Week 5 - Contact lenses for sport

Question 1

Benefits of cls:

Answer 1

• ** wider field of view **
• ** Less minification/magnification** -
• Less adaptation may be required -
• Greater stability
• ** Enhanced depth perception**
• Fewer aberrations
• Fewer reflections
• Not affected by fogging up or rain
• Less susceptible to dirt
• Allow protective eyewear or sunglasses to be worn
• Protect against peripheral and obliquely incident UV
• Low risk of damage to lens during wear (soft lenses)
• ** Disposability viable**

Question 2

Considerations:

Answer 2

• Alot Px may be children
• Communication
• Px required, make sure px involved

• Length of time playing sport
• Environment which played
• General physical demands of sport
• Appropriate material + wear time

• Modify criteria to be sport specific
• Visual skills must improve + remain consistent
• Be cautious about fitting/refitting athlete

Question 3

Material - SCL

Answer 3

• Soft CLs material of choice
• Tend to move less compared to RGP’s > less likely dislodged
• Dust debris trapped under RGP lens result in corneal damage

• For CL dryness or dehydration use:
- Thicker, high water; thin, low water; or SiHy CLs

Question 4

Material - RGP’s

Answer 4

• Excellent visual acuity
• Lens loss more likely
• Avoid with:
- dynamic sports
- high-risk sports
- contact sports

• Large TD
• Steeper fit required so not dislodged
• Dispense spare pair

Question 5

Daily Disposable

Answer 5

• Dependent on prescription and availability of lens material
• Potential for lens contamination and handling problems reduced with daily lens
• Allows for single use
• Particularly suited to part-time wear
• Convenient (no solutions, spare lenses readily available, relatively inexpensive etc)

Question 6

2 weekly/monthly

Answer 6

• Dependent on prescription and availability of lens material
• Potential for lens contamination
• Need to think about hygiene
• Cost when lost

Question 7

Toric Lenses

Answer 7

• Spherical contact lenses for patients with astigmatism to ~0.75-1.0
• Toric contact lenses with astigmatism of 1.00D or above
• Optimum correction vital in many sports
• May be worth fitting toric lenses at lower levels of astigmatism to maximise VA

Question 8

Ortho-K Lenses: what

Answer 8

• Individually designed RGP lenses are worn overnight
• Removed in daytime
• Alteration in corneal curvature reduces myopia and some forms of astigmatism
• May be an option for those athletes unable to tolerate modern contact lenses/prohibited from wearing them

Question 9

Ortho-K lenses: limitations

Answer 9

• Limited Rx range addressable…
Will be covered in its own lecture

• Infection risk similar to other modalities

• Who would this be good for?
- No worries about glasses or lenses being knocked off/out
- No need to have spare lenses or solution nearby
- Sports where lenses could be more risky or more likely to be knocked out like boxing or rugby

Question 10

Acuvue Oasys Transition lenses

Answer 10

• “reduce haloes and starbursts at night”
• “help your vision recover from bright light up to 5 seconds faster”
• “squint less, see more”
• All compared to standard Oasys lenses.

Not replacement for sunglasses, but useful when sunglasses cannot be worn!

Question 11

Dk levels:

Answer 11

• Dk and Dk/t are important
D
• Low Dk/t = less oxygen to the anterior surface
• Duration of the sporting activity needs to be taken into consideration to v hypoxia
• Low Dk/t lenses may be unsuitable for use at high altitudes due to reduced corneal oxygenation
• Silicone hydrogels are advisable for skiing and mountaineering

Question 12

Prescription:

Answer 12

• Maximise VA
• Correct all myopic & significant hyperopic refractive errors
• Correct anisometropia ≥ 0.50 D
• Correct astigmatism > 0.50 D with toric or RGP lenses? (different factors to consider)

Question 13

Endurance events:

Answer 13

• Mountaineering
• Ocean racing
• Rally driving

EW lenses may be the best solution

Question 14

Racquet Sports:

Answer 14

• Squash and badminton
• Eye protection!!
• Serious eye injuries can occur from the ball, racket and opponent
• Soft CL should be the lens of choice - good stability and centration

Question 15

Contact sports:

Answer 15

• Football, rugby, boxing, martial arts etc.
• RGP CL are not recommended for contact sports as these can fracture in the eye or dislodge on impact
• Soft CL should be the lens of choice - good stability and centration
• Sweat entering the eyes may cause stinging and discomfort? Why?

Question 16

Boxing:

Answer 16

• Research shows a boxer has a 20% chance of a retinal detachment and a 95% chance of a retinal tear after 75 bouts!
• Some organisations do not allow boxing participants to wear contact lenses or spectacles.
• UK amateur boxing says soft lenses allowed
• In karate, soft contact lenses are the only contact lenses of choice.

Question 17

Running

Answer 17

• Environmental factors such as changes in air velocity and temperature = ocular dryness
• Dynamic sport - requires extra stability of SCL to provide minimal movement on blinking
• For long-distance and marathon runners, protection from dust/debris also an issue -> protective eyewear
• UV

Question 18

Cycling:

Answer 18

• Problems with dust and flying debris, causing eye irritation
• 1 airflow may cause dryness
• Silicone hydrogel CL best option
• If choosing CL as mode of correction, protective spectacles are also advisable
• UV protection
• Polarised lenses can be useful when cycling on wet surfaces

Question 19

Shooting:

Answer 19

• CL provide good peripheral vision
• SCL are the lens of choice for shooters due to windy conditions making RGPs uncomfortable
• Movement of lenses on blinking may impede performance
• Difference in tear quality/quantity pre and post training due to decrease in blink rate
• High water content hydrogel lenses should therefore be avoided and low water content hydrogel / silicone hydrogel prescribed

Question 20

Sub-aquatic sports

Answer 20

• A sudden decrease in atmospheric pressure e.g. while resurfacing after diving, causes bubbles to form in the body, including the eve,
• Contact lenses (especially RGPS) are a contraindication in these conditions
• Small bubbles observed in tear film when wearing ROPS can result in corneal damage
• Better with a prescription diving mask

Question 21

Water sports advice

Answer 21

• Avoid rigid lenses
• Fit larger diameter lenses
• Consider thicker lenses
• Consider spherical lenses for toric patients
• Recommend disposable lenses
• Carry spare lenses
• Eye rinse upon leaving water
• Remove, clean and disinfect lenses promptly
• Consider goggles

Question 22

CL Loss in water sports

Answer 22

• High-impact sports (e.g. water skiing) most affected but.
- in a study of 119 water skiing trials, no CLs were lost (76% fully submerged)1
- blink reflex may be protective; sea water may cause CLs to tighten’
• When fitting, ensure CLs remain in place with a strong blink
- consider DD CLs or Ortho-K
• Goggles an option - caution with high impact!

Question 23

Risk of infection in water sports:

Answer 23

• MK is a significant concern, especially Acanthomeba sp.
- also… Staphylococcus,
- Pseudomonas sp,
- & other amoebae

• Recommend DD CLs & protective goggles
- change (or clean) CLs immediately after event
- sunglasses may help in some sports (e.g. sailing)

• Patient education is crucial!

Question 24

Motor sports

Answer 24

• The Motor Sports Association UK (body responsible for medical standards in most UK motor sports) recommends:
• Spectacles should be fitted with ‘shatterproof lenses’
• SCL can be worn for motor cycling but under a full face visor or goggle
• RGP contact lenses not advised

Question 25

Tinted lenses:

Answer 25

• Preference specific to individuals and their sports
• Can assess this using the Eye Bright Test
• Consists of different coloured lenses incorporating colours to enhance contrast (e.g. yellow) and help light sensitivity (e.g. grey)
• Test conditions should really simulate sporting environment and preferred colour is chosen

Question 26

Tinted lenses - possibilities: Skiing, shooting, golf, football

Answer 26

• Skiing -> Brown, red/orange, grey

• Shooting -> Reddish brown, orange, yellow

• Golf -> Grey/green

• Football-> (and fast-moving ball sports) Amber

Question 27

Tinted lenses - possibilities: cycling, tennis, running, motor sports

Answer 27

• Cycling - Yellow

• Tennis -> Amber

• Running -> Grey/green

• Motor sports -> Yellow, red

Question 28

Aftercare:

Answer 28

• Stress necessity of good contact lens care
• Improve regimen compliance by using simple care systems
• Emphasise personal hygiene and appropriate lens handling
• Do not compromise on follow-up care

Question 29

Educating Coaches:

Answer 29

• CL handling
• CL insertion & removal
• Manage ocular emergencies

• CL solutions or sterile saline (preferably unit-dose form)
• Artificial tears
- unit-dose is ideal
• CL cases
• Spare CLs
• Penlight
• Magnifier of some sort (hand or head-band)