As eye care professionals, we all know that using contact lenses instead of spectacles to play sport is a good combination. Yet often patients are unaware of the benefits contact lens wear could have for them while playing sport. In fact many spectacle-only wearers simply manage without their vision correction while taking part in sport; just over half (52 per cent) say they leave their glasses off compared with only one in 10 contact lens users who don’t wear their contact lenses for sport.1
Awareness that sports play an important role in living our lives in a healthy way is very high. Today, about four in 10 Europeans (41 per cent) exercise or participate in sport at least once a week.2 This creates a huge opportunity not only for our practices but also to incorporate lifestyle discussion in all interactions with our patients, including the benefits of a healthy diet and avoiding smoking, as well as regular exercise.3
In our practices we care about eye health and advise our patients on a daily basis about the well-being of their eyes. But we tend to focus on the obvious areas alone, while the connection between sport/fitness and clear, uninterrupted vision is left unexplored. Let’s use the fact that our patients are already convinced of the benefits sports can have in their lives to help them maintain and enjoy a healthy lifestyle even more.
Opportunities and patient benefits
Looking at sports and vision correction, one of the most obvious ways to correct refractive errors is with contact lenses, and especially with soft lenses. Not only do contact lenses provide intrinsic visual and optical benefits over spectacles, they also have many practical advantages (Table 1).
With elite athletes, and enthusiastic amateurs too, an accurate contact lens correction can give that additional competitive edge. Correcting small cylinders with toric soft lenses and prescribing the best type of contact lens correction for presbyopes for a given sport can make a difference, especially if the alternative is participating without any correction.
There are also opportunities to deliver benefits to specific patient groups such as children and teens, and to combine contact lens correction with eye protection for sport at all levels of participation. Being seen as knowledgeable in sports and vision can benefit your practice too, through increased patient loyalty, recommendation and community involvement, as well as additional revenue streams.
Prescribe for children
Children who actively play sports can be considered among the best candidates for contact lenses.4 In fact sport is the number one driver for contact lens use among teens and young adults; nearly eight in 10 teens (79 per cent) aged 13-17 years are interested in contact lenses for sport.5 And practitioners report that the primary reason given by parents for requesting contact lenses is that their child’s vision correction interferes with sports (46 per cent).6
Compared to glasses, athletic competence in young myopes improves with contact lenses, which also have a positive impact on their self-esteem.4,7 Most parents (70 per cent) agree that correcting their child’s vision can help with sports performance and that contact lenses are a better choice for sport than glasses (76 per cent).8 Additionally, in school-age children, more time spent outdoors is associated with less myopia.9 Children are especially vulnerable to over-exposure from UV radiation because of their larger pupils and clearer media, as well as spending more hours outdoors than adults, so UV-blocking contact lenses have advantages.
Provide UV protection
In recent years, more has been learned about the impact UV radiation has on our skin and also on our eyes. Most patients will be aware of the need to protect skin from harmful UV rays, especially during outdoor sports, but few understand the impact on eyes and the benefits of comprehensive protection from the transmission of UV radiation (wraparound sunglasses, a wide brimmed hat and UV-blocking contact lenses) to help protect their eyes.10
Combining UV protection with the advantages of contact lenses has obvious benefits for sports and leisure pursuits, from running to fishing, that involve long hours outdoors. Awareness of UV-blocking contact lenses is low and only about half of practitioners (53 per cent) actively recommend them to their patients yet, when prompted, consumers show a high level of interest in trying these lenses.10
[CaptionComponent="480"]Although recognition of UV risks in general has increased we tend to link the need for skin protection to the ultraviolet index (UVI), in other words to the amount of sunshine we’re exposed to. For the eye this is not sufficient and is also misleading. Light scatter and reflection are more of a concern for the eye than direct exposure. Eye protection just in summer months or around midday is inadequate as UV exposure can occur all day and all year.11 If you use the analogy of ‘Protect your eyes, just like you would protect the skin’, remember to explain how and when protection is needed and that this advice differs from that for skin.
Lack of awareness of the all-day, all-year-long, all-weather risks posed by UV to those involved in outdoor sports, and the options available for protection, indicates an opportunity for practitioners to improve their communication.
Recommend protective eyewear
Injuries other than ocular trauma are more commonly associated with sport, but they do occur. A guide to sports eye protection states: ‘Any sport that involves a stick or racket, a ball or other projectile, or body contact presents a risk of serious eye injury.’12 A recent survey reported 48 sports-related eye injuries seen in two UK hospitals over a three-month period.13 A majority of these injuries (81 per cent) were caused by ball-to-eye contact.
The need for advice on protective eyewear creates a huge opportunity for our practices. Eye protection is not limited to those in need of a refractive correction, but should be recommended for everyone involved in sports where there might be a risk of getting a ball or object in the eye.
Combine different lens types
Any discussion about sport is an ideal opportunity to suggest not only a combination of vision correction solutions but also additional contact lens types to your patients. Reusable lens wearers might benefit from daily disposable lenses for sport for convenience and hygiene reasons. Keeping a strip of daily disposables in their sports bag offers patients the flexibility of switching between spectacles and contact lenses.
Presbyopic patients may also need an additional lens type to give them the best possible vision for their chosen sport. Multifocal contact lenses can be very successful for golfers, for instance, enabling them to see the ball, the tee and the score card, irrespective of direction of gaze.
What to look and listen for
You and your staff’s sports vision assessment begins as soon as the patient walks through the door. Patients’ appearance often provides useful clues to their fitness and lifestyle. And they don’t necessarily need to be wearing full sports kit or carrying sports equipment! Although all patients should be asked about their sports and leisure pursuits, do they look as though they take regular exercise and are they wearing some form of sports clothing or footwear? Did they mention they arrived by bicycle or walked a long distance to the practice? Did they mention sport when they booked an appointment or is a sport noted on their record card? Have they recently retired, in which case their leisure activities may have changed? Or has there been a change in their general health or medication that might impact on fitness?
Use sports and vision-related signage and literature in the reception area to prompt a discussion about vision correction for sport. It’s also important to have protective eyewear on display in your practice to make patients aware of the solutions you can offer. A good example is the cycling store, where not only bicycles are stocked but also all kinds of indirectly related materials such cycling kit, food, drinks, and protective headgear and eyewear.
Brief all staff to listen for comments about sport while patients are making appointments or browsing for frames, and turn complaints such as glasses ‘getting in the way’, ‘needing tightening up’ or even ‘flying off’, into a conversation about situations in which contact lenses may provide practical benefits.
Enquiries about lightweight frames, sports bands, prescription tints, anti-reflection coatings, or problems with lenses scratching, fogging or getting wet, are all opportunities to turn the conversation around to contact lenses rather than looking for a spectacle solution alone. And brief your staff to look out for a sports participant who is a serial glasses breaker or constantly coming in for repairs and adjustments.
Use a pre-exam lifestyle questionnaire to ask patients directly about their specific sports and fitness regime and what vision correction and/or eye protection they currently use for these activities. The use of questionnaires is another way to get the whole practice team involved in eye care, as well as offering a structured approach to gaining information from our patients.
What to say and do
It seems clear that sports play an important part in the lives of our customers, both social and recreational, to maintain and/or improve their health.
Start the conversation
The easiest way to get started is to ask each patient if they play sports or, better still, an open question about the kind of sports and physical activities they enjoy. It seems like a very obvious question, but most of time the obvious isn’t asked.
[CaptionComponent="481"]Go on to ask ‘How do you manage with your spectacles when playing sport, and add ‘Is that good enough or would you like to see better?’, ‘Would it be easier to do that without your glasses on?’ or ‘What if I said you could do that without your spectacles?’ Alternatively, consider a more direct question, such as: ‘Are there occasions during sport when contact lenses would be more convenient?’
Question patients about their exercise habits as well as sports. Their experience of going to the gym, fitness class or yoga, as well as walking or hiking, might be improved with contact lenses. Try ‘Would you like to see the TV when you’re running on the treadmill?’ or ‘When you’re out walking do lenses mist up or rain drops cause you problems?
Try asking school-age children, ‘Are you allowed to wear glasses for games?’ Some schools don’t allow spectacles for safety reasons and parents may not be aware of this. You can then go on to ask the child about their specific sport, such as ‘Do you struggle to see the ball at the other end of the pitch?’ Holding up plus lenses to show parents how their myopic child sees without glasses can help emphasise the point. Remember that indoor pursuits such as dance, karate and gymnastics may be improved with contact lenses as well as traditional school games.
Engage with patients
Try to gauge patients’ level of involvement and ability in their chosen sport. Empathise with them by referencing your own exercise regime and the difficulty of maintaining fitness when work and family commitments intervene. Remember the seasonality of some sports, such as tennis and cricket in summer at school, to renew conversations about sport at each appointment.
Harness interest in major sporting events to open a discussion about sport in general, whether as a participant or a spectator. ‘Which team are you supporting in the World Cup?’, ‘Have you been following Wimbledon?’ or ‘What are your favourite Olympic sports’? are among the obvious opening gambits. Follow up with ‘Do you play football/tennis/go running yourself?’
Humour can also help establish a rapport. Jokes about the British climate not being conducive to spectacles for outdoor activities often lead to a contact lens conversation. Examples might be ‘We can offer you two options – windscreen wipers for those rainy days… or contact lenses!’ or ‘Playing golf in your glasses on a rainy day must be irritating – I can’t promise to reduce your handicap but we could make seeing the ball easier with contact lenses!’
Once the discussion has started about lifestyle, we can discuss ways to help them with vision correction solutions for their needs. In practice, asking about lifestyle seems to be more difficult than asking about the type of sport so it’s also important to ask them why they play sports. If the answer is to stay healthy we can easily direct the discussion towards how to keep eyes healthy.
Inform them of the options
After we’ve learned how our patients play sports (and which type), we need to advise them about the best options for correcting their vision with contact lenses. All aspects should be discussed such as convenience, hygiene, comfort, vision and UV-blocking. We also need to discuss other recreational needs in vision correction, such as use of contact lenses on holiday.
Swimming and other water sports are activities that call for very specific advice. Even if you tell your contact lens patients not to swim in their lenses, or to shower in them, we know that many are likely to ignore that advice. Try asking them ‘How often do you swim wearing your lenses?’ to elicit this practice.
Practitioners should warn patients about potential risks when wearing lenses during water sports such as swimming since exposing lenses to water may increase the risk of eye infection from microorganisms such as Acanthamoeba keratitis.14 Have an agreed practice policy and advice you give on swimming in contact lenses, and include it in your written as well as verbal instructions.
For winter sports, where goggles and/or sunglasses are essential, point out that contact lenses mean fewer options to carry around when weather conditions change and may also allow the presbyopic skier to see the piste map! Discuss the increased levels of UV at altitude and in snow. Use analogies to make this clear, such as ‘You’re used to protecting your skin when in the mountains so it’s clear that eye protection is necessary too.’
We also need to talk about the need for mechanical protection against injuries in specific sports (squash, tennis, etc). The use of filters in these types of protective eyewear to enhance visual performance could easily be discussed when talking about eye protection.
By discussing sports and linking this to lifestyle and eye protection, we create a completely new environment for our patients. What we communicate is not limited to eye care; we send out the message that we care about their health and wellbeing.
Get your staff involved
It’s important to get everyone in your practice involved. Every signal a patient sends needs to be received in order to provide them with the best solution. Everyone who is in direct contact with patients should know the benefits of contact lenses for sport. So in every conversation with a patient they need to ask about the patient’s visual correction requirements, and specifically about sporting activities. Sports-related practice promotions and displays are another great way to get the whole team on board.
Other options
Orthokeratology and refractive surgery may be valid options for some patients and should be taken into account when advising them about their vision. Look at the visual demands for specific sports, which also depend on the athletic ambition of the patient or the level at which the sport is performed.
Every type of vision correction has its effect on visual performance. In other words, failing to choose or advise the most suitable option could affect the performance level of the patient since certain types of sports require specific visual skill sets.15
Conclusion
Many of our patients are actively involved in sports and for various reasons, but an important reason is to stay healthy. This opens up an opportunity for a health-driven discussion with our patients about healthy options for their eyes. And it gives us an opportunity to discuss lifestyle solutions we can offer with contact lenses and spectacles.
We can enhance the lives of our patients, and help them to gain more enjoyment from sport, by prescribing more convenient forms of vision correction. It’s very easy for us to ask our patients about their fitness regimes and offer specific solutions. Try initiating a conversation about sport with each of your patients. You’ve got more than a sporting chance of converting them to contact lens wearers!
References
1 Aslam A. Contact lenses and spectacles: a winning combination. Optician, 2013; 246:6425 26-28.
2 Special Eurobarometer 412. Sport and physical activity. European Commission, March 2014.
http://ec.europa.eu/health/nutrition_physical_activity/docs/ebs_412_en.pdf.
3 Lifestyle and Eye Health, The Vision Care Institute. www.thevisioncareinstitute.co.uk/sites/default/files/private/uk/pdf/TVCI%20Eye%20Health%20papers%20Jan2010.pdf
4 Rah MJ, Walline JJ, Jones-Jordan LA et al. Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci, 2010;87:560-6.
5 Data on file, Johnson & Johnson Vision Care 2011. Face-to-face consumer research in seven countries (France, Germany, Italy, Spain, Sweden, Russia and the UK).
6 A survey of UK contact lens practice for children and young people. College of Optometrists, 2014.
7 Walline JJ, Jones LA, Sinnott L et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci, 2009;86:222-32.
8 McParland M and Esterow G. Parent and child attitudes to vision correction. Poster presentation at British Contact Lens Association Clinical Conference, 2014.
9 Rose KA, Morgan IG, Ip J et al. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology, 2008;115:8 1279-1285.
10 Sulley A and Ruston D. What practitioners and patient understand about UV. Poster presentation at British Contact Lens Association Clinical Conference, 2013.
11 Sasaki H, Sakamoto Y, Schnider C et al. UV-B Exposure to the eye depending on solar altitude. Eye & Contact Lens, 2011;37:191–5.
12 Vinger PF. A practical guide for sports eye protection. Phys Sportsmed, 2000;28:49–69.
13 Ong HS, Barsam A, Morris OC et al. A survey of ocular sports trauma and the role of eye protection. Cont Lens Anterior Eye, 2012;35:285-7.
14 Thebpatiphat N, Hammersmith KM, Rocha FN et al. Acanthamoeba keratitis: a parasite on the rise. Cornea, 2007;26:6 701-6.
15 Laby DM, Kirschen DG and Pantall P. The visual function of Olympic-level athletes – an initial report. Eye & Contact Lens, 2011;37:3 116-22.
Acknowledgement
Images courtesy of The Vision Care Institute.
Optometrist Marco van Beusekom is Professional Affairs Manager for Benelux at Johnson & Johnson Vision Care