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PEDIATRICS Vol. 113 No. 3 March 2004, pp. 619-622

POLICY STATEMENT

Protective Eyewear for Young Athletes

Committee on Sports Medicine and Fitness

	ABSTRACT

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
The American Academy of Pediatrics and American Academy of Ophthalmology strongly recommend protective eyewear for all participants in sports in which there is risk of eye injury. Protective eyewear should be mandatory for athletes who are functionally 1-eyed and for athletes whose ophthalmologists recommend eye protection after eye surgery or trauma.

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Abbreviations: ASTM, American Society for Testing and Materials • ANSI, American National Standards Institute • CSA, Canadian Standards Association • HECC, Hockey Equipment Certification Council

	BACKGROUND

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
More than 42 000 sports and recreation-related eye injuries were reported in 2000.¹ Seventy-two percent of the injuries occurred in individuals younger than 25 years, 43% occurred in individuals younger than 15 years, and 8% occurred in children younger than 5 years.¹ Children and adolescents may be particularly susceptible to injuries because of their aggressive play, athletic maturity,^2–4 and poor supervision in some recreational situations.

The sports highlighted in this statement were chosen on the basis of their popularity and/or the high incidence of eye injuries in that sport. Participation rates and information on the severity of the injuries are unavailable; therefore, the relative risk of significant injuries cannot be determined for various sports. Baseball and basketball are associated with the most eye injuries in athletes 5 to 24 years old.¹

The eye-injury risk of a sport is proportional to the chance of the eye being impacted with sufficient energy to cause injury. The risk is not correlated with the classification of sports into collision, contact, and noncontact categories. Instead, the risk of eye injury to the unprotected player is roughly categorized as high risk, moderate risk, low risk, and eye safe. The sports included in each of these categories are listed in Table 1.

View this table: [in this window] [in a new window]   TABLE 1. Categories of Sports Eye-Injury Risk to the Unprotected Player*

 

	EVALUATION

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
All athletes and their parents should be made aware of the risks associated with participation in sports and the availability of a variety of certified sports eye protectors. Although eye protectors cannot eliminate the risk of injury, appropriate eye protectors have been found to reduce the risk of significant eye injury by at least 90% when fitted properly.^4–6 It would be ideal if all children and adolescents wore appropriate eye protection for all eye-risk sports and recreational activities.

Physicians should strongly recommend that athletes who are functionally 1-eyed wear appropriate eye protection during all sports, recreational, and work-related activities. Functionally 1-eyed athletes are those who have a best corrected visual acuity of worse than 20/40 in the poorer-seeing eye.^1,4,7 If the better eye is injured, functionally 1-eyed athletes may be handicapped severely and unable to obtain a driver’s license in many states.⁸

Athletes who have had eye surgery or trauma to the eye may have weakened eye tissue that is more susceptible to injury.⁹ These athletes may need additional eye protection or may need to be restricted from certain sports; they should be evaluated and counseled by an ophthalmologist before sports participation.

	PROTECTIVE EYEWEAR OPTIONS

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
Eye protection and different brands of sports goggles vary significantly in both the way they fit and their capacity to protect the eye from injury. An experienced ophthalmologist, optometrist, optician, physician, or athletic trainer can help an athlete select appropriate protective gear that fits well and provides the maximum amount of protection. Sports programs should assist indigent athletes in evaluating and obtaining protective eyewear.

There are 4 basic types of eyewear. The 2 types that are satisfactory for eye-injury risk sports include:

1. Safety sports eyewear that conforms to the requirements of the American Society for Testing and Materials (ASTM) standard F803 for selected sports (racket sports, baseball fielders, basketball, women’s lacrosse, and field hockey).¹⁰
   
2. Sports eyewear that is attached to a helmet or for sports in which ASTM standard F803 eyewear is inadequate. Those for which there are standard specifications include youth baseball batters and base runners (ASTM standard F910), paintball (ASTM standard 1776), skiing (ASTM standard 659), and ice hockey (ASTM standard F513).¹⁰ Other protectors with specific standards are available for football and men’s lacrosse.
   

The 2 types of eyewear that are not satisfactory for eye-injury risk sports include:

1. Streetwear (fashion) spectacles that conform to the requirements of American National Standards Institute (ANSI) standard Z80.3.¹¹
   
2. Safety eyewear that conforms to the requirements of ANSI standard Z87.1,¹² which is mandated by the Occupational Safety and Health Administration for industrial and educational safety eyewear.
   

Prescription or nonprescription (plano) lenses may be fabricated from any of several types of clear material, including polycarbonate. Polycarbonate is the most shatter-resistant clear lens material and should be used for all safety eyewear.¹³

	PROTECTIVE EYEWEAR CERTIFICATION

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
Protectors that have been tested to an appropriate standard by an independent testing laboratory are often certified and should afford reasonable protection. The Protective Eyewear Certification Council has begun certifying protectors that comply with ASTM standard F803 (racket sports, basketball, baseball, women’s lacrosse, and field hockey), ASTM standard F1776 (paintball), and ASTM standard F910 (youth baseball batters and base runners) standards.¹⁰ The Canadian Standards Association (CSA) certifies products that comply with the Canadian racket-sport standard, which is similar to the ASTM standard.¹⁰ The Hockey Equipment Certification Council (HECC) certifies ice hockey equipment including helmets and face shields. The National Operating Committee on Standards in Athletic Equipment certifies baseball and football helmets as well as the face protectors for men’s lacrosse and football. For those sports with certified protectors, it is recommended that products bearing the Protective Eyewear Certification Council, CSA, HECC, or National Operating Committee on Standards for Athletic Equipment seals be used when available.

	RECOMMENDATIONS

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 

1. All youths involved in organized sports should be encouraged to wear appropriate eye protection.
   
2. The recommended sports-protective eyewear as listed in Table 2 should be prescribed. Proper fit is essential. Because some children have narrow facial features, they may be unable to wear even the smallest sports goggles. These children may be fitted with 3-mm polycarbonate lenses in ANSI standard Z87.1 frames designed for children.¹² The parents should be informed that this protection is not optimal, and the choice of eye-safe sports should be discussed.
   
3. Because contact lenses offer no protection, it is strongly recommended that athletes who wear contact lenses also wear the appropriate eye protection listed in Table 2.
   
4. An athlete who requires prescription spectacles has 3 options for eye protection: a) polycarbonate lenses in a sports frame that passes ASTM standard F803 for the specific sport; b) contact lenses plus an appropriate protector listed in Table 2; or c) an over-the-glasses eyeguard that conforms to the specifications of ASTM standard F803 for sports in which an ASTM standard F803 protector is sufficient.¹⁰
   
5. All functionally 1-eyed athletes should wear appropriate eye protection for all sports.
   
6. Functionally 1-eyed athletes and those who have had an eye injury or surgery must not participate in boxing or full-contact martial arts. (Eye protection is not practical in boxing or wrestling and is not allowed in full-contact martial arts.) Wrestling has a low incidence of eye injury. Although no standards exist, eye protectors that are firmly fixed to the head have been custom made. The wrestler who has a custom-made eye protector must be aware that the protector design may be insufficient to prevent injury.
   
7. For sports in which a face mask or helmet with an eye protector or shield must be worn, it is strongly recommended that functionally 1-eyed athletes also wear sports goggles that conform to the requirements of ASTM standard F803 (for any selected sport).¹⁰ This is to maintain some level of protection if the face guard is elevated or removed, such as for hockey or football players on the bench. The helmet must fit properly and have a chinstrap for optimal protection.
   
8. Athletes should replace sports eye protectors that are damaged or yellowed with age, because they may have become weakened and are, therefore, no longer protective.
   

View this table: [in this window] [in a new window]   TABLE 2. Recommended Eye Protectors for Selected Sports

 
Committee on Sports Medicine and Fitness, 2003–2004
Reginald L. Washington, MD, Chairperson

David T. Bernhardt, MD

Joel S. Brenner, MD, MPH

Jorge Gomez, MD

Thomas J. Martin, MD

Frederick E. Reed, MD

Stephen G. Rice, MD, PhD, MPH

Liaisons
Carl Krein, AT, PT

National Athletic Trainers Association

Claire LeBlanc, MD

Canadian Paediatric Society

Judith C. Young, PhD

National Association for Sport and Physical Education

Staff
Jeanne Christensen Lindros, MPH

Eye Health and Public Information Task Force, 2003–2004
M. Bowes Hamill, MD, Chairperson

Stuart R. Dankner, MD

Roberto Diaz-Rohena, MD

James Garrity, MD

Ana Huaman, MD

Henry Jampel, MD

Terri D. Pickering, MD

Tamara Vrabec, MD

Secretariat
Paul Sternberg, Jr, MD

Staff
Peggy Kraus

Georgia Alward

Annamarie Harris

	RESOURCES

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 
American Academy of Ophthalmology, Communications Department, PO Box 7424, San Francisco, CA 94120-7424.

Prevent Blindness America (formerly National Society to Prevent Blindness), 500 E. Remington Rd, Schaumburg, IL 60173.

	FOOTNOTES

 
All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

	REFERENCES

TOP ABSTRACT BACKGROUND EVALUATION PROTECTIVE EYEWEAR OPTIONS PROTECTIVE EYEWEAR CERTIFICATION RECOMMENDATIONS RESOURCES REFERENCES

 

1. US Consumer Product Safety Commission. Sports and Recreational Eye Injuries. Washington, DC: US Consumer Product Safety Commission; 2000
2. Nelson LB, Wilson TW, Jeffers JB. Eye injuries in childhood: demography, etiology, and prevention. Pediatrics.1989; 84 :438 –441[Abstract/Free Full Text]
3. Grin TR, Nelson LB, Jeffers JB. Eye injuries in childhood. Pediatrics.1987; 80 :13 –17[Abstract/Free Full Text]
4. Jeffers JB. An on-going tragedy: pediatric sports-related eye injuries. Semin Ophthalmol.1990; 5 :216 –223[CrossRef]
5. Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sports-related ocular trauma. Ophthalmology.1990; 97 :1265 –1269[Web of Science][Medline]
6. Strahlman E, Sommer A. The epidemiology of sports-related ocular trauma. Int Ophthalmol Clin.1988; 28 :199 –202[CrossRef][Web of Science][Medline]
7. Wichmann S, Martin DR. Single-organ patients: balancing sports with safety. Phys Sportsmed.1992; 20 :176 –182[Web of Science]
8. Federal Highway Administration. Manual on Uniform Traffic Control Devices for Streets and Highways. Washington, DC: US Department of Transportation; 1988
9. Vinger PF. The eye and sports medicine. In: Duane TD, Tasman W, Jaeger EA, eds. Duane’s Clinical Ophthalmology. Vol 5. Philadelphia, PA: JB Lippincott; 1994:1–103
10. American Society for Testing and Materials. Annual Book of ASTM Standards: Vol 15.07. Sports Equipment; Safety and Traction for Footwear; Amusement Rides; Consumer Products. West Conshohocken, PA: American Society for Testing and Materials; 2003
11. American National Standards Institute. Ophthalmics—Nonprescription Sunglasses and Fashion Eyewear—Requirements. Washington, DC: American National Standards Institute; 2001
12. American National Standards Institute. Occupational and Educational Personal Eye and Face Protection Devices. Washington, DC: American National Standards Institute; 2003
13. Vinger PF, Parver L, Alfaro D III, Woods T, Abrams BS. Shatter resistance of spectacle lenses. JAMA.1997; 277 :142 –144[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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Statement of reaffirmation:

AAP Publications Reaffirmed and Retired, February and May 2008
Pediatrics 122: 450-450. [Full Text]

The following policy statement has been revised:

Protective Eyewear for Young Athletes

and
Pediatrics 98: 311-313.

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