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SOCCER injuries are disproportionately severe compared with those of other sports and are on the way to becoming the number one cause of sports-related eye injury, according to a new Portuguese study. "Few appreciate that a patient probably has an equivalent risk of blindness from playing squash as from glaucoma," said João Capão Filipe MD, who recently co-authored a study describing soccer related eye injuries. "To properly care for patients involved in active sports, we should recommend and prescribe protective eyewear in addition to offering a glaucoma evaluation. Injuries are predictable and, for the most part, preventable if we all make an eye safety prescription part of our routine. Available eye protectors have been found to reduce the risk of eye injury by at least 90%," he stressed. Dr. Capão Filipe is part of a team from the Sports Ophthalmology Unit at the University of Porto School of Medicine. The Portuguese team published the results of an eight-year research programme into soccer injuries in Portugal . Their findings, published in the Archives of Ophthalmology, will dispel a few myths.For example, while it is commonly believed that injury occurs primarily among inexperienced football players, the team revealed that players at all skill levels were at risk from ocular trauma.
"I think that the football associations ignore the subject. Even so, a newspaper reported recently that the Portuguese Football Federation was forced to pay damages to a soccer player who was blind due to a traumatic maculopathy after a soccer ball trauma. This underlines the educational role that ophthalmologists can play to minimise the number and severity of eye injuries," said Dr. Capão Filipe. The report also found that routine ophthalmologic examinations were recommended in cases of soccer related eye injury. The severity of the anterior segment injury was not a good predictor of posterior segment damage, he noted. "This was emphasised by the considerable number of patients presenting with ‘normal' visual acuity in which we disclosed unsuspected vitreous and retina damage. It is therefore likely that, in general, non-ophthalmic emergency rooms, severe intra-ocular injuries are overlooked in this type of patient. The primary care physicians must play a critical role in alerting patients that a "simple black eye" requires ophthalmologic referral." Dr. Capão Filipe made a plea that soccer protective eyewear be worn particularly for patients who require prescription lenses, for functionally one-eyed athletes and for those who have had refractive surgical procedures that weaken the eye. Dress wear glasses are never recommended in any circumstances during soccer.
"One of the main reasons for that is that it's so common. People thought ocular trauma was primarily caused by small balls, but that's not the case. It's not related to the size. The reason I think there's a problem is head-to-ball contact. In our research we found that Gaelic football, where there is little head-to-ball contact and people can use their hands, there were significantly fewer eye injuries," said Dr Rowan. Dr. Capão Filipe's study appeared in a recent issue of the Archives of Ophthalmology, (Arch Ophthalmol. 2003; 121:687-694.). Dr. Rowan's study appeared in the Irish Medical Journal, April/May 1997 Vol 90 No 3. João Artur Capão Filipe MD |
"It is a common misconception that experience in itself protects players from injury. In our series, 27.6% of the sample were professional sports players of proven competence. The illusion that injuries occur only among beginners must be quashed," the researchers note.One of the most surprising results of the study was that the age, sex, type of soccer, level of athletic expertise, and player position did not relate to the severity of ocular injury, despite the inherent differences. Soccer has an added risk because it is a game that forbids the use of hands. And the report also found that spectators and referees were also at risk. 
Furthermore, severe ocular lesions can occur in soccer players without symptoms. While previous studies linked myopic globes with traumatic retinal detachment, in the Portuguese study none of the retinal detachment cases were associated with severe myopia.This indicates that the impact of the soccer ball is strong enough to cause a lesion in persons without previous ocular fragility. The team's research also revealed that direct trauma to the globe from a soccer ball is possible. So far, sporting associations have shown little interest in promoting eye-safety: 
Bernie Rowan MD, co-author of an earlier study on sports-related eye injuries in Ireland in 1995 concurred, "I have a definite interest in this. I would be treating children for amblyopia, and some become functionally one-eyed. I would advise them not to put themselves at risk, they have to look after the remaining eye, but few children will give up playing soccer altogether. I would be very much in favour of enforcing some form of eye-protection for soccer, and other sports." Efforts to prevent eye injury have focused thus far on hockey, baseball, and racquet sports. Meanwhile, soccer is becoming the most common cause of sports-related trauma. It recently achieved the dubious distinction of being the number one cause of sports-related eye injuries in Europe and Israel , and it is on its way to becoming number one worldwide.