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Health Topics for Eyes and Vision Department of Ophthalmology and Visual Sciences Ophthalmology and Visual Sciences |
Frequently Asked Questions
Sports and Eye Injury Prevention
Why can't I use my glasses prescription to get contact lenses? There are a number of reasons why the glasses prescription cannot be used for contact lenses. Contact lenses classified by the FDA as a medical device and are therefore regulated differently than glasses. Because you are actually putting a contact lens on the surface of the eye, there are risks for infections, ulcers, and other complications that are not present with glasses. When contact lenses are fitted to the eye, much more is taken into account than just the numbers from the glasses prescription. The curvature of the cornea (the clear tissue at the front of the eye that the contact lens sits on) is one important measurement that is taken. The diameter of the contact lens with respect to the diameter of the cornea is looked at as well. Position of the eyelids can affect contact lens choice. Additionally, health of the surface of the eye and the surrounding lids is taken into account. People often notice that the contact lens prescription differs from the glasses prescription in the numbers. This is because glasses sit about 12 mm from the eye, and contact lenses sit right on the eye. In order to account for this distance between the glasses and the eye, a mathematical calculation is made to determine the appropriate contact lens power. What is Computer Vision Syndrome and what can I do about it? I have always wanted to change my eye color. What are my options with contact lenses? There are an increasing number of options to change or enhance your eye color with contact lenses. There are two broad categories of lenses: those that have sheer or transparent tints and those that have opaque tints. Individuals with light colored eyes can wear either type. Individuals with dark colored eyes generally see more dramatic effects with opaque lenses that actually cover their natural eye color. The exciting thing about colored contact lenses is that you don't have to even need visual correction to wear these lenses! You can have great eyesight and still be fit with lenses. It is important to remember, though, that contact lenses are a medical device. Because of this, the fitting process for colored contact lenses is the same as non-tinted lenses. Measurements must be taken of the eye in order to determine the proper fit. Assessment of the fit of the lenses on the eye and the impact that could have on eye health must be evaluated. Once a good fit is achieved, then the fun with colors can begin! It is important to actually try on the colors in which you're interested because different colors have different appearances on each individual. There are many colors available from a number of different lens manufacturers. Some of the colors include the more traditional blue, brown, green, and hazel. There are also colors like violet, honey, gray, and aqua. There are colored lenses available in spherical and toric (for astigmatism) lenses. I have astigmatism. What exactly is that and can I wear contact lenses? Astigmatism is a commonly heard term, but few people know exactly what it is. Like near-sightedness (myopia) and far-sightedness (hyperopia), astigmatism is another condition that is usually correctable with glasses or contact lenses. Astigmatism is typically a result of the cornea (the clear dome-shaped part that covers the colored part of the eye) being shaped more oblong like a football than round like a basketball. Because of this variation in curvature, when light enters the eye, it focuses in more than one place. To correct for this, we put two powers in the glasses or contact lenses in order to allow all the entering light to focus in one spot to give you the best, clearest vision possible. In the past, patients with astigmatism were more difficult to fit with contact lenses. But with today’s technology, most people can successfully be fit into soft toric lenses or rigid gas permeable (RGP) lenses. With soft lenses, the type of lens is dependent on the amount of astigmatism. We have disposable soft toric lenses that correct for low to moderate amounts of astigmatism, as well as custom toric lenses that correct for higher amounts of astigmatism. RGP lenses, the newer generation of hard contact lenses, do an excellent job at correcting for astigmatism, too. For lower amounts of astigmatism, often standard lens designs can be used. If you have a higher degree of astigmatism, you may need a design called a bitoric lens. How would I know if I have an eye infection or a corneal ulcer? Wearing contact lenses puts you at a higher risk for infections and ulcers. A good "rule of thumb" to keep in mind is the RSVP rule: Redness -- can be one eye or both Secretions -- can be tearing, clear stringy mucous, yellow or green sticky mucous Vision changes -- typically mild to moderate decrease in vision or blurring Pain -- may be aching, sharp, dull, or just uncomfortable If you have any of these symptoms, it is essential that you remove your contact lenses immediately. For this reason, it is important to always have an up-to-date pair of back-up glasses. Do not attempt to treat a red eye yourself; go to your eye doctor as soon as possible. Non-preserved artificial tears may be used, however avoid Visine and other "get the red out" drops, and do not use someone else’s eye medications. I wear bifocals or reading glasses - can I still wear contact lenses? In most cases, yes! Around the age of 40, give or take, the focusing system of the eye becomes less flexible, a normal aging process called presbyopia. When this occurs, there are a number of contact lens options available to people. Some people prefer to have both eyes corrected for distance vision and have a pair of reading glasses to wear over the contact lenses in cases where clear near vision is needed. Another option some people are successful with is called monovision. Monovision is where one eye, typically the dominant eye, is corrected fully for distance, and the other eye is slightly undercorrected in order to see up close. Although the eyes aren’t fully working together at all times, the brain learns to adapt, and many people very successfully wear monovision. There are also bifocal contact lenses available. In general, these lenses provide patients with good vision most of the time, at most distances, and in most lighting conditions. Bifocal contact lenses are available both in soft lenses and rigid gas permeable (RGP) lenses. Within these groups there are two basic designs &endash; alternating and simultaneous. Alternating designs work very much like bifocal glasses where the top portion correct for distance and the bottom portion corrects for reading. There is a definite area of the lens for each working distance. Simultaneous designs allow clear distance and near vision at the same time. Some of these lenses have concentric rings of distance and near correction, while others are more like the no-line glasses (or progressive lenses) and the power changes from the center out to the edge of the contact lens. The process for fitting bifocal contact lenses can be time consuming because the fit of the lenses, the vision in the distance, and the vision up close all must be considered. If you and your doctor decide that this is the best option for you, be patient with lens changes because the final outcome will be worth it. What is the best soft bifocal contact lens available on the market? There is no one "best" soft bifocal contact lens. Different soft bifocals work differently for different people. There are a number of designs available, including lenses that have the distance portion in the center and lenses that have the reading portion in the center. In addition to soft bifocals, there are many rigid gas permeable (RGP) bifocal options. With both SCL’s and RGP’s, patients may be fit with monovision where one eye is corrected for distance and one eye for near. This fitting strategy may incorporate bifocal contact lenses and is then referred to as modified or enhanced monovision. Your eye care practitioner will select the best option for you based on the measurements of your eyes and your specific visual demands. The fitting process may take several visits in order to find the lenses that work best for you. What are the advantages and disadvantages of soft contact lenses compared to RGP's (Rigid gas permeable lenses)? There are so many different contact lens options available today that the choices can become confusing! There are two broad categories of contact lenses, however: soft contact lenses (SCL’s) and rigid gas permeable lenses (RGP’s). Each type of lens has advantages and disadvantages. Soft contact lenses tend to be very comfortable initially. They drape over the eye, so patients don’t feel them much when blinking. SCL’s tend to stay on the eye without becoming dislodged or displaced. Many people find disposable SCL’s (lenses are worn for a specific period of time &endash; from one day to several months - and then thrown away) very convenient and like knowing they have back-up lenses in case something happens to a lens. Disadvantages of soft contact lenses include the risk of tearing a lens and less oxygen getting to the cornea than with RGP’s. Some patients experience more dryness with SCL’s. RGP’s, on the other hand, allow more oxygen to the cornea by they tears flowing under the lenses. They provide very crisp, clear vision, and often people with mild to moderate dry eye find they can wear RGP’s longer and more comfortably than SCL’s. Some studies have shown that children fitted with RGP’s tend to have a more stable prescription than children do in glasses. Rigid gas permeable lenses are smaller in diameter than SCL’s and are felt more initially by the eyelids as you blink over the lenses. This lid sensation decreases quickly with time, and the final comfort of SCL’s and RGP’s is very similar. RGP’s may become dislodged from the eye or pushed off to the side more easily than SCL’s. Telling your eye care provider about your visual needs and the types of activities you enjoy will help him or her select the best lens option for you. I have diabetes. Can I still be a successful contact lens patient? Diabetes has an effect on the eye, as it does the rest of the body. Most diabetics are familiar with the risk of diabetic retinopathy, complications inside the eye from the disease. It also affects the front surface of the eye, or the cornea. Patients with diabetes may notice dryness more often and more severely than non-diabetic patients. In some patients, this dryness is not severe enough to prohibit contact lens wear. But dryness is only the initial concern. Diabetics tend to heal more slowly than individuals without diabetes. This is true for the eye as well as other tissues of the body. Contact lenses increase the risk of corneal ulcers and infections, both of which are of more concern to a diabetic patient due to the lengthened healing time. This does not mean that individuals with diabetes can’t wear contact lenses. Make sure to let your eye care provider know if you have diabetes as it may impact the choice of lenses or solutions. It is also important to remember to follow the wearing and care schedule your practitioner gives you in order to minimize the increased risk contact lenses have for patients with diabetes. Who is an ideal candidate to receive an eye donation? Is it possible to help someone who is completely blind? In talking about reception of the tissue, the eye tissue is used several different ways, most commonly for corneal transplantation. Patients who need a corneal transplant are those who have a disease, scar, or active infection involving the cornea. The cornea is the clear part of the eye much like a watch crystal. People who are completely blind and cannot see light cannot benefit from any type of corneal transplantation. Other parts of the eye including the sclera or white part of the eye are used in some types of oculoplastic surgery and in glaucoma surgery. So you can be an eye donor and help more than 1 or 2 people. I assume a donor must be dead? For the most part, corneal donation comes from people who are dead. In very rare circumstances, a donor may be living. For example a patient who has an ocular tumor in the back of the eye may be able to donate the eye at the time the eye is removed. If an eye is blind and it is removed, but is healthy in the front, that cornea might also be used. There are no instances of donation between people who are living in other circumstances. Another special circumstance where a person may donate a cornea to themselves is where one eye can still see and one can't. That is very rare. Is it possible to use artificial tissue to help those who need this procedure? There are types of surgery called keratoprostheses, which use artificial corneas. These are very difficult to use and are still being investigated and probably no more than 400 or 500 are done each year worldwide. It's used where it's impossible to get the donor cornea to take. For example, some patients with severe scarring of the eye socket where the lids don't operate normally might benefit from a keratoprosthesis. There are newer types of prostheses being developed to substitute for the cornea, but nothing is as useful as a human-donated cornea. The University of Iowa will be using the FDA approved keratoprosthesis alphacor in 2004. Is this a new procedure? How common is this procedure? Corneal transplantation is not a new procedure. The first ones were done in the late 1800s. The first eye bank was established more than 50 years ago. This procedure has been done routinely since the 1960s. The first eye bank was in Russia in the 1930s. At present, there are over 44,000 corneal transplants done every year, making it the second-most common transplant after blood donors. What would you do if a living person wanted to donate an eye? You have to discuss with the potential donor the motivation for the donation. Under ordinary circumstances, eyes are not the same as kidneys and are generally considered to need both for your best function. In circumstances where you've lost vision in an eye or you no longer see daylight, there might be exceptions, but otherwise donation would not be acceptable. Would someone with macular degeneration benefit from a donor procedure such as this? Patients with macular degeneration have a disease of the retina. The retina is like the photographic film inside a camera. It is a thin tissue that lies in the inside of the eye. Consequently, unless the cornea is also affected in some way, corneal transplantation would not help a patient with macular degeneration. There are some people who have corneal dystrophies such as Fuchs who also have macular degeneration, and they can benefit from transplantation when the cornea becomes cloudy. Are people with glaucoma candidates for this procedure? People with glaucoma have an eye condition where the optic nerve is being damaged, usually by pressure inside the eye that is too high. The cornea is not affected by glaucoma, but some patients will have both glaucoma and a corneal condition. Those patients may require surgery for the glaucoma and surgery for the cornea. Glaucoma is one of the factors that harms corneal transplant, so the glaucoma must be controlled before or at the time of the corneal transplant. Would diabetic retinopathy benefit from a transplant? Or would this or diabetes in general prevent someone from being a donor? For the first part, I would refer you to the answer about macular degeneration. Diabetic retinopathy affects the retina, not the cornea directly, so transplant would not help unless there is also a problem with the cornea. For the second part of your question, only the advanced stages of diabetes that require insulin prevent a patient from being a donor. Patients who have diet-controlled diabetes may still be eye donors. Patients who have severe forms of diabetes may donate their eyes for research rather than for corneal transplantation. Research is a very valuable mission and may lead to prevention or cure of blindness for many more than 1 patient. Is this an operation that is done more frequently on elderly patients or younger patients? Many patients who receive transplants are older, but the populations who are very old or very young are the populations that receive most transplants. Similarly, most of the donors are also older. The typical eye bank will accept donations from the age of 2 to 70 and donors younger than 2 and older than 70 are helpful for research tissue but not for corneal transplantation. In general, patients receive corneal tissue from donors approx the same age or younger than themselves. Is there a certain time frame that the eye must be recovered from the donor? Yes, there are time frames which are best. It's always the sooner the better. Eye banks are allowed to set their own time frame but typically if the donor has been kept cool, the tissue may be recovered for up to 8-12 hours and then placed in special solution before 24 hours. This would allow the tissue to be used for up to 7 days. Can you tell me where to go for help on organic brain damage? Organic brain damage, where there's no known cause for the damage, is a contraindication to corneal donation. There are many causes for organic brain damage. Among them are chronic abuses of alcohol or hardening of the arteries. Organic brain damage may lead to clinical dementia and patients with organic brain damage are usually helped through their family doctor or internist with the assistance of a neurologist. Who is the ideal candidate for this procedure (corneal donation)? The ideal candidate is a person who has corneal disease that is in the center of the cornea, and no other problems. The typical ideal candidate is one who has a condition called keratoconus. Patients with this condition have thinning of the central cornea to the point they can't wear glasses or contact lenses. Corneal transplant replaces that thin zone, allowing them to see. This group has the best prognosis for good vision with a clear graft. In general, good candidates have corneal conditions which need the transplant and have good ocular and physical health so they can take care of the transplant, and it will survive. What was the procedure Stevie Wonder was having tried on him at Hopkins? The procedure that Stevie Wonder was considering is to implant electrodes in the retina area that would then pick up light and transmit it to the brain. There are some similar procedures done creating artificial retinas with electrodes implanted in the brain that help patients to tell night and day and shadowy images. These are somewhat useful in very select patients but they take a great deal of learning. They will not be widely available for many more years. What is your opinion of Lasik Surgery of the eyes, and how does one decide on a good surgeon to perform the operation? My opinion of Lasik surgery of the eye is that is it very useful for the right people. We do Lasik surgery at the University of Iowa as do most academic medical centers. The second part of the question is difficult to answer. The best way to find a surgeon is talking to patients who've had the surgery or learning about the surgeon's experience both with Lasik and in ophthalmology in general. The patient needs to be careful that the surgeon they pick counsels them and examines them before surgery and after surgery. In some circumstances patients are "co-managed". Co-management involves other ophthalmologists or optometrists who see you first and then refer you for surgery. If you are in such a situation, you should know the financial arrangements to be sure that the co-manager is compensated appropriately and that you are not being led to surgery only for someone else's profit. What is the success rate of this procedure (corneal donation) and what is considered a success? The corneal transplant is successful if it remains clear. Success rate is usually determined at 1, 2, and 5 years. The best success rate in 1 year will be 98 percent clear corneas and is usually in patients with keratoconus or other corneal dystrophies. Over time, success rates drop, so that at 5 years, this group would be 90 percent clear. For all grafts, success rates are typically 80-90 percent in 1 year and 70-75 percent in 5 years, but that includes patients who are less than ideal candidates or who have problems that involve the peripheral cornea. These patients have a higher rate of corneal rejection. How does one become a donor? The first thing about becoming a donor is to tell your family. In every state it is a matter of eye bank policy that the family will be asked whether the patient wished to be a donor, even if you have signed an advance directive. When you go to the driver's license bureau in many states, you can sign a card stating that you wish to donate. The card will allow you to specify whether you wish to donate your eyes or your organs or other tissues. If you wish to donate then of course you should sign the card, but the most important thing is to tell your family and close friends about your desire to help even after you're gone. In some states, if you die and the circumstances involve the medical examiner, such as in a car accident, then the medical examiner can authorize donation, but nowadays, every attempt is made to find your family or close friends to find out what your wishes were. So the best thing is to always tell your family. If you have questions about donation, you can contact the eye bank in your area or the organ procurement organization, sometimes called OPO or OPA, for your region. They can provide further information. In Iowa, you can sign up through the Donor Registry on the internet (www.iowadonorregistry.org). Are there any things that would disallow a person to become a donor, as far as their health while living? The principal things that disallow you to be a donor are things that would be regarded as unsafe for people who collect the tissue. This would include obvious conditions such as HIV positive status or AIDS, severe infectious problems such as sepsis or hepatitis that is active, which would be unsafe for technicians. The concern would be transmission of these diseases to both the technician through a needle stick or to a recipient of the transplant. There are other more rare conditions such as rabies, which the eye banks and the eye bank technicians will be aware of, but the general public would probably not know about. Every donor has their medical history screened prior to being accepted and having the tissue recovered. Can someone who has had Lasik surgery be an eye donor for transplant purposes? The tissue can be used for research and possibly for new forms of deep endothelial corneal transplant. Anyone who's had Lasik, PRK, RK or other corneal surgeries except for cataract surgery cannot be a donor for typical transplant purposes. There are two concerns: The first is the new shape for the cornea will be incorrect for the new recipient. The second is these prior surgeries may keep the donor cornea from surviving the next surgery or transplantation. The healthy posterior portions of donor cornea can be used for this new procedure, DLEK (Deep Lamellar Endothelial Keratoplasty) that helps people with swollen corneas from cataract surgery or Fuchs Dystrophy. Has consumer designation on driver's licenses been successful? Consumer designation has been successful because it raises awareness of the public to the need for both tissue and organ transplantation. In this country we have a shortage of organs such as kidneys, hearts and livers for transplantation b/c the requirements are much more stringent than for tissue such as cornea, sclera, bone or skin. By raising the awareness, we make it possible for more people to become donors by asking their families. One law passed in the last year has required all hospitals to notify their regional organ procurement organizations on every death in the hospital. If they don't, the government will cut off their federal funding. This has increased the number of potential and actual donors by a large amount. But nevertheless, unless the potential donor wished to donate or the family feels they wished to be a donor, their tissue and organs cannot be recovered. Hypothetically, what if everyone had lasik surgery and there was no one left to donate corneas? What would those who need a transplant do? First of all, not everyone will have Lasik surgery because only about 25 percent of the population needs it. At the present time, less than 1 percent of the population who needs Lasik surgery has had it. There will always be people who have not had eye surgery who can be donors. It merely means we have to get the word out to everyone. People who need corneal transplants will be able to get corneal transplants. I have had recent problems with what my physician called floaters. What causes this? Floaters are symptoms of things in front of the eye when you know there's nothing there. They are typically found inside the vitreous cavity. Most of the time they are remnants of arteries that helped form your eye. When you get older the vitreous jelly begins to liquefy and you can see these floaters more easily. Most of the time, they are harmless, but patients who have new floaters, especially associated with flashes of light, should see their ophthalmologist for a complete dilated eye exam to rule out more serious problems such as retinal tears, detachments, or bleeding. What are the risks of undergoing transplant? Risks of transplantation are numerous. The most common is that the transplant fails to work. At the time of surgery there are the risks inherent in surgery including infection, bleeding and leaking of the wound so that the eye becomes too soft, but the more usual risks are that the patient will have a rejection episode. Rejection occurs when the body recognizes new tissue that doesn't belong there and tries to eliminate it. This happens about 1 in 7 times. Most of the time it can be prevented or treated with special medications including steroids. Other risks include glaucoma as mentioned earlier, and problems with focusing afterwards such as astigmatism or being too near or far-sighted, so that in general, the procedure is very successful with very rare severe complications, but may need to be repeated in order to finally succeed. How does macular degeneration affect vision? There are two main ways that macular degeneration can affect vision: the loss of retinal cells and the development of abnormal blood vessels. The inside of the eye is lined by three layers of tissue that each has a critical role in normal vision. The innermost layer (the layer first struck by the light that enters the eye) is known as the retina and consists of a complex network of nervous tissue. Some of the cells in this layer (the photoreceptors) convert light into an electrical signal, which is then amplified and processed by other cells before being sent to the brain via the optic nerve. The central part of the retina (the macula) has a number of special structural features that allow images focused on it to be seen with very high resolution. The middle layer is a one-cell-thick sheet known as the retinal pigment epithelium or RPE. The RPE provides metabolic support for the photoreceptor cells and also removes old bits of cellular debris from the tips of the photoreceptor cells as they renew themselves. The layer farthest from the incoming light is a rich network of blood vessels known as the choroid. These vessels supply oxygen and nutrients to the retinal pigment epithelium and photoreceptor cells and carry away waste products. In macular degeneration, clumps of yellowish material gradually accumulate within and beneath the retinal pigment epithelium. These deposits are visible to a doctor who looks inside the eye as small yellow spots known as drusen (singular: druse). With the passage of time, patches of retinal pigment epithelial cells may die, resulting in bare spots known as geographic atrophy. When the support functions of the RPE are lost, the photoreceptor cells overlying the areas of geographic atrophy cannot function and the vision from this patch of retina is lost. If these patches become large and involve the very center of the macula (the fovea), the individual's visual acuity can fall to the point that they are considered legally blind. This atrophic phase of macular degeneration is sometimes referred to as "dry" macular degeneration and is the most common mechanism of vision loss in affected individuals. In approximately 10% of patients with macular degeneration, the injury of the retinal pigment epithelium described above stimulates new choroidal blood vessels to grow up into the RPE and retina--seemingly in an attempt to heal the defects in these layers. This reparative response is very similar to those that occur elsewhere in the body in response to injury, such as scar formation in response to a cut on the skin. Unfortunately, the retina is such a complex and highly ordered tissue that the ingrowth of these new blood vessels causes more visual loss than the original degenerative process does. In fact, although only 10% of patients develop new blood vessels, this complication is responsible for the majority of the legal blindness associated with macular degeneration. The vascular phase of macular degeneration is sometimes called "wet" macular degeneration. What are the symptoms of macular degeneration? The most common symptom of macular degeneration is decreased visual acuity, that is, decreased ability to see fine detail. Individuals with macular degeneration can experience small gaps in their vision, which they recognize as the need for larger print in order to be able to discern the letters. Sometimes, the disturbance of the structure of the retinal pigment epithelium causes the surface of the retina to be irregular and this results in distortion of the viewed image. This may be viewed by some as bending or curving of straight lines. When a growth of abnormal blood vessels occurs, such bending and waviness can become quite pronounced. Visual distortions of this type are sometimes more easily seen when viewing a high contrast grid. This is the basis for the test known as an Amsler Grid. What causes macular degeneration? The term macular degeneration refers to a group of different diseases that will almost certainly prove to have several different causes. Physicians have wondered about the causes of macular degeneration for more than a century. In the late 1800s, when doctors first began looking into eyes with ophthalmoscopes, they believed that the yellow spots (drusen) they observed represented some type of infection, or at least inflammation, of the choroid. Even today, there is some evidence to suggest that the body's immune system plays a role in the development of some forms of macular degeneration, especially the development of neovascularization. Another group of possible causes are environmental factors. That is, with any late-onset, degenerative process, it is tempting to hypothesize that the degeneration has resulted from an exposure to a bad agent, or lack of exposure to a good agent, sometime during the course of the patient's life. Scientists have searched for evidence of such factors for decades. The factors studied in this way include various nutritional factors (e.g. zinc, B-vitamins, antioxidant substances), light exposure, drugs (e.g. caffiene, nicotine, oral contraceptives, etc.), and toxins (e.g. plasticizers). Although some of these factors appear to have a demonstrable effect on prevalence or course of macular degeneration (green leafy vegetables and some specific nutritional supplements are good, cigarettes are bad), none has emerged as a likely major cause of macular degeneration. Another important group of likely causes of age related macular degeneration are mildly abnormal genes. It has been recognized for over a century that some forms of macular degeneration run in families, and during the past 30 years, an increasing amount of evidence has been gathered that suggests that a significant fraction of macular degeneration has a hereditary basis. This has important implications for understanding macular degeneration at the molecular level, as well as for designing improved treatments for the disease. When a disease like macular degeneration is caused by a single gene, a number of family members may be similarly affected. Such families can be studied by modern molecular genetic methods in ways that allow the causative gene to be identified. In the past 10 years, the chromosomal locations of several genes that cause macular-degeneration-like conditions have been identified, and six of these (ABCA4, VMD2, RDS, ELOVL4, TIMP3, and EFEMP1 have actually been identified. Unfortunately, none of these six genes causes a significant fraction of typical late-onset macular degeneration, but the disease mechanisms are similar enough to the latter condition that scientists can already begin to develop animal models of macular degeneration based on these genes to use in developing new treatments. The genetic approach is particularly appealing because if a genetic predisposition to macular degeneration can be identified, it raises the possibility that individuals can be tested for the predisposition early in life and given some sort of treatment that will delay or prevent the onset of the macular disease. Such treatment has the potential to be safer, simpler, cheaper (and hence more globally available) than some of the other experimental treatments currently under development. Sports and Eye Injury Prevention What types of sports do you find yield the most eye injuries? It depends on the age of the participant. Baseball has the most eye related injuries in the U.S. This is especially true for children under age 12. In the age 15 to 24, basketball results in the most injuries. The most severe injuries used to occur in hockey, but the addition of strict eye protection requirements has significantly reduced ocular related eye injuries. What type of protection do you recommend? That depends on the type of sport one is playing. The American Academy of Ophthalmology has specific recommendations for appropriate eye protection for different sports. For example, a sport such as soccer is adequately protected with sports goggles that have polycarbonate lenses. Football requires a polycarbonate shield on the helmet. For some sports such as wrestling, no eye protection is available. What should be done at the time of injury to take precautions before a medical professional arrives or is seen? The first thing to do is to cover the eye for protection. This could be done with a metal shield or any rigid structure that could be taped over the eye. Sometimes, if nothing else is available, a Styrofoam cup can be taped over the eye such that it fits snugly around the bones of the eye. If the injury was such that the eye had been ruptured, even minor pressure on the globe could result in irreparable damage. What type of injury is most common to the eye during sports? Fortunately, the most common injury would be a corneal abrasion. This injury, although quite painful, usually heals with no permanent damage. However, more serious injuries can occur such as blood in the eye (hyphema), cataract, glaucoma, or retinal detachment. When blood vessels are broke in the eye, how long does it take for them to clear up? That is quite variable. It is very similar to a bruise. A small amount of blood can clear within hours to a day but a large amount of blood may never clear. In these cases, surgery is required to remove the blood. Is it dangerous to play sports after a lasik procedure? How much time is needed after procedure to play basketball for instance? Lasik weakens the cornea and thus would increase the chance of damage to the cornea with severe trauma. However, generally speaking, there are other areas in the eye that would rupture at the time of trauma before the cornea and thus Lasik procedure is generally felt to be safe, for people in sports. Nevertheless, eyewear protection that is appropriate to the sport still needs to be worn. How many injuries require surgery? Of sports related injuries, less than 10 percent would require surgery. This number is quite variable however depending on the sport. For example, squash injuries are more likely to be mild and not require surgery than are paintball injuries or ice hockey injuries. Do many eye injuries lead to blindness? In sports injuries, approximately 90 percent of injuries can be prevented by protective eyewear. Blinding injuries occur in over 41,000 cases of sports related injuries a year. What is a lasik procedure? A lasik procedure is a surgery to correct nearsightedness. Part of the cornea is surgically removed and the cornea is reshaped to eliminate the need for glasses for nearsighted patients. Is it safe to wear hard contacts while playing sports? Yes it is, as long as appropriate eye protectors are being worn for that specific sport. What is the most common eye injury found in squash, now that you mention it? Fortunately, it again is corneal abrasion. More severe injuries from squash are much less common. Is there such thing as temporary blindness? Yes there is. Many problems, such as hemorrhaging in the eye, can lead to temporary blindness. Why is eye protection during sports participation so important? Because 90 percent or more of sports related appropriate eye protectors could prevent eye injuries. Is any research being done on this topic? Yes definitely. The U.S. Eye Injury Registry was formed in the early 1990s to try to provide epidemialogic data regarding eye trauma. However, at this time, only about 3 cents of every eye research dollar is spent on eye trauma. Since eye trauma is estimated to be the most preventable cause of blindness in young America, it is my opinion that more research dollars should be spent on this topic. What are some of the risks involved with eye surgery? That varies quite a bit depending on what surgery is being performed. As with most surgeries, bleeding and infection are possible and can cause permanent loss of all sight. Fortunately, these are rare complications in most surgeries. In temporary blindness, how long does it take to recover sight? It is quite variable and depends upon the reason for temporary blindness. It can last from hours to months. What is a detached cornea? There actually is no such thing as a detached cornea. The most common injury to the cornea is an abrasion, but the cornea can also sustain partial thickness or full thickness laceration. Are eye injuries as common in sports as orthopedic injuries? The type of injury depends on the sport. For example, orthopedic injuries are more common in wrestling than eye injuries. In some sports such as golf, eye injuries are quite rare. However, the injuries in golf usually result in loss of all useful vision. This is due to the high velocity and size of the golf ball and golf club. Why do you think people don't protect their eyes? There are many reasons for this. Probably the most common reason is its inconvenience. If someone does not already wear glasses, it is inconvenient for them to put a pair on. At least they feel this way until they get an eye injury. Often times, a severe eye injury will change this opinion. We strongly recommend that people who have had severe injury to one of their eyes wear protective eyewear at all times. It is still possible to safely participate in most sports if you have only one good eye. However, some sports have no adequate eye protection. For example, boxing and full contact martial arts have no adequate eye protection available. It is best for functionally one-eyed people to avoid these sports in my opinion. Do you tell people to stay away from sports after having an injury? Until their injury is healed, it is best to refrain from certain strenuous activities. Your eye care practitioner should be able to give you advice as to which activities are appropriate. Most people can safely return to sports following an eye injury if they use appropriate eye protection specific for their sport. Did you see the injury the hockey player suffered a few weeks ago? Wow! What was that type? I think he is blinded in that eye. I have not heard all the details about this injury, but I am pretty sure that his eye was ruptured. This means his eye was "split open" and that some of the internal contents came out. This kind of injury has a very poor prognosis. How long does it take to heal? It is variable, but for ruptured globes, there is usually massive, permanent damage. Do you think they should require face shields? In my opinion, yes. Face shields, when used in the Canadian youth leagues, decreased significant eye injuries to a very small level. It has been very difficult, however, to get the older hockey players to wear such protection. Some hockey players object that shields restrict their peripheral vision. They feel that it decreases their performance. Obviously, severe loss of vision severely affects your performance as well. We always have to make tradeoffs in the world. Is the eye a very durable muscle? That is, can it take a lot of abuse? The eye is actually not a muscle. The eye is very similar to a camera in that it has a lens that focuses light on a piece of "film". This film is called the retina. Information that is focused on the retina is then transmitted down the nerve, called the optic nerve, and arrives at the brain. The white part of the eye is called the sclera. It is a tough durable layer, but it is relatively weak in the region where it attaches to the cornea in the front of the eye and where it attaches to the optic nerve in the back. These are two areas of the sclera that are susceptible to rupture during eye trauma. There are some people whose sclera is much thinner than others in these people minimal trauma to the eye can cause rupture to the sclera. What type of surgery do you most often perform, and who is your typical patient? In my practice, the most typical surgery I perform is called the vitrectomy. This surgery involves removing the vitreous jelly from the center of the eye. Frequently in people with severe diabetic changes in the eye, the vitreous can become very cloudy due to hemorrhaging. Sometimes a remove of the hemorrhage is required to restore useful vision. Minimal amounts of hemorrhage can sometimes settle to the bottom of the eye and clear without surgical intervention. Are there any eye injuries that are hopeless, meaning, no treatment available? Generally speaking, many injuries that have been severe enough to result in loss of the ability to see even brightest light are "hopeless." There are, however, some eyes that only transiently lose the ability to see light. It is very important to have a trained eye practitioner examine patients to make this determination. What do you consider the most dangerous sport, for eyes? Some people consider war the ultimate sport. Wartime injuries to the eye have increased with each war. Fortunately, military has eye protection programs underway. If you exclude war, probably the most dangerous sport currently being played is paintball. The gelatin coated pellets shot from air guns during war games travel at 300 feet per second and can easily rupture the eye when fired from distances of 12 feet or less. BB guns and air rifles also are extremely risky "sports" for the eye. What do you think is important for us to know, as athletes, about protecting our eyes? I think the most important take home message is the greater than 90 percent of sports related eye injuries can be prevented with appropriate eye protection. How frequently do injuries occur from basketball? In any given year, approximately 1 in 10 basketball players will sustain an eye injury. Most injuries are corneal abrasions caused by opponentŐs fingers or elbows striking a player's eye usually during aggressive play under the boards. More severe injuries can occur including retinal detachments and even tearing the optic nerve. Again, almost all of these injuries can be prevented by protective eyewear. It has become more fashionable to use protective eyewear in basketball since several high profile NBA players have adopted this habit. Should women not wear eye make up when playing a sport? If the eye makeup runs with perspiration, there is a good chance that it will eventually get into the eye. Some types of makeup will be quite irritating to the eye and this could decrease your performance of playing the sport. There is really no absolute contraindication to wearing makeup while playing a sport, however. Can blind people participate in athletics? Over the last 20 years, there has been a major increase in sports activities available for blind athletes. These include track and field, wrestling, gymnastics and several specialty sports such as beep baseball and goal ball. This is a fast paced game developed especially for blind athletes in which a 4-1/2 pound ball containing bells is rolled on a 30 by 60 foot mat passed opposing players across an end zone. Blind athletes also participate in golf and skiing. What is the role of sports visual training? Some people believe that one can increase their performance in sports by training their eyes to "react better". There are quite extensive training courses on the subject, but the results have been quite difficult to interpret. Some claim that visual training improves athletic performance. However, a key question remains. Would the same amount of time spent with a good coach under actual game conditions result in a better final performance than that same amount of time spent with visual training? The answer to this question is yet unclear. Do different sports injuries occur at different ages, do children get the same eye injuries as adults? Most sports injuries occur in individuals under age 25 and almost half of injuries occur in people under age 15 and 6 percent of injuries occur in children under age 5. Younger children, from age 5 to 14, have about 20 percent of their injuries from baseball. Overall, sports most commonly associated with eye injuries in adults are baseball, basketball, soccer, football and hockey. Younger children are more susceptible to severe eye trauma because of their athletic maturity and overall fearless attitude towards participation. In summary, sports are to be enjoyed by all, but will certainly be enjoyed more fully if one still has their vision at the end of the day. The best way to assure this is to use protective sports wear, appropriate for your individual sport. Your eye care practitioner should be able to advise you in the appropriate eye protection. Thank you. Last Reviewed 2005 Source: University of Iowa Hospitals and Clinics Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.
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