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54 mivision OCT 13 mitechnology Protecting Vision, Enhancing Performance Why Sunglasses can’t be Eye Protectors but Eye Protectors can be Sunglasses WRITER Annette Clayfield Hoskin For most people in Australia, recreational activities are a regular and growing part of our daily lives. Eye care practitioners have a duty of care to present the best possible options for eyewear that will protect and enhance each patient’s vision while they’re out and about. That means it’s time to change your mindset, the mindset of your staff and your patients – you’re not selling a second pair of glasses, you’re selling an essential piece of sporting kit! ENQUIRE AND RESEARCH To ensure you can provide patients with the very best advice on eyewear, it’s essential to ask them about their recreational pursuits. If you operate in an area renowned for a particular activity, such as biking or fishing, it’s a good idea to take the time to understand the relevant visual requirements and physical demands – in doing so, you’ll be in the best position to provide advice on the appropriate eye protection. Once armed with the information you need, use it during your consultation times. Explain to your cyclist patient the importance of protecting their eyes from dust and flying particles, of accurate glare free vision and of having frames that stay in place on the face… talk to your fishing customers about the value of polarised lenses… and inform tennis players about the dangers of wearing regular eyewear with glass lenses on the court… help them It’s not unusual for your average lycra clad, café going cyclist to spend Au$10,000 on a performance bike, for a bait loving fisherman to spend $1,000 on a rod and reel or a race-going yachtie to spend several hundred dollars on a pair of deck shoes (not to mention the spray jacket, leggings etc. etc.). So why wouldn’t they invest a few extra dollars into the appropriate eyewear to both protect their vision and enhance their performance?

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  • 54 • mivision • OCT 13

    mitechnology

    Protecting Vision, Enhancing Performance

    Why Sunglasses can’t be Eye Protectors but Eye Protectors can be Sunglasses

    writer Annette Clayfield Hoskin

    For most people in Australia, recreational activities are a regular and growing part of our daily lives. Eye care practitioners have a duty of care to present the best possible options for eyewear that will protect and enhance each patient’s vision while they’re out and about. That means it’s time to change your mindset, the mindset of your staff and your patients – you’re not selling a second pair of glasses, you’re selling an essential piece of sporting kit!

    EnquirE and rEsEarch To ensure you can provide patients with the very best advice on eyewear, it’s essential to ask them about their recreational pursuits. If you operate in an area renowned for a particular activity, such as biking or fishing, it’s a good idea to take the time to understand the relevant visual requirements and physical demands – in doing so, you’ll be in the best position to provide advice on the appropriate eye protection.

    Once armed with the information you need, use it during your consultation times. Explain to your cyclist patient the importance of protecting their eyes from dust and flying particles, of accurate glare free vision and of having frames that stay in place on the face… talk to your fishing customers about the value of polarised lenses… and inform tennis players about the dangers of wearing regular eyewear with glass lenses on the court… help them

    It’s not unusual for your average lycra clad, café going cyclist to spend Au$10,000 on a performance bike, for a bait loving fisherman to spend $1,000 on a rod and reel or a

    race-going yachtie to spend several hundred dollars on a pair of deck shoes (not to mention the spray jacket, leggings etc. etc.). So why wouldn’t they invest a few extra dollars into

    the appropriate eyewear to both protect their vision and enhance their performance?

  • OCT 13 • mivision • 55

    understand that protective eyewear must become an integral part of their kit.

    Working through thE options When it comes to helping your patients choose the best possible eyewear to protect and maximise their vision, there are several design elements for both the lens and frame that need to be considered:

    Light and coLour High glare environments can result in one to two lines reduction in visual acuity, so by ensuring adequate protection from glare and intense lighting conditions, you can help maximise your patients’ vision. For example, customise the tint to meet your patients’ needs, keeping in mind that lighter eyes are more sensitive to light and therefore require a darker lens. Consider also the particular activity your customer is involved in – brown lenses – help increase contrast on a green background for sports such as golfing, whereas for target shooters, a yellow tint in low light conditions can enhance targets against a blue background.

    The notion of reducing blue light to enhance vision and protect our eyes remains controversial. Some studies have suggested that blue light is phototoxic; while others argue the doses in natural light and from LED’s are far too small to have a damaging effect. More research is required.

    The harmful effects of ultraviolet light, however, are well understood and documented. Both short-term discomfort and long-term eye damage, including pterygium and cataract, result from exposure to UV light. To help protect from these diseases, it’s important to choose a lens material and/or coating that eliminates harmful UV rays. It’s also critical to select frames with adequate fit and coverage. A close fitting wraparound frame and lens with UV protection will provide the very best possible defense for your patients’ eyes from UV light.

    impact rEsistancE Increasingly, evidence is showing that the incidence of eye injuries from high-risk sports is reduced by 77 – 84 per cent when mandatory eye protection is worn.1,2,3

    Sports identified as medium to high risk include those where there are balls or bats, as well as where there is a risk of a finger in the eye or a collision. Some examples of medium to high-risk sports include cycling, squash, tennis, basketball, lacrosse, field and ice hockey (See Table 1).4-9 Regular dress optical spectacles should not be worn for these activities, as the additional risk carried by the frame and or lens can result in increased risk of facial and ocular trauma.10-12

    Instead people who participate in activities associated with a moderate to high risk of acute eye injury should wear a frame and lens capable of withstanding impact energies without cracking or shattering.

    Sport Specific Demands Suggested Solution and Tint Relevant Requirements

    Cycling High speed small particlesDust . water, insectsRoad glareNear (trip meters) and distance critical

    Progressive lens designPhotochromic or interchangeable lensImpact Resistant

    AS1067 (with increased impact resistance in accordance with AS/NZS 1337.1)

    Fishing, boating, water sports

    High GlarePenetrating eye injury hazard

    PolarisedPhotochromic polarisedFloating frameImpact Resistant

    AS1067 (with increased impact resistance in accordance with AS/NZS 1337.1)

    Racquet sports including tennis, squash

    Squash- artificial lightBlunt trauma hazardTennis – high glare

    Polarised for tennis or clear for squash AS4066 Racquet Sports Eye Protection

    Golf Eye-hand co-ordination criticalTiming and positionGreens – flat with high glare

    UVAR CoatingWrap frameScorecard, end of club and far distanceBrown or Golf Green tints enhance white on green

    AS1067

    Cricket High glare environmentHigh impactHigh speed ball

    UVAR CoatingWrap frameTints enhance red ball on green surface

    AS4499.3 Cricket Face shields

    Driving High glare environmentVariable light conditionsColour and warning lights critical

    Wide field of view criticalNear (dash) and distance requirements criticalNeutral tints and polarised NOT Category 4 Sunglasses (NB Marked NOT SUITABLE FOR DRIVING)Photochromic polarisedEnsure patients with colour vision anomalies don’t choose lenses that may further distort colour

    AS1067 Sunglasses AS1609 Motor cycle face shields

    Alpine sports

    Increased UV levels due to altitudeRange of light conditions

    Photochromic for variable light or interchangeable lensesDouble lens to reduce foggingCategory 4 Lens on very bright days (NB Not For Driving)

    AS1067 Sunglasses

    Table 1: Sports Eye Protection Guide

  • Polycarbonate and Trivex are the materials of choice in this regard and they must be housed in a frame that provides lateral protection. Additionally, they must be expertly fitted to ensure adequate lens retention. It is important to remember that a sunglass is not an eye protector but an eye protector can be a sunglass.

    Activities identified in Australia with standards that have specific impact resistance requirements include racquet sports (AS4066)13, cricket (AS 4499.3)14

    and motorcycle and racing car drivers (AS1609).15 Internationally, standards exist for eye protection for snow skiing goggles, field hockey, lacrosse and ice hockey.15-19

    In the United States there are moves toward mandatory use of sports eye protection in several high-risk sports including lacrosse and hockey.

    It’s worth noting that amblyopic patients, or those at increased risk due to previous surgery or eye disease, are of particular concern when it comes to participating in sports with moderate to high risks of eye injury. This group of patients requires eye protection when and wherever hazards exist and should be counseled against participating in high risk sports such as mixed martial arts where adequate eye protection is not available.

    Children also face a greater risk of eye injury when participating in sport because of their facial morphology, i.e. their eyes are more prominent. The disproportionate rate of children with eye injuries that require hospitalisation should be enough to encourage all eye care professionals to provide eye protection for every child that participates in medium to high risk sports – regardless of visual acuity.

    customising thE BEst option By combining knowledge of your customers’ sport with a customised fitting system that attempts to replicate their head position while participating in that sport, you can optimise your patient’s vision (see table 1).

    Assessing the fitting parameters in the actual position of wear, taking into account the vertex distance, frame and lens curvature and other relevant considerations, will help to ensure the patient is wearing the very best prescription to maximise their vision.

    Space permitting, consider establishing a dispensing area dedicated to sporting pursuits. In doing so you will visually position yourself as a sports specialist and clearly differentiate your practice from the competition.

    Encourage patients to bring any key elements of their sporting activities along with them to the consultation. For example, if your cyclists bring their helmets, you’ll be able to more easily

    find the best fitting frames to comfortably accommodate the shape of their helmets. Additionally, cyclists could bring along their trip computers to help you understand their near visual requirements when riding. And golfers could bring in their favourite number one wood to simulate head position while playing.

    choosing thE FramE Thanks to state-of-the-art technology and concentrated research, new frame materials and manufacturing methods are evolving, facilitating the production of more performance oriented frames. Double injection molding of frames to incorporate rubber components, for example, delivers a molded fit to the wearer’s head, and in doing so, increases security and comfort. Lateral protection has been incorporated into frame designs to ensure maximum protection without compromising style.

    Already we are seeing electronic devices, including MP3 players and wearable computers, integrated into spectacles. Once the fancy of sci-fi movies, this technology is moving closer to reality with the Google Glass wearable computers due for consumer release within the next few months.

    Combining material and design innovations for consumer products provides exciting opportunities. However great care must still be exercised to ensure that your patients’ visual and safety demands are also considered.

    Annette Clayfield Hoskin is an optometrist with more than 20 years experience in the field of eye protection, product development, compliance and quality control. She is Optometry Association Australia’s representative on Australian Standards Committees (SF006 Eye Protection) and (MS024 Spectacle Frames and Lenses with the generous support of EYRES Optics) and is a Research Fellow at the Lions Eye Institute Centre for Ophthalmology and Visual Science at The University of Western Australia. Since 2011 Annette has also worked as Optometry Development Consultant to EYRES Optics, a WA based manufacturer of eye protection.

    References:

    1. Kriz PK, Comstock D, Zurakowski D, Almquist JL, Collins CL, d'Hemecourt PA. Effectiveness of Protective Eyewear in Reducing Eye Injuries Among High School Field Hockey Players. Pediatrics. 2012;130:1069-75.

    2. Lincoln AE, Caswell S, Almquist JL, Dunn RE, Clough MV, Dick RW, Hinton RY. Effectiveness of the Women's Lacrosse Protective Eyewear Mandate in the Reduction of Eye Injuries. Am J Sports Med. 2012;40:611-15.

    3. Pashby T. Eye injuries in Canadian Hockey Phase 3: Older player are at risk. Canadian Medical Association Journal. 1979;121:643-44

    4. A position statement from International Federation of Sports Medicine (F.I.M.S). Eye injuries and eye protection in sports. Br J Sports Med. 1988;23(1):59-60

    5. The American Academy of Paediatrics. [cited 2013 9th July].http://www.sportseyeinjuries.com/docs/AAP_Policy_statement.pdf

    The American Academy of Ophthalmology. [cited 2013 9th July].http://www.aao.org

    6. Sports Medicine Australia, www.sma.org.au, accessed 10th July 2013. http://sma.org.au/wp-content/uploads/ 2011/01/719-SMA-InjuryBrochure-Eye-Injuries_web.pdf.

    7. Coalition to Prevent Sports Eye Injuries, www.sportseyeinjuries.com accessed 14th July 2013.

    8. Bremner M. Eye Protection for children. Sport Health. 2000;18(4):38-9

    9. Jones, N.P. Eye Injuries in Sport: An increasing problem. The British Journal of Sports Medicine. 1987;21 (4):168-170.

    10. Parver LM, Dannenberg AL, Blacklow B, Fowler CJ, Brechner RJ, Tielsch JM. Characteristics and causes of penetrating eye injuires reported to the National Eye Trauma Registry 1985-1991. Public Health Rep. 1993;108(5):625-30.

    11. Sinclair SA, Smith G, Xiang H. Eyeglasses-Related injuries treated in US emergency departments in 2002-2003. Ophthalmic Epidemiology. 2006;13:23-30.

    12. Gault JA, Vichnin M, Jaeger EA, Jeffers JB. Ocular Injuries Associated with Eyeglass wear and airbag inflation. The Journal of Trauma: Injury, Infection and critical care. 1995;38(4):494-97.

    13. AS4066- 2992. Eye Protectors for Racquet Sports. Standards Australia. www.standards.org.au.

    14. AS/ NZS 4499.3- 1997 Protective headgear for cricket- Faceguards. Standards Australia. www.standards.org.au.

    15. AS 1609- 1981 Eye protectors for motor cyclists and racing car drivers. Standards Australia. www.standards.org.au.

    16. ASTM F659-10 Standard Specification for Ski and Snowboard Goggles. ASTM International. www.astm.org

    17 ASTM F2713- 09 Standard Specification for Eye Protectors for Field Hockey. ASTM International . www.astm.org

    18. ASTM F803- 11 Standard Specification for Eye Protectors for Selected Sports. ASTM International . www.astm.org

    19 ASTM F513- 12 Standard Specification for Eye and Face Protective Equipment for Hockey Players. ASTM International. www.astm.org

    56 • mivision • OCT 13

    mitechnology