Fierce competition drives professional, collegiate and even teenage athletes to look to their ophthalmologists for an extra edge on the playing field.
Until recently, the ophthalmic discipline was the only health care specialty that dealt with athletes on a professional level but did not have a sports-related organization.
There appears to be a growing trend toward sports specialization among ophthalmologists, but there are many questions that athletes will ask in any general ophthalmology practice, according to Rolando Toyos, MD, team ophthalmologist for the Memphis Grizzlies of the National Basketball Association and the Memphis Redbirds, the St. Louis Cardinals’ AAA baseball team.
Dr. Toyos is also president of the Sports Ophthalmic Society of the Americas (SOSA), the organization he helped form about 2 years ago.
“A lot more doctors will be dealing with these topics, and they are going to have to realize this is a totally different ball game,” Dr. Toyos said.
The idea for the organization emerged when Dr. Toyos began working with the Memphis Grizzlies. He became aware of the potential liability issues involved in sports ophthalmology because he realized there was no official organization he could turn to for advice.
Creating a team
Dr. Toyos and several colleagues started SOSA to create a centralized resource for ophthalmologists who work with athletes and to provide a unified voice to address related legislation in the sports industry.
“I had a meeting with David Stern, who is the commissioner of the NBA, and I was talking to him about there not being any specific standards of what constitutes a thorough preliminary exam before the season starts for the NBA players,” Dr. Toyos said. “He was unaware about this, and I was coming to him as the president of [SOSA], not just as some random ophthalmologist. If a group of us are saying this is something that needs to be addressed, then it will be addressed.”
SOSA had its first board meeting at the American Academy of Ophthalmology meeting in Chicago in 2005, and another at the meeting in Las Vegas in 2006.
This year, SOSA will organize its first sports vision course during the American Society of Cataract and Refractive Surgery meeting in San Diego. The course will feature topics including vision in baseball and basketball, refractive surgery, eye injuries and legal issues.
Medical malpractice is a serious issue on its own, but it becomes even more complicated when combined with the multimillion dollar contracts of professional athletes.
“These people are making millions of dollars a year based on their vision. It’s their livelihood, and they’re getting paid a lot of money,” Dr. Toyos said. “Their window of making their livelihood is much smaller than the general population, so all those things come into play.”
Pre-existing conditions are another legal issue that comes up often with professional players, Dr. Toyos said.
“If a patient comes in and says they have a pre-existing condition, you really have to document all of this because say they have an eye injury in the game and that stops them from continuing to play,” he said. “If you didn’t document this as a pre-existing condition, then that player can claim that this happened during work and then that’s a work-related injury.”
All of the rules that are established by HIPAA also apply to athletes, Dr. Toyos said.
“They’re protected by the same laws that anyone else is protected by. You can run into some huge legal problems there if you don’t handle that situation in the right way,” he said. “Before this organization we really didn’t have anyone to turn to about these ideas. If this organization didn’t exist, there could be some doctors out there putting themselves in a bad position.”
Filling a need
Dr. Toyos said the organization is helping to fill a void.
“Before we ever started this organization, I never realized how many eye injuries happen in sports and how many athletes have eye problems that, if you deal with them, can improve their performance,” he said.
Dr. Toyos said one example of how ophthalmology plays a major role in athlete performance was a baseball player whose batting average during the day was far above what it was at night.
“He had a lot of higher-order aberrations causing glare and halos. We did custom corneal LASIK on him. The following year he went from a .278 hitter to a .350 hitter, just based on him seeing the ball better for night games,” he said.
Psychology of athletes
Dr. Toyos said the most challenging aspect of dealing with athletes of all levels is telling them what they often do not want to hear.
“They don’t really want to hear the truth sometimes when it comes to their physical well being, meaning you have a player that has this eye condition and you say, ‘Look, it would be better if you wore goggles. It would be safer for you.’ Then they give you an answer like it’s almost like superstition. ‘I’ve never played with goggles before and I need to do really well. It might affect my game.’ There is a psychological aspect,” he said.
Dr. Toyos recalled a story of a team ophthalmologist who was called in by the coach to check on a player’s condition.
“The management said, ‘His psyche was down. Is there something you can tell him to do?’” he said.
The ophthalmologist had him wear some low-prescription glasses during the day to take the strain off of his eyes.
“The first time he did that, he hit 4 for 5. Ever since that time, he wears the glasses,” he said.
Right-handed hitters have right-eye dominance, which means when they are at the plate, their nondominant eye is what picks up the ball. Then they do a switch in their vision where they go from seeing the ball with their nondominant eye and then hitting it with their dominant eye. “So we talk to them about opening their stance to see the ball with their dominant eye,” Dr. Toyos said.
One basketball player who was not shooting his free throws well was encouraged to change his stance to improve his stereovision, and his free-throw average improved, Dr. Toyos said.
“An ophthalmologist can play a huge role in the success of an athlete. They are all looking for little edges. That is why players are taking human growth hormone and steroids. It’s nothing more than trying to gain a little bit more of an advantage that can make them a better ball player,” he said.
A lot of hype
Dr. Toyos said one of the organization’s goals is to get more professionals involved with research in sports and vision.
“Right now there is a lot of ‘hocus pocus’ going on with professionals and non-professionals coming to sports teams with all sorts of ideas on how athletes can improve their vision to become more productive athletes, and there is no basis for this,” he said. “What we want to do is put more science behind these things so we can say it won’t work or that some of it does work. There are a lot of hucksters out there getting rich preying on not just the [professional] athletes, but [also on] the 12-year-old who has aspirations of being an athlete.”
For more information:
- Rolando Toyos, MD, can be reached at Toyos Clinic, 569 Skyline Drive, Suite 200, Jackson, TN 383301; 731-660-3937; e-mail: firstname.lastname@example.org.
- The Sports Ophthalmic Society of the Americas can be found online at www.sosas.org.
- Daniele Cruz is an OSN Staff Writer who covers all aspects of ophthalmology, focusing on optics, refraction and contact lenses.
Academy initiative urges sports safety for athletes
In light of the roughly 40,000 sports-related eye injuries in the United States each year, the American Academy of Ophthalmology is sending out a message for athletes to protect themselves.
According to a press release from the AAO, April is recognized as Sports Eye Safety Month, and members are urging their patients to use protective eyewear, whether they are involved in youth sports or the professional leagues.
“Athletes need to choose to use protective eyewear because eye injuries can be devastating,” Monica L. Monica, MD, PhD, MHA, clinical correspondent for the AAO, said in a press release. “The injuries range from abrasions of the cornea and bruises of the lids to internal eye injuries, such as retinal detachments and internal bleeding.”
Protection is available for patients involved in almost any sport, including but not limited to basketball, baseball, hockey, football, lacrosse, fencing, paintball, water polo, racquetball, soccer and skiing.
“Eyewear properly fitted and worn does not hinder performance in any way and can prevent most sports eye injuries,” M. Bowes Hamill, MD, associate professor of ophthalmology at Baylor College of Medicine in Houston and clinical correspondent for the AAO, said in the release.
Dr. Hamill also stated that protective lenses should be made of polycarbonate, which is durable enough to withstand the impact from objects traveling up to 90 mph.
Most sports leagues, especially for children, do not require protective eyewear, so parents should urge their children to wear protection, according to the AAO release.
For more information:
- The American Academy of Ophthalmology can be reached at www.aao.org.