming and distance judgement are critical, prescription-swimming goggles are not generally worn because of their tendency to mist up, retain water droplets and reduce peripheral vision affecting the ability to accurately judge gates (see Figure 1). Similarly, catching and aiming the ball in water polo would be seriously affected in competition under these circumstances (see Figure 2).

Orthokeratology is a viable alternative to standard contact lenses for water sports participants. The use of these custom-designed rigid gas permeable (RGP) lenses to correct myopic refractive error during sleep eliminates the risks associated with using standard contact lenses in water.

Athletics

Track and field athletics are dynamic sports where rapid eye movements are as common as explosive body and head movements. (5) Contact lenses are an ideal option for vision correction in this sport. The stability of the contact lens in the eye due to capillary attraction can deal with the most vigorous body or head movement and are only likely to become displaced by physical contact with other competitors.

Some contact lenses offer protection against ultraviolet radiation although athletes often seek further protection to the eyes and adnexa using appropriately dispensed wrap sunglasses to wear in conjunction with their contact lenses. (6)

Shooting

Shooting is the essence of visual performance in sport. In the elite shooter, the athlete may appear to be stationary but at a micro level the whole body is in dynamic equilibrium. As they look through the foresight of the rifle it will drift over the target with timing of the release of shot being critical. In pistol and rifle shooting the stability of the contact lens is critical; if there is too much movement on blink the aim will be disrupted and delay the shot. Needless to say, the comfort of the contact lens should be maximised using optimal materials with high oxygen transmission. If necessary, rewetting eye drops, ideally in a preservative-free format, can be used to keep the contact lens hydrated and help to maintain the stability of the tear film. Most clay shooters wear protective shooting spectacles which can be worn in conjunction with contact lenses, incorporating tints and prisms where necessary (see Figure 3). A regular review of optimal correction is essential in this highly vision-dependent sport.

Racket and ball sports

Contact lenses are a good option for vision correction in racket sports such as tennis and squash. However, it is important to consider the potential risks of ocular trauma from impact by the ball or racket. Therefore, contact lens wearers should also be advised on suitable protective eyewear for these activities while taking advantage of the visual benefits that contact lenses provide. These protectors can also be used to carry appropriate tints as required by the competitor.

Contact sports

In contact sports, the first rule of protection is avoidance. In all sports, to avoid an object you need to see it coming; this depends critically on the ability to judge the position of the object in relation to the athlete (aiming) and how far away and how fast it is travelling (depth perception).

It is obvious that failure to suitably correct for refractive error will reduce the ability to avoid or hit an oncoming object. (7) The primary responsibility is to protect the eye from injury and if this cannot be done with an eye protector then it should be done with the best possible visual correction. In football for example, it could be argued that poorly corrected vision contributes to ill-timed tackles or being caught on the ball.

Martial arts and boxing

If shooting is the essence of vision in sport, then boxing is the essence of competition in sport. In contact sports, such as boxing and martial arts, spectacles are clearly not a sensible option for vision correction. Refractive surgery such as LASIK could also pose risks in pursuits of this nature. Everything should be done to maximise vision for combat sports and soft contact lenses are a good option for patients involved in these activities.

Snooker

Snooker at a competitive level has a small margin for error and is highly vision-dependent, requiring accurate aim and excellent depth perception. Of course, snooker players often choose the custom-designed high fitting frames with adjustable pantoscopic tilt made popular by Dennis Taylor. Nevertheless, contact lenses have a number of advantages over these appliances by avoiding problems with reflections, discomfort from frames, peripheral distortions and prismatic effects.

The importance of visual correction

Once the direct relationship between vision and sporting performance is understood in relation to the two primary visual skills of aiming and anticipation, the importance of correction can be clinically justified. Even small refractive errors can have a profound effect on the ability to see a ball, and judge its distance and position. For instance, if the dominant aiming eye has an uncorrected refractive error, the non-dominant eye may take over the aiming process.

Contact lenses are ideal for correcting myopia; even -0.25D could be worth prescribing for sports with a high visual requirement such as archery. Astigmatism is equally important to correct, as it will affect aim in the dominant eye and depth perception if present in the non-dominant eye. Even spherical soft lenses can correct a little residual astigmatism, which can make a significant difference to a competitive sports person with high visual demands. Certainly, astigmatic refractive errors of 0.75D or more should be corrected with toric soft lenses, which are now available in a wide range of parameters and modalities. Large diameter RGP lenses and mini-sclerals should not be overlooked as offering a viable alternative to soft contact lenses. Young hyperopes who may typically remain uncorrected for much of the time will benefit from optimal correction with contact lenses if undertaking visually demanding sporting activities. Contact lenses may also be considered to control distance exophoria by negatively over-correcting the refractive error where amplitudes of accommodation permit.

Tinted lenses in sport

The use of specific hues and saturations in sport can be a great advantage, especially in light-sensitive athletes. (8) Contrast is an important consideration whether the sport is explosive (soccer) or controlled (golf). Specific contact lenses for sport have been developed and marketed in the past with the intention of improving contrast in fast moving sports using an amber tint for sports such as tennis and football and a grey-green tint for golfers.

Unfortunately these modalities never gained mainstream popularity within their intended markets. It is likely that the saturation of the tints distorted the real-world view, which outweighed any benefits obtained from contrast-enhancement. In reality, contrast enhancement can be achieved in all sports and occupations by filtering out the blue and UV end of the end of the spectrum to remove the veiling background haze. (9) Any filter further up the electromagnetic spectrum than blue can enhance contrast. Green for instance gives very good contrast as does brown or tan. The hue and saturation used for contrast enhancement needs to be athlete specific not sport specific; this can be determined by measuring colour preference and light sensitivity. (8)

Conclusion

Catering for the high visual demands of sports participants represents multiple opportunities for the practitioner. Contact lenses should be considered as a primary method of correction for the majority of sports with the use of additional appliances to offer further protection from the elements where required. The opportunity for the practitioner to embrace the diverse needs of their patients in this regard allows a broadening of professional experience, interest and reputation, while serving the interests of the patient to the highest level. The wide range of soft contact lenses available in different modalities and parameters, along with suitable alternatives in RGP and mini-scleral designs, means the the choice has never been greater for practitioner and patient alike.

Reflective learning

Having completed this CET exam, consider whether you feel more confident in your clinical skills--how will you change the way you practice? How will you use this information to improve your work for patient benefit?

Course code: C-36691 | Deadline: July 4, 2014

Learning objectives

To be able to obtain appropriate history relating to sporting activities (Group 1.1.1)

To be able to select appropriate contact lens designs suitable for a range of sporting activities (Group 5.1.1)

Learning objectives

To be able to understand the suitability of different contact lenses for a range of sporting activities (Group 5.1.1)

Learning objectives

To be able to obtain appropriate history relating to sporting activities (Group 1.1.1)

To be able to select appropriate contact lens designs suitable for a range of sporting activities (Group 5.1.1)

Exam questions

Under the enhanced CET rules of the GOC, MCQs for this exam appear online at www.optometry.co.uk/cet/exams. Please complete online by midnight on July 4, 2014. You will be unable to submit exams after this date. Answers will be published on www.optometry.co.uk/cet/exam-archive and CET points will be uploaded to the GOC every two weeks. You will then need to log into your CET portfolio by clicking on 'MyGOC' on the GOC website (www.optical.org) to confirm your points.

References

Visit www.optometry.co.uk/ clinical, click on the article title and then on 'references' to download.

Acknowledgement

The author would like to thank Martin Cardall for his advice in writing this article.

Geraint Griffiths MSc, MCOptom

Geraint Griffiths is chair of the Association of Sport and School Vision Practitioners, having published extensively in the field of sports vision. He is in independent practice at Optical3 in Leicester and the College of Optometrists councillor for the East Midlands region.

Table 1 Advantages of contact lenses for sport

Optometric                         Dispensing

* Reduction of differential        * Protection from UV
prismatic effect

* Reduction of magnification       * Do not steam up
differential in anisometropia

* Correction of small amounts of   * Reduced risk of facial trauma
astigmatism with aspherics or GP
lenses                             * No problems with poor fit or
                                   frame slipping

* Correction of moderate           * Improved cosmesis
hyperopia when unaided vision is
normal to control esophoria

* Reduced magnification/           * Full wrap protection from plano
minification effect in high        sunglasses over contact lenses
prescriptions.
                                   * Increased peripheral awareness

                                   * Reduced spatial distortion

                                   * Good vision in the rain
COPYRIGHT 2014 Ten Alps Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:1 CET POINT
Author:Griffiths, Geraint
Publication:Optometry Today
Geographic Code:4EUUK
Date:Jun 6, 2014
Words:1995
Previous Article:Colour concern: with awareness campaigns running in practices across the country on the dangers of 'blue light'.
Next Article:Recurrent corneal erosion syndrome.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters