Eyes and sport: the injuries and the advantage

Two separate things are worth saying about eyes and sport. One is about protection. The other is about performance, which is a legitimate and under-used area of optometry.

Protection

Sport accounts for a substantial share of serious eye injuries, particularly in young people, and the great majority are preventable.

The high-risk activities are those involving a small fast projectile or a close-range implement: squash, badminton, tennis, hockey, and any racquet sport, along with boxing and martial arts where fingers and gloves reach the eye. Football causes fewer eye injuries per participant but is played by so many that the absolute numbers are considerable — an elbow, a finger, or a ball at close range.

Ordinary prescription spectacles are not protection. The lenses are not impact-rated, and a frame can drive fragments into the eye. Sports eyewear with polycarbonate lenses in a proper frame is inexpensive relative to what it prevents, and can be made to a prescription.

For anyone with sight in only one eye, this is not optional. The good eye should be protected during any activity carrying impact risk, and that is a conversation worth having explicitly rather than assuming the family has thought of it.

What to do about an injury

Any blow to the eye that produces pain, changed vision, flashing lights, new floaters, blood visible in front of the iris, or a pupil that is no longer round needs same-day assessment. The external appearance is a poor guide — a blunt impact can cause retinal tears, lens dislocation or bleeding inside the eye behind an eye that looks essentially normal.

Do not press on it, and do not attempt to remove anything embedded in it.

Performance

Sport makes demands that a standard examination does not measure.

Dynamic visual acuity — resolving detail on a moving object, which is not the same as reading a stationary chart.

Depth perception, from the two eyes working together. Judging the flight of a ball depends on it.

Peripheral awareness — seeing the teammate arriving without turning to look.

Eye–hand and eye–body coordination, and the speed of the visual-motor loop.

Contrast sensitivity, which matters for picking a ball out against a crowd or a floodlit sky.

These can be assessed and, for some of them, trained. Sports vision is a recognised area of optometric practice, and at competitive levels the marginal gains are real. At school and club level the more common finding is simpler and more useful: a young player with an uncorrected prescription who has been assumed to lack ball skills.

Spectacles or contact lenses

For most sports, contact lenses are preferable — no fogging, no slipping, full peripheral field, no frame in the way — with sports goggles over them where impact protection is needed. Soft daily disposables suit sport well because a lens lost on the pitch costs nothing.

The water rule applies with force here: no swimming in contact lenses without sealed goggles, because of the risk of Acanthamoeba infection. Prescription swimming goggles are a better solution and are widely available.

For schools and clubs

Vision screening before a season is quick and finds the children who cannot see what they are being asked to hit or catch. It is worth as much to performance as most coaching, and it occasionally finds something clinical that nobody had picked up.

Members of the chapter can arrange screening for schools and clubs; the secretariat can put you in touch.