Pediatric Golf-Related Ophthalmic Injuries

Abstract

Source: Hink EM, Oliver SCN, Drack AV, et al. Pediatric golf-related ophthalmic injuries. Arch Ophthalmol. 2008;126(9):1252–1256; doi:10.1001/archopht.126.9.1252Researchers from the University of Colorado and Emory University Schools of Medicine performed this retrospective study to document ophthalmic morbidity in golfrelated injuries and report specific injury patterns. The medical records of all children younger than 18 years with ophthalmic injury resulting from golf clubs or golf balls seen between 1992 and 2007 at the two institutions were reviewed.Eleven eyes of 11 pediatric patients (6 boys; mean age 10.2 years, range 714 years) were injured by golfassociated trauma. Ten patients (91%) were injured by golf clubs and one patient (9%) by a golf ball. Injuries occurred at home (6), at school (2), on a golf course (1), and at sites unknown (2). At the initial posttraumatic examination, four injured eyes (36%) had a visual acuity of 20/20, three (27%) had a visual acuity of 20/25 to 20/80, three (27%) had no light perception, and one (9%) could not be assessed due to altered mental status. Injuries included orbital fracture (11), hyphema (4), and traumatic optic neuropathy (3); separation of the iris from its attachment to the ciliary body, ruptured open globe, optic nerve avulsion, retrobulbar hemorrhage, macular chorioretinal scar, and zygomaticomaxillary complex fracture each occurred in one eye. The only injury caused by a golf ball resulted in the only ruptured open globe. Nine of the 11 patients required surgery.Followup ranged from 066 months (mean followup 12 months). Three of 11 subjects had permanent deficits. Final visual acuity at followup included two eyes (18%) with no light perception (both of these presented initially with no light perception), one eye (9%) with 20/70 visual acuity (the original exam in this case elicited no light perception), and eight eyes (73%) with 20/20 or better visual acuity (all improved or equal to visual acuity at initial presentation). The authors conclude that eye injuries related to golf, although rare in children, may result in permanent visual loss.Dr. Pujazon-Zazik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Fortytwo thousand patients per year in the US are treated for eye injuries from sportsrelated trauma and recent data indicate that this number is increasing.1Golf is an increasingly popular sport, with an estimated two million junior (age 1217 years) golfers in the US.2 The pattern of golfrelated ophthalmic injuries in pediatric patients has changed over the years. In the 1960s and 70s most ophthalmic injuries were caused by a curious child dissecting a golf ball.2 In these cases, the high pressure center of the ball would explode as the child dissected the ball. Changes in golf ball design have, fortunately, eliminated this type of injury. Most pediatric golfrelated injuries do not happen on the golf course or during supervised play; most children are injured wielding a golf club while playing at home or school. This is in contrast to adult injuries, where most are caused by a golf ball rather than a golf club.3In their joint statement on protective eyewear during sports participation, the AAP and the American Academy of Ophthalmology list golf as a moderaterisk sport for eye trauma. Furthermore, the joint statement strongly recommends protective eyewear for all participants in sports in which there is risk of eye injury. Protective eyewear should be mandatory for athletes who are functionally oneeyed and for athletes whose ophthalmologists recommend eye protection after eye surgery or trauma.Identification of injury patterns may facilitate determination of effective preventive measures and elevation of public awareness of this issue. The study by Hink, et al, suggests that close adult supervision, adequate distance between children, and protective eyewear are measures that might enable those aspiring to be the next Tiger Woods or Annika Sorenstam to fulfill their golf dreams.