Consenso do Comitê Olímpico Internacional sobre questões de oftalmologia relacionadas ao esporte de elite

Morten Carstens Moe; Emin Özmert; Christophe Baudouin; Abhinav Binadra; Sven Crafoord; Young Jo; Hayyam Kiratli; Melita Moore; Yannis P Pitsiladis; Udo Rolle; Ben Tan; Özge Yanik; Richard Budgett; Ugur Erdener; Kathrin Steffen; Lars Engbretsen

Autores

Morten Carstens Moe Department of Ophthalmology, Oslo University Hospital Ullevaal, Norway
Emin Özmert Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye / Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
Christophe Baudouin Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital & Vision Institute, Paris, France
Abhinav Binadra Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
Sven Crafoord Faculty of Medicine and Health, Department of Ophthalmology, Örebro University Hospital, Sweden
Young Jo Department of Ophthalmology, Chungnam National University Hospital, Daejeon, South Korea
Hayyam Kiratli Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye
Melita Moore Physical Medicine and Rehabilitation, University of California Davis Medical Center, Sacramento, California, USA
Yannis P Pitsiladis School of Sport and Health Sciences, University of Brighton, Eastbourne, UK / International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
Udo Rolle Department of Paediatric Surgery and Paediatric Urology, University Hospital Frankfurt, Germany
Ben Tan SingHealth Duke-NUS Sport & Exercise Medicine Centre, Singapore
Özge Yanik Ophthalmology, Ankara University Faculty of Medicine, Ankara, Türkiye / Department of Ophthalmology, Vehbi Koç Eye Hospital, Ankara, Türkiye
Richard Budgett Medical & Scientific, International Olympic Committee, Lausanne, Switzerland
Ugur Erdener Medical & Scientific, International Olympic Committee, Lausanne, Switzerland / Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Türkiye / World Archery, Lausanne, Switzerland
Kathrin Steffen Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Norway
Lars Engbretsen Medical & Scientific, International Olympic Committee, Lausanne, Switzerland / Oslo Sports Trauma Center, Institute of Sports Medicine, Norwegian School of Sport Sciences, Norway / Division of Orthopaedic Surgery, University of Oslo Faculty of Medicine, Norway

Resumo

A visão desempenha um papel importante no sucesso dos atletas. Nos esportes, quase 80% das informações sensoriais recebidas são visuais; assim, a saúde ocular e a medicina esportiva são áreas intrinsecamente ligadas e de suma importância para os atletas. A natureza física das atividades esportivas torna os indivíduos mais suscetíveis a diversas lesões oculares do que a população em geral. Traumas oculares podem deixar sequelas permanentes, e o comprometimento da visão exige acompanhamento e manejo cuidadosos. Além de lesões, os atletas também podem apresentar problemas de visão que prejudicam seu desempenho, como visão turva, visão dupla e sensibilidade à luz.

A natureza interdisciplinar da medicina esportiva exige a colaboração entre profissionais da área e oftalmologistas. Por meio dessa colaboração, os atletas podem receber cuidados oculares adequados, orientações sobre proteção ocular correta e aconselhamento para a adoção de bons hábitos de saúde ocular. Caso sintomas menos evidentes não sejam detectados e tratados prontamente, os atletas podem sofrer lesões sistêmicas decorrentes de problemas de visão, o que os impediria de alcançar um alto nível de desempenho esportivo em competições.

A proteção do atleta de elite é responsabilidade de todos nós que atuamos na medicina esportiva. Com o objetivo de promover uma abordagem mais unificada e baseada em evidências para a avaliação e o manejo da saúde oftalmológica de atletas — tema relevante para os médicos do esporte —, o Grupo de Consenso do Comitê Olímpico Internacional busca realizar uma avaliação crítica do estado atual da ciência e da prática clínica em relação a questões e doenças oftalmológicas no esporte de alto rendimento, bem como apresentar recomendações para uma abordagem unificada dessa importante questão.

Referências

(1) Laby DM, Appelbaum LG. Review: vision and on-field performance: A critical review of visual assessment and training studies with athletes. Optom Vis Sci 2021;98:723–31. 10.1097/OPX.0000000000001729 (DOI)

(2) Arie B. Sports vision: how enhancing your vision can give you that extra edge in competition. Peak Performance 2003;22:6–8.

(3) Engebretsen L, Steffen K. Protection of the elite athlete is the responsibility of all of us in sports medicine. Br J Sports Med 2015;49:1089–90. 10.1136/bjsports-2015-095221 (DOI)

(4) van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, Aetiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14:82–99. 10.2165/00007256-199214020-00002 (DOI)

(5) Ashraf G, Arslan J, Crock C, et al. Sports-related ocular injuries at a tertiary eye hospital in Australia: A 5-year retrospective descriptive study. Emerg Med Australas 2022;34:794–800. 10.1111/1742-6723.13982 (DOI)

(6) Micieli JA, Easterbrook M. Eye and orbital injuries in sports. Clin Sports Med 2017;36:299–314. 10.1016/j.csm.2016.11.006 (DOI)

(7) Dain SJ. Sports Eyewear protective standards. Clin Exp Optom 2016;99:4–23. 10.1111/cxo.12349 (DOI)

(8) Leivo T, Haavisto AK, Sahraravand A. Sports-related eye injuries: the current picture. Acta Ophthalmol 2015;93:224–31. 10.1111/aos.12633 (DOI)

(9) Gardner EC. Head, face, and eye injuries in collegiate women’s field hockey. Am J Sports Med 2015;43:2027–34. 10.1177/0363546515588175 (DOI)

(10) Haring RS, Sheffield ID, Canner JK, et al. Epidemiology of sports-related eye injuries in the United States. JAMA Ophthalmol 2016;134:1382. 10.1001/jamaophthalmol.2016.4253 (DOI)

(11) Zhang J, Zhu X, Sun Z, et al. Epidemiology of sports-related eye injuries among athletes in Tianjin, China. Front Med (Lausanne) 2021;8. 10.3389/fmed.2021.690528 (DOI)

(12) Soligard T, Palmer D, Steffen K, et al. Sports injury and illness incidence in the Pyeongchang 2018 Olympic winter games: a prospective study of 2914 athletes from 92 countries. Br J Sports Med 2019;53:1085–92. 10.1136/bjsports-2018-100236 (DOI)

(13) Soligard T, Palmer D, Steffen K, et al. New sports, COVID-19 and the heat: sports injuries and illnesses in the Tokyo 2020 summer Olympics. Br J Sports Med 2022. 10.1136/bjsports-2022-106155 (DOI)

(14) Soligard T, Steffen K, Palmer D, et al. Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic summer games: A prospective study of 11274 athletes from 207 countries. Br J Sports Med 2017;51:1265–71. 10.1136/bjsports-2017-097956 (DOI)

(15) Soligard T, Steffen K, Palmer-Green D, et al. Sports injuries and illnesses in the Sochi 2014 Olympic winter games. Br J Sports Med 2015;49:441–7. 10.1136/bjsports-2014-094538 (DOI)

(16) Toldi JP, Thomas JL. Evaluation and management of sports-related eye injuries. Curr Sports Med Rep 2020;19:29–34. 10.1249/JSR.0000000000000677 (DOI)

(17) Engebretsen L, Soligard T, Steffen K, et al. Sports injuries and illnesses during the London summer Olympic games 2012. Br J Sports Med 2013;47:407–14. 10.1136/bjsports-2013-092380 (DOI)

(18) Patel PS, Uppuluri A, Oydanich M, et al. Epidemiology of United States tennis-related ocular injuries from 2000 to 2019. Int Ophthalmol 2023;43:997–1003. 10.1007/s10792-022-02502-3 (DOI)

(19) Junge A, Engebretsen L, Alonso JM, et al. Injury surveillance in multi-sport events: the International Olympic committee approach. British Journal of Sports Medicine 2008;42:413–21. 10.1136/bjsm.2008.046631 (DOI)

(20) Bahr R, Clarsen B, Derman W, et al. International Olympic committee consensus statement: methods for recording and reporting of Epidemiological data on injury and illness in sport 2020 (including STROBE extension for sport injury and illness surveillance (STROBE-SIIS)). Br J Sports Med 2020;54:372–89. 10.1136/bjsports-2019-101969 (DOI)

(21) Basic and clinical science course (BCSC) section 02: 2022-2023 fundamentals and principles of Ophth. Available: aao.org

(22) Spaide RF. CHOROIDAL BLOOD FLOW: review and potential explanation for the Choroidal venous anatomy including the vortex vein system. Retina 2020;40:1851–64. (DOI)

(23) Campbell WG, Pejnovic TM. Treatment of Amelanotic Choroidal Melanoma with Photodynamic therapy. Retina 2012;32:1356–62. 10.1097/IAE.10.1097/IAE.0b013e31822c28ec (DOI)

(24) Kuhn F, Morris R, Witherspoon CD, et al. The Birmingham eye trauma terminology system (BETT). J Fr Ophtalmol 2004;27:206–10. 10.1016/s0181-5512(04)96122-0 (DOI)

(25) Kunz C, Audigé L, Cornelius C-P, et al. The comprehensive AOCMF classification system: orbital fractures - level 3 Tutorial. Craniomaxillofacial Trauma & Reconstruction 2014;7(1_suppl):92–102. 10.1055/s-0034-1389562 (DOI)

(26) Petrigliano FA, Williams RJ. 3rd orbital fractures in sport: a review. Sports Med 2003;33:317–22. 10.2165/00007256-200333040-00005 (DOI)

(27) Ohana O, Alabiad C. Ocular related sports injuries. J Craniofac Surg 2021;32:1606–11. 10.1097/SCS.0000000000007618 (DOI)

(28) Burnstine MA. Clinical recommendations for repair of isolated orbital floor fractures: an evidence-based analysis. Ophthalmology 2002;109:1207–10. 10.1016/S0161-6420(02)01057-6 (DOI)

(29) Lozada KN, Cleveland PW, Smith JE. Orbital trauma. Semin Plast Surg 2019;33:106–13. 10.1055/s-0039-1685477 (DOI)

(30) Scolozzi P. Reflections on a patient-centered approach to treatment of blow-out fractures: why the wisdom of the past must guide our decision-making. J Plast Reconstr Aesthet Surg 2022;75:2268–76.:S1748-6815(22)00229-7. 10.1016/j.bjps.2022.04.034 (DOI)

(31) Kim HS, Jeong EC. Orbital floor fracture. Arch Craniofac Surg 2016;17:111–8. 10.7181/acfs.2016.17.3.111 (DOI)

(32) Sung EK, Nadgir RN, Fujita A, et al. Injuries of the globe: what can the Radiologist offer Radiographics 2014;34:764–76. 10.1148/rg.343135120 (DOI)

(33) Theadom A, Starkey NJ, Dowell T, et al. Sports-related brain injury in the general population: an Epidemiological study. J Sci Med Sport 2014;17:591–6. 10.1016/j.jsams.2014.02.001 (DOI)

(34) McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5(Th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838–47. 10.1136/bjsports-2017-097699 (DOI)

(35) Putukian M. The acute symptoms of sport-related concussion: diagnosis and on-field management. Clin Sports Med 2011;30:49–61, 10.1016/j.csm.2010.09.005 (DOI)

(36) Kontos AP, Elbin RJ, Schatz P, et al. A revised factor structure for the post-concussion symptom scale: baseline and Postconcussion factors. Am J Sports Med 2012;40:2375–84. 10.1177/0363546512455400 (DOI)

(37) Cockerham GC, Goodrich GL, Weichel ED, et al. Eye and visual function in traumatic brain injury. J Rehabil Res Dev 2009;46:811–8. 10.1682/jrrd.2008.08.0109 (DOI)

(38) Lau BC, Kontos AP, Collins MW, et al. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players Am J Sports Med 2011;39:2311–8. 10.1177/0363546511410655 (DOI)

(39) Mehra D, Galor A. Digital screen use and dry eye: A review. Asia Pac J Ophthalmol (Phila 2020;9:491–7. 10.1097/APO.0000000000000328 (DOI)

(40) Fjaervoll H, Fjaervoll K, Magno M, et al. The association between visual display terminal use and dry eye: a review. Acta Ophthalmol 2022;100:357–75. 10.1111/aos.15049 (DOI)

(41) Baudouin C, Labbé A, Liang H, et al. Preservatives in Eyedrops: the good, the bad and the ugly. Prog Retin Eye Res 2010;29:312–34. 10.1016/j.preteyeres.2010.03.001 (DOI)

(42) Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. The Ocular Surface 2017;15:276–83. 10.1016/j.jtos.2017.05.008 (DOI)

(43) Courtin R, Pereira B, Naughton G, et al. Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis. BMJ Open 2016;6:e009675. 10.1136/bmjopen-2015-009675 (DOI)

(44) Friedman NJ. Impact of dry eye disease and treatment on quality of life. Curr Opin Ophthalmol 2010;21:310–6. 10.1097/ICU.0b013e32833a8c15 (DOI)

(45) Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the ocular surface disease index. Arch Ophthalmol 2000;118:615–21. 10.1001/archopht.118.5.615 (DOI)

(46) Labbé A, Wang YX, Jie Y, et al. Dry eye disease, dry eye symptoms and depression: the Beijing eye study. Br J Ophthalmol 2013;97:1399–403. 10.1136/bjophthalmol-2013-303838 (DOI)

(47) Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. Ocul Surf 2017;15:511–38. 10.1016/j.jtos.2017.05.004 (DOI)

(48) Bulirsch LM, Weber C, Saßmannshausen M, et al. Histological changes in Keratoconus and wound healing after corneal cross-linking (Impact of ultraviolet radiation on the retina). Ophthalmologe 2022;119:342–9. 10.1007/s00347-021-01537-8 (DOI)

(49) Fonn D. A special issue on ultraviolet radiation and its effects on the eye. Eye Contact Lens 2011;37:167. 10.1097/ICL.0b013e318227a1ef (DOI)

(50) Eisenbeisz HC, Kudrna JJ, Greenwood M, et al. Corneal refractive surgery in the right patient at the right time. S D Med 2021;74:358–62.

(51) Willmann G. Ultraviolet Keratitis: from the pathophysiological basis to prevention and clinical management. High Alt Med Biol 2015;16:277–82. 10.1089/ham.2015.0109 (DOI)

(52) Modenese A, Korpinen L, Gobba F. Solar radiation exposure and outdoor work: an underestimated occupational risk. Int J Environ Res Public Health 2018;15. 10.3390/ijerph15102063 (DOI)

(53) Delcourt C, Cougnard-Grégoire A, Boniol M, et al. Lifetime exposure to ambient ultraviolet radiation and the risk for cataract extraction and age-related macular degeneration: the Alienor study. Invest Ophthalmol Vis Sci 2014;55:7619–27. 10.1167/iovs.14-14471 (DOI)

(54) Bányai FMDG, Király O, Demetrovics Z. The psychology of Esports: a systematic literature review. J Gambl Stud 2019;35:351–65. (DOI)

(55) Kaur K, Gurnani B, Nayak S, et al. Digital eye Strain- A comprehensive review. Ophthalmol Ther 2022;11:1655–80. (DOI)

(56) Kaur K, Gurnani B, Nayak S, et al. Digital eye strain-a comprehensive review. Ophthalmol Ther 2022;11:1655–80. 10.1007/s40123-022-00540-9 (DOI)

(57) Erdinest N, Berkow D. Computer vision syndrome (COMPUTER VISION SYNDROME). Harefuah 2021;160:386–92.

(58) Ahmed SF, McDermott KC, Burge WK, et al. Visual function, Digital behavior and the vision performance index. Clin Ophthalmol 2018;12:2553–61. 10.2147/OPTH.S187131 (DOI)

(59) Dağ U, Çağlayan M, Öncül H, et al. Central Serous chorioretinopathy associated with high-dose Follistatin-344: a retrospective case series. Int Ophthalmol 2020;40:3155–61. 10.1007/s10792-020-01501-6 (DOI)

(60) Tzekov R, Quezada A, Gautier M, et al. Repetitive mild traumatic brain injury causes optic nerve and retinal damage in a mouse model. J Neuropathol Exp Neurol 2014;73:345–61. 10.1097/NEN.0000000000000059 (DOI)

(61) Chan JW, Hills NK, Bakall B, et al. Indirect traumatic optic neuropathy in mild chronic traumatic brain injury. Invest Ophthalmol Vis Sci 2019;60:2005–11. 10.1167/iovs.18-26094 (DOI)

(62) Ciuffreda KJ, Kapoor N, Rutner D, et al. Occurrence of Oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry 2007;78:155–61. 10.1016/j.optm.2006.11.011 (DOI)

(63) Master CL, Scheiman M, Gallaway M, et al. Vision diagnoses are common after concussion in adolescents. Clin Pediatr (Phila) 2016;55:260–7. 10.1177/0009922815594367 (DOI)

(64) Jiang H, Wei Y, Shi Y, et al. Altered macular Microvasculature in mild cognitive impairment and Alzheimer disease. J Neuroophthalmol 2018;38:292–8. 10.1097/WNO.0000000000000580 (DOI)

(65) Lanzillo R, Cennamo G, Criscuolo C, et al. Optical coherence tomography angiography retinal vascular network assessment in multiple sclerosis. Mult Scler 2018;24:1706–14. 10.1177/1352458517729463 (DOI)

(66) Yanik Odabaş Ö, Demirel S, Özmert E, et al. Repeatability of automated vessel density and superficial and deep foveal avascular zone area measurements using optical coherence tomography angiography: diurnal findings. Retina 2018;38:1238–45. 10.1097/IAE.0000000000001671 (DOI)

(67) Wroblewski JJ, McChancy C, Pickel K, et al. Reproducibility of fixed-Luminance and multi-Luminance flicker electroretinography in patients with diabetic retinopathy using an office-based testing paradigm. J Diabetes Sci Technol 2020;14:1095–103. 10.1177/1932296819882719 (DOI)

(68) Pescosolido N, Barbato A, Stefanucci A, et al. Role of electrophysiology in the early diagnosis and follow-up of diabetic retinopathy. J Diabetes Res 2015;2015. 10.1155/2015/319692 (DOI)

(69) Goldstein MH, Wee D. Sports injuries: an ounce of prevention and a pound of cure. Eye Contact Lens 2011;37:160–3. 10.1097/ICL.0b013e31821790db (DOI)

(70) Hoskin AK, Mackey DA, Keay L, et al. Eye injuries across history and the evolution of eye protection. Acta Ophthalmol 2019;97:637–43. 10.1111/aos.14086 (DOI)

(71) Micieli JA, Zurakowski D, Ahmed IIK. Impact of Visors on eye and orbital injuries in the National hockey League. Can J Ophthalmol 2014;49:243–8. 10.1016/j.jcjo.2014.03.008 (DOI)

(72) Micieli R, Micieli JA. Visor use among national hockey League players and its relationship to on-ice performance. Inj Prev 2016;22:392–5. 10.1136/injuryprev-2015-041900 (DOI)

(73) Micieli R, Micieli JA. Factors influencing visor use among players in the National hockey league (NHL). Open Access J Sports Med 2014;5:43–6. 10.2147/OAJSM.S61010 (DOI)

(74) Maxén M, Kühl S, Krastl G, et al. Eye injuries and orofacial Traumas in Floorball--a survey in Switzerland and Sweden. Dent Traumatol 2011;27:95–101. 10.1111/j.1600-9657.2010.00960.x (DOI)

(75) Eime R, Finch C, Wolfe R, et al. The effectiveness of a squash Eyewear promotion strategy. Br J Sports Med 2005;39:681–5. 10.1136/bjsm.2005.018366 (DOI)

(76) Kriz PK, Zurakowski D, Almquist JL, et al. Eye protection and risk of eye injuries in high school field hockey. Pediatrics 2015;136:521–7. 10.1542/peds.2015-0216 (DOI)

(77) Ghosh F, Bauer B. Sports-related eye injuries. Acta Ophthalmol Scand 1995;73:353–4. 10.1111/j.1600-0420.1995.tb00042.x (DOI)

(78) Drolsum L. Eye injuries in sports. Scand J Med Sci Sports 1999;9:53–6. 10.1111/j.1600-0838.1999.tb00207.x (DOI)

(79) American Academy of Pediatrics, Committee on Sports Medicine and Fitness, American Academy of Ophthalmology, Eye Health and Public Information Task Force . Protective Eyewear for young athletes. Ophthalmology 2004;111:600–3. 10.1016/j.ophtha.2003.12.027 (DOI)

(80) Laby DL, Kirschen DG. A new model for sports and performance vision. Vision Development & Rehabilitation 2018;4.

(81) Dalton K. Review: the quiet eye in sports performance-is the quiet eye the ultimate explanation or only the beginning? Optom Vis Sci 2021;98:732–7. 10.1097/OPX.0000000000001728 (DOI)

(82) Schwab S, Memmert D. The impact of a sports vision training program in youth field hockey players. J Sports Sci Med 2012;11:624–31.

(83) Maman P, Gaurang S, Sandhu JS. The effect of vision training on performance in tennis players. Serb J Sports Sci 2011;5:11–6.

(84) Abernethy B, Wood JM. Do generalized visual training programmes for sport really work? an experimental investigation. J Sports Sci 2001;19:203–22. 10.1080/026404101750095376 (DOI)

(85) Di Noto P, Uta S, DeSouza JFX. Eye exercises enhance accuracy and letter recognition, but not reaction time, in a modified rapid serial visual presentation task. PloS One 2013;8:e59244. 10.1371/journal.pone.0059244 (DOI)

(86) Clark JF, Ellis JK, Bench J, et al. High-performance vision training improves batting statistics for University of Cincinnati baseball players. PLoS One 2012;7. 10.1371/journal.pone.0029109 (DOI)

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