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Sport-Related Ocular Trauma in Vancouver, British Columbia: Not the Usual Suspects

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Sport-Related Ocular Trauma in Vancouver, British Columbia: Not the Usual Suspects Heather E. Cadenhead, BKin, Brennan Eadie, MD, PhD, Colten Wendel, MD, Simon J. Warner, MD, FRCSC Sport-related ocular trauma in Vancouver, British Columbia: Not the usual suspects A remarkably high rate of badminton-induced eye injury was found in a retrospective chart review. ABSTRACT Background Background: Vision loss due to eye Results: Of 1301 charts reviewed, Vision loss resulting from traumatic injury has a significant effect on 58 were found to describe sport-re- eye injury has a significant effect on quality of life. In the US, trauma to lated traumatic eye injuries (4.45%) quality of life in the developed world.1 the ocular structures is one of the sustained in 23 activities. The most Trauma to the ocular structures is one most common causes of blindness, common sports leading to injury of the most common causes of blind- second only to cataracts, and 15% of were soccer and badminton. The ness in the US, second only to cata- these injuries occur during baseball, majority of patients with badminton- racts, and 15% of these injuries occur basketball, racquetball, football, and induced injuries felt that eye pro- during sporting activities.1 The most soccer activities. A study was pro- tection would have prevented their common activities related to traumat- posed to establish the chief sport- injuries, yet only a minority agreed ic eye injury in the US are baseball, ing causes of traumatic eye injury that the use of eye protection for the basketball, racquetball, football, and in Vancouver, BC, and to determine sport should be encouraged. soccer.1 if individuals could be encouraged Our clinical experience in Van- to use eye protection for high-risk Conclusions: Soccer and badmin- couver, BC, suggests that US sport- sports. ton were the chief causes of sport- related injury findings do not apply related injury seen at the Vancouver to our patient population. A Canadian Methods: The study was conducted General Hospital Eye Care Centre in study found that the three most com- using data for patients with ocular 2013. All badminton-induced inju- mon locations for ocular injuries were trauma referred to the Vancouver ries resulted in traumatic hyphema. the home, the workplace, and sport- General Hospital Eye Care Centre Primary care physicians should be ing activity sites.2 While Canada has in 2013. Sport-related cases were confident in managing minor ocu- identified in a retrospective chart lar trauma but be aware of potential Ms Cadenhead is a fourth-year medical review and follow-up visits were complications and not hesitate to student at the University of British Co- arranged. Patient characteristics, contact an ophthalmologist should lumbia. Dr Eadie is a glaucoma fellow in cause of injury, visual function, and they have concerns. Mandating eye the Department of Ophthalmology and Vi- ocular diagnosis were analyzed. A protection for youth, normalizing the sual Sciences at Dalhousie University. Dr subgroup of patients was surveyed use of protective eyewear, and edu- Wendel is a resident in the Department to assess their attitudes toward the cating those participating in high- of Ophthalmology and Visual Sciences at use of eye protection. risk sporting activities should be UBC. Dr Warner is a clinical professor in considered to reduce ocular trauma. the Department of Ophthalmology and This article has been peer reviewed. Visual Sciences at UBC. BC MEDICAL JOURNAL VOL. 60 NO. 1, JANUARY/FEBRUARY 2018 bcmj.org 47 Sport-related ocular trauma in Vancouver, British Columbia: Not the usual suspects a similar proportion of sport-related dents based on recent survey results.2 signing and executing the study. eye injuries (8.6% of all traumatic eye We hypothesized that the unique Ethics approval was granted by the injuries), it is unclear which sports are demographics of Vancouver would University of British Columbia’s primarily responible.2 Reports of pre- mean some sports not identified in US Clinical Research Ethics Board. vious studies have not provided de- studies are the primary cause of trau- tails about type of sporting activity, matic eye injuries. Our goal was to es- Results presence of eye protection, type of tablish the chief sport-related causes Of 1301 charts reviewed, 58 described eye protection used, if any, and atti- of traumatic eye injury at our hos- sport-related traumatic eye injuries tudes toward eye protection.2 Further pital, and to determine which sports (4.45%). The mean age of injured pa- research in this area could have im- participants were amenable to using tients was 29.8 (SD 14.8) years. The portant implications for injury pre- eye protection. youngest patient was 5 years old and vention in Canada. Moreover, this is the oldest was 64 years old. The male of particular concern in British Co- Methods to female ratio was 2.1 to 1.0. The ma- lumbia, a province ranking in the top Charts were reviewed for patients vis- jority of injuries (35 of 58) occurred three for number of eye injury inci- iting the Vancouver General Hospital in the summer months. (VGH) Eye Care Centre from 1 Janu- Twenty-three sporting activities Table 1. Sporting activities resulting in ary 2013 to 31 December 2013. All were identified and three or more inju- traumatic eye injuries. charts describing sport-related trau- ries occurred in seven activities: soc- matic eye injury were identified and cer, badminton, cycling, squash, ball Activity Number of patients patients were contacted for follow-up. hockey, baseball, and rugby ( Table 1 ). Soccer 12 Data collected and analyzed in- Soccer was the sport most commonly Badminton 9 cluded patient age, sex, community of associated with eye trauma at the VGH residence, ethnicity, and cause of in- Eye Care Centre in 2013, followed by Cycling 5 jury (i.e., sport played). Visual func- badminton. Together these activities Squash 4 tion was assessed at each patient’s accounted for one-third of all ocular Ball hockey 3 follow-up visit to determine second- trauma seen at the centre. Traumatic ary complications related to hyphema, hyphema was seen in all nine patients Baseball 3 the accumulation of blood in the ante- with badminton-induced injuries, and Rugby 3 rior chamber. Examination results for three of the nine patients had intraocu- Frisbee 2 the affected eye versus the unaffected lar pressure rise. One had commotio eye were compared for best corrected retinae and vitreous hemorrhage and Hockey 2 visual acuity (BCVA) and intraocular one had cystoid macular edema. Snowboarding 2 pressure (IOP) using paired sampled t Of the nine patients with bad- Boxing 1 tests. Significance was set at an alpha minton-induced traumatic eye injury, Dodgeball 1 value of .05. most had evidence of angle recession Six binary questions were an- on gonioscopy. Moreover, we ob- Fishing 1 swered by patients with badminton served a statistical impairment in both Football 1 injuries to assess their attitude toward best corrected visual acuity (P = .027) Golf 1 eye protection. and intraocular pressure (P = .011) in The principles of the Declaration the affected eye compared with the Inner tubing 1 of Helsinki were followed when de- unaffected eye ( Table 2 ). Lacrosse 1 Longboarding 1 Table 2. Analysis of results for best corrected visual acuity (BCVA) and intraocular pressure Martial arts 1 (IOP) following badminton-induced traumatic eye injury. Mountain climbing 1 Metric Affected eye Unaffected eye P-value Polo 1 BCVA (logMAR) 0.61 0.06 0.027 Underwater hockey 1 IOP (mm Hg) 20.6 13.1 0.011 Volleyball 1 logMAR = logarithm of the minimum angle 48 BC MEDICAL JOURNAL VOL. 60 NO. 1, JANUARY/FEBRUARY 2018 bcmj.org Sport-related ocular trauma in Vancouver, British Columbia: Not the usual suspects Five of the nine patients injured Ocular trauma from sport is often the sequelae may ultimately result in re- playing badminton responded to the result of a blunt force that results in duced visual acuity or, in severe cas- survey questions. The majority be- hyphema.4 Although hyphemas are es, blindness. lieved eye protection could have most commonly caused by trauma, prevented their injuries, yet only a they can also be caused by postopera- Injury prevention minority agreed that the use of eye tive complications, iris neovascular- Eye protection in sport is widespread protection for the sport should be ization, melanoma, leukemia, and and has a long history. Around 1200 encouraged. juvenile xanthogranuloma.4 BC the first use of a protective face Traumatic hyphemas occur when mask for fencing was documented Conclusions a blunt force indents and stretches by the Egyptians.8 Since then, many Results of this retrospective chart re- the globe, resulting in architecture forms of eye protection have de- view suggest that the sports associated disruption and increased intraocular veloped, including visors, goggles, with ocular trauma in the Vancouver pressure. This intraocular pressure and sunglasses. In many Olympic area differ from those reported in the US,1 and that badminton is under- recognized as an activity associated with significant intraocular injury. In 2013 badminton caused 15% of all sport-related traumatic eye in- juries at the VGH Eye Care Centre In 2013 badminton caused 15% of all and led to hyphema in 100% of cases. sport-related traumatic eye injuries Other investigations have not iden- tified badminton as a cause of trau- at the VGH Eye Care Centre and led matic eye injury, which may be due to hyphema in 100% of cases. to the differences in sporting inter- ests seen in Vancouver’s ethnically diverse population.1 The 2011 cen- sus found that approximately 40.1% of the population in Vancouver spoke a nonofficial language (i.e., not Eng- lish or French) at home.3 Badmin- causes a posterior displacement of sports, eye protection is mandated to ton is a popular sport in Vancouver’s the lens-iris diaphragm and bleed- protect competitors from both exter- large Asian community and three of ing from disruption of the highly nal injuries such as corneal abrasion the five survey respondents were of vascularized ciliary body and iris.4 and internal injuries such as retinal Asian ethnicity.
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