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LASIK and sports-related eye injuries

  

In the simplest of terms, LASIK surgery can be described as a procedure that is a means for people to have their problems of nearsightedness, farsightedness and even astigmatism corrected. During the procedure, the Excimer Laser is used to reshape the cornea after a thin corneal flap is formed. This surgery is becoming very popular throughout the world, as the quantity of people undergoing it is increasing at an enormous rate.

   According to Dr. Arun Gulani, a world famous pioneer in Lasik surgery who has invented Lasik surgery instruments and protocols along with complication correction techniques he teaches that Lasik is actually one among many Laser vision surgeries which are among many refractive or vision corrective surgeries.


   He believes that Lasik was conceptualized nearly half a century ago, when Dr. Jose Barraquer in Columbia, South America found that refractive errors could be fixed using a process of flap-based corneal surgery. The cornea itself is lamellar in anatomy, and the fact that Dr. Barraquer himself followed a Lamellar Refractive surgical approach adds credibility to his discoveries. He is now known as the father of LASIK surgery, and for good reason since he laid the foundation of this very popular surgery. Although technology has improved dramatically over time, the groundwork still remains the same.

 
   The Excimer Laser was initially used for the purpose of PRK (Photo Refractive Keratectomy), a surgery performed without making any flaps, but gradually it came to be used also for the flap-based LASIK surgery. Combined with Barraquer’s concepts, the Excimer Laser is now a major component of LASIK surgery.

 
   Despite the fact that millions of people are deciding on LASIK surgery as an option to correct their eye problems, it is important to note that LASIK may not always be the best option. For example, a patient may have an irregular condition such as an especially thin cornea, which would make the patient unsuitable for LASIK and instead more suitable for PRK. Dr. Gulani has initiated the use of a special technology known as the Pentacam, which takes pictures from different angles of various parts of the eye and rebuilds them in three dimensions. Also vision measurement is performed with new wavefront technology, which use waves of light to help ophthalmologists determine the higher and lower aberrations in the eyes of his/her patients. These devices not only expose the shape of the cornea, but also it provides thorough information about the cornea’s size, thickness, and anatomical relation to the anterior segment. Using the information provided by the Pentacam, ophthalmologists are then able to determine which specific surgery would be best for the patient. Dr. Gulani says, “The whole spectrum of refractive surgery [surgery to remove the need for glasses] is further refined by this technology.” Consequently, the Pentacam is truly a landmark achievement in the field of ophthalmology, and can significantly enhance the power of ophthalmologists to identify abnormalities in the eyes. A long-term effect of the use of the Pentacam could actually be a slight decrease in the amount of LASIK surgeries taking place daily, as ophthalmologists will progressively come to the conclusion that LASIK surgery may not be the best surgery for all patients. Thus, if the quantity of people undergoing LASIK surgery actually decreases due to fastidious preoperative patient selection on the part of the ophthalmologists, then the post-LASIK difficulties that are becoming a part of many athletes’ lives will also probably decrease. It is noteworthy that a majority of the LASIK surgeons in this country are not corneal surgeons, and this is definitely problematic. Also, many LASIK surgeons are powerless in performing the entire range of refractive surgeries, so LASIK becomes the only option for a great deal of patients, including athletes as well.

 
   For right now, the number of patients undergoing LASIK surgery daily remains high. Unfortunately, complications may arise for patients who are actively involved in sports. According to Dr. Gulani, sports can be classified into three categories based on the amount of risk involved in each. He says, “Any sport that involves a stick or racket, a ball or other projectile, or body contact presents a risk of serious eye injury. Existing classification systems rank sports with their risk for eye injuries - basketball, baseball, and hockey is high risk; horse racing, polo and handball have a moderate risk: and track and field, fishing and golf have a low risk for eye injury.” In every sport, eye protection is crucial for the purpose of preventing any major injuries to the eye. The best source of eye protection for most sports is polycarbonate lenses, which are light, slender, and scratch-resistant.

 

   As mentioned before, many people are daily choosing to undergo LASIK surgery in order to correct their eyesight as opposed to wearing glasses and/or contacts. Sports participants form a substantial constituent of these people. What athletes truly need to take into account is that after carrying out LASIK surgery, their likelihood of having flap displacement or other major eye injuries increases dramatically. Let’s be frank—how many of the devoted athletes in the world who have had LASIK surgeries actually wear eye protection? By my estimate, there is not too many that do. According to the National Eye Institute, “In 2002, 15 percent of children and 33 percent of adults reported wearing eye protection always or most of the time when participating in sports, hobbies, or other activities that can cause eye injuries.” The reason why athletes are so prone to eye injuries is simple—REM, or rapid eye movement, is very frequent in sports. Players need to constantly be aware of their surroundings and react to them fittingly. Thus, much stress is caused to the eyes, making them more susceptible to eye injuries.

 

   Consider, for example, the role of a goalie in soccer. He has to keep his eyes moving unremittingly so that he is conscious of the location of the ball at all times. Therefore, his eyes must remain open for a longer period of time than normal. Unfortunately, this could possibly lead to some undesirable after-effects such as dry eyes.

 

   There are two types of tears that work together to lubricate the eyes. One kind is constant tears, which form naturally and are important because they help fight infections. The other kind is reflex tears, which are only created to counter emotion, injury, or infection. A balance of these two types of tears is critical to protect the eyes from infections. A lack of tears and improper lubrication are all possible causes of dry eyes. One way to deal with the problem of dry eyes is to use artificial tears, which are a substitute for the natural tears that are lacking. Not only can these artificial tears reduce the ability of the eyes to fight infections, however, but also they are highly impractical for athletes. Thus, athletes require an alternative method of treatment. A tiny plug can be inserted into the eyes, thereby allowing a temporary closure of the tear duct, which lets the tears stay immersed in the eyes for extra amounts of time. If this temporary solution, after attempted for a one-week period, succeeds in truly benefiting the athlete, then long-term closure quickly becomes a prospect. In this case, instead of the plug dissolving, it will remain permanently in its place unless removed as viewed necessary. Punctum and intracanalicular plugs are both options, but intracanalicular plugs are probably the better option just because they are more comfortable and do not fall out spontaneously. They also do come with their disadvantages, however, as it sometimes becomes difficult to determine if they are still even in the eyes and can be hard to remove. The plugs, as of now, are the most effective solution for dry eyes, not to mention the most practical for athletes since they can wear the plugs while playing sports to eliminate their dry eyes problems.

 

    Now, you may ask, why in an article about LASIK and sports-related injuries would dry eyes be brought up? The undesirable condition of dry eyes is discussed because one of the adverse by-products of LASIK surgery may be a post-LASIK condition that emulates dry eyes. See, there are primarily two reasons for this condition. Eric Donnenfield, surgeon of Rockville Center in New York, believes neurotrophic keratitis to be an underlying cause. During LASIK, as discussed earlier, a corneal flap is flap is created before the Excimer Laser is used to shape the cornea. If the hinge of the flap is located superiorly, then the nerves of the cornea could be detached, and ultimately a temporary neurotrophic keratitis could result. The other major reason for post-LASIK dry eye is the change in curvature of the cornea between the treated and non-treated zones as a result of the creation of a flap. Accordingly, tear film would lose its ability to properly drape the cornea, and tears would be unable to flow. Post-LASIK dry eye is becoming exceedingly commonplace among LASIK patients, and consequently it serves as another reason as to why athletes must wear the necessary eye protection after having LASIK surgery.

 
   I, for one, play basketball on a daily basis with my friends and experience REM day after day. Recently, after finding out the risks involved in playing sports without eye protection, I asked them why they choose not to wear eye protection They, like me, had never previously thought about the dangers of playing sports without eye protection. Therefore, awareness must be raised throughout society so that people of all ages are familiar with these hazards. Only then will more athletes start wearing eye protection. I personally do not think the problem is that athletes dislike eye protection; rather, they are just not accustomed to it. Especially because the discovery of post-LASIK problems for athletes is fairly new, it remains unknown to a plethora of athletes across the globe.

   In an organized amateur hockey league in Canada, all of the players were required to wear full-face protection. Noticeably, this had a huge impact on the frequency of ocular injuries, as the number decreased by approximately fifty percent. Similarly, steps could be taken by sports organizations here in the U.S. to avoid many eye injuries from occurring. Still, if the sports organizations themselves are reluctant to take such a stand for safety, then it becomes the responsibility of the individual him/her self to wear adequate protection for their own benefit. Along with the previous advancements in protecting athletes from harm such as kneepads and masks, certified eye protection would lead to a heightened sense of security for all players involved. Especially for the athletes who have already experienced LASIK surgery, the risk looms ever more larger for major injuries such as flap displacement. The players themselves, then, must realize the consequences of their actions, or in fact, lack of action (not putting on sufficient eyewear). Else, they will be inevitably forced to suffer these dire consequences and regret their careless decisions.

 

   Numerous steps can be taken by the athletes to manage and take care of their eyes. Dr. Gulani recommends a three-step process. The first step in the process is prevention. This, of course, involves a firm obedience on the part of the sports player to wear whatever eye protection the physician recommends. Also, parents can do their part. Since roughly one-third of sports-related eye injuries occur in children under 16 years of age, it is of paramount importance that parents help raise awareness to their children of the various dangers involved in playing sports without wearing ample protection for their eyes. The next step, if prevention fails, is recognition. This involves an instant recognition and a high degree of suspicion that one has an eye injury. Without immediate recognition of the injury, the effects could be fatal and drastic measures may be the last option. Finally, the eye injury must be managed effectively in order to restore clear vision. Whether this requires corrective surgery or not, adherence is of vital importance.

 

   Unquestionably, the amount of athletes who have gone through LASIK surgery and are currently wearing enough eye protection is not as high as the maximum potential. Nevertheless, if the right steps are taken, these injuries can not only be handled in an appropriate fashion, but also prevented from occurring whatsoever. This liability rests primarily on the athletes themselves, but also on their physicians, since physicians can help the players in choosing the necessary eye protection by examining their eye history. Nonetheless, improvements in the field of ophthalmology itself can also be beneficial for athletes in the long term. Laser Corneoplastique™ may be what the future holds in store for us, as, according to Dr. Gulani, who has introduced and published this new super-specialty in Lasik surgery. “This provides the best choice of surgery or even combination surgeries based on age, profession, lifestyle, previous eye surgery and personality tailored to the individual”.

 

Thus in summarizing factors, I shall close with Dr. Gulani’s classification (www.gulanivision.com) as below:

 

Doctor related: Lasik surgeons should have the expertise to perform the full range of Lasik Laser vision surgery and not just Lasik so they can provide “No-Flap” surgeries like PRK/ASA and Lasek. They should also be knowledgeable about Lasik alternatives like ICL lens implant surgery.

They should also be able to recognize injuries and have the training to fix the situation to an excellent vision outcome.

 

Patient related

People and athletes in particular need more awareness about sports related eye injuries and protection.

 

Community related:

   Right from community to Parents at home, we need to be role models for our children, friends and families. We need to take sports related eye injuries seriously and then understand the implications of Lasik and sports and ask for alternative Laser Vision Surgeries.

 
   In conclusion, if the injuries are indeed handled in an efficient manner and actually even prevented, then sports can come remarkably closer to fulfilling the dual goals of being both safe and fun. Nevertheless, if milestone achievements in ophthalmology are made such as Laser Corneoplastique ™, then the course of action certainly becomes easier.

 

To further educate yourself about Sports-related eye injuries please visit-

http://www.gulanivision.com/sports-related-eye-injuries.html



Bibliography

 

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Article By: Amandeep Singh; Co-Author: Dr. Arun Gulani
Views: 2354

Comments On LASIK and sports-related eye injuries  "5 Comment(s)"

Herand The NYLasik Man22/8/2010

It is so important to read such article to inform potential patients for any developments and observations on this kind of surgery procedure. In some states,like the New York Lasik have become well known, as told by my friend, because of its expertise reputation in conducting LASIK surgery.

Dr. Rajib27/10/2009

this is a nice article on this subject.

Prachi Soni21/9/2009

In today's world when everyone is busy and swamped with work people do forget about little things that matters the most. Protecting eyes is important and necessary. I liked the article it was informative and well written. I liked the flow of the article and how it educated me about options other than LASIK. I would say it gave me the necessary information without overwhelming me. I agree with the author that raising awareness among people is crucial for both prevention and cure.

sunil misra18/9/2009

An excellent article well written and easily understood by the lay person. A lot of good information on LASIK, dry eyes and sports related eye injuries and it relates the three in a simple to understand fashion. As mentioned in the article, it is not generally recognized how important protection is when playing most sports. People do not tend to give it any thought when playing occasionally. But something that would seem minor at the time could have serious implications. Protection is of utmost importance and the article lays that out quite clearly. If there is even one person that uses eye protection as a result of reading this article it would be a very worthy effort indeed to have written it.

Ashok K Bazaz18/9/2009

It is highly commendable on the part of Amandeep to write such an applied Article on the most vital part of the body and related to the common youth activity. The message, calibre and depth of writing has given an insight to Amandeep's deep interest in the science of Medicine. We pray for his al round sucess and wish him the best.Thanks.

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