Meeting the Eye Care Needs of Student Athletes

Digital eye strain and dry eye disease are not just problems for adults.

By Bridgitte Shen Lee, OD

As I write this in August, just like the rest of the world, I am watching and cheering for the amazing young athletes at the 2016 Summer Olympics in Rio de Janeiro, Brazil. So are my two young daughters, who are athletes themselves. It hurts my heart every time I see a young athlete squinting to see the scoreboard, and I hear my daughters say, “Mommy, they need an eye doctor and contact lenses.” I cannot help but wonder what uncorrected refractive errors those young athletes may have, whether they have an eye doctor, and whether they know about all the recent advances in contact lenses that could help them compete to the best of their athletic abilities.


As an owner of a private optometric practice for 18 years (and a mother to two children who are both fencers and dancers), I have had the privilege of examining many children who play sports, some of them at competitive levels. These student athletes lead demanding lives, many of them spending at least 10 to 20 hours a week practicing and competing, some playing multiple sports.1 When kids participate in sports, the documented physical, emotional, social, and educational benefits last a lifetime.2 In addition, participation in National Collegiate Athletic Association (NCAA) sports can help athletic high school students gain college entrance.3 Nearly 8 million students participate in high school athletics in the United States, and more than 480,000 compete as NCAA athletes in college.4

Source: American Optometric Association. Through the Eyes of the 21st-Century Child.

Student athletes may have to practice both before and after school, doing homework and studying whenever and wherever they can, staying connected on their digital devices, staying up late to finish their schoolwork, and repeating this life week after week. In addition to taking care of traditional visual needs and checking ocular health, in the digital age we are seeing an increasing incidence of digital eye strain (DES) and modern dry eye disease (DED). Modern DED is on the rise, and the common risk factor is the use of computers, smartphones, and tablets.5 DES affects 65% of all Americans, including kids.6

It is essential that eye doctors educate these student athletes and their parents about the latest eye care developments and provide them with solutions that will help them see their best, keep up with their demanding schedules, and prevent DES and DED.


Since the introduction of the first daily disposable contact lens in 1995,7 student athletes and adults alike have enjoyed the comfort and convenience of this vision correction modality. In the past 2 decades, many daily disposable contact lenses have come onto the market, with each generation bringing improved comfort and health benefits.

As firm believers that daily disposable contact lenses are the healthiest, most comfortable, and most convenient option for our patients, at Vision Optique we have tried every single daily disposable contact lens marketed since 1999. We have found that the premium daily disposable contact lenses shown in Table 1 match our student athletes’ needs the best.

For those who wear contact lenses 14 to 18 hours a day, comfort at the end of the day is as important as health benefits such as the ultraviolet light protection and oxygen transmissibility of the lens material. According to the young fencers at the Salle Mauro Fencing Academy in Houston, where my daughters fence, these contact lenses will not dry out as much at the end of the day and do not sting their eyes when they sweat during competitions.


According to a 2015 survey, the increasing use of technology at home and at school is taking a toll on the eye health and vision of the 38 million children in America. Fully 80% of school age children spend at least 1 to 2 hours on average per day on various digital devices.8 Although these technologies may enhance these children’s learning and provide them with entertainment, the long-term effects on their eyes are not yet fully known.9

What is known, however, is that DES now affects 65% of all Americans (including kids). The Vision Council defines DES as a condition characterized by dry irritated eyes, blurred vision, fatigue, headache, and neck and back pain.10 DES associated with long-term digital device use (for both studying and playing) is becoming problematic among students. It can be even worse for student athletes because they are more likely to use digital devices in nonideal environments such as airports, automobiles, gymnasiums, and sports fields, as they travel to compete on weekends.

In addition, studies have found that exposure to the harmful high-energy visible (HEV) blue light wavelengths from digital devices before bedtime can interfere with and disrupt sleep patterns by increasing alertness in the brain.11

In response to these digital habits, the optical industry has developed new lens technologies to reduce glare, block HEV blue light from penetrating our eyes, and prevent eye fatigue and sleep disturbance. Wearing glasses with blue light protection (BLP) lenses can mitigate the melatonin suppression and decreased alertness brought on by staring into digital devices before bedtime.12 Figure 2 lists antifatigue lens designs with BLP coating that can help to relax and protect the eyes of student athletes, allow them to study more effectively, and facilitate better sleep. For students who have perfect vision or who prefer to wear contact lenses full time, plano lenses with only BLP coatings can work well. For students with heavy digital usage and multiple DES symptoms, an antifatigue lens design should be used.


With increasing use of digital devices at school and at home, many of us, including kids, forget to blink. The more concentrated you are on a task, the less frequently you blink. Good, full blinks are important for the maintenance of healthy meibomian glands and a healthy ocular surface.

The most common cause of DED in children is evaporative eye disease, most frequently caused by meibomian gland dysfunction.13 Other common causes include blepharitis, Demodex infestation, ocular rosacea, allergies, infections, and mechanical irritation.14 Autoimmune diseases, hormonal changes, pharmaceuticals with dry eye side effects, diets low in omega-3 fatty acids, and inadequate daily hydration can also contribute to DED.

The Vision Council infographic on DES.

When we evaluate children for DED, in addition to careful patient case history and traditional tests, we now have new technologies such as the TearLab Osmolarity Test (TearLab), InflammaDry (Rapid Pathogen Screening), and LipiView II (Tear Science) to help determine the type of DED the patient has and to track the progress of treatment.

Those who have mild evaporative DED may benefit from use of an oil-based tear such as Retaine MGD (OcuSoft) with application of a warm compress such as the Bruder Eye Hydrating Mask (Bruder Healthcare). Those with mild aqueous-deficiency DED may benefit from a tear substitute such as Refresh Optive (Allergan).

Meibography helps to evaluate meibomian gland functions in teens and adults alike. If the gland has undergone damage or capping, it is helpful to treat the patient with gland expression. The LipiFlow devide (TearScience) can help to improve gland function by expressing hardened meibum within the gland.

Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), which is approved for use in those age 16 years and older, has been the go-to drop for inflammatory DED since its introduction. With the recent approval of Xiidra (lifitegrast ophthalmic solution 5%, Shire), approved for treating signs and symptoms of dry eyes and for those age 17 years and older, we now have two drops in our arsenal to treat DED.

Debris on the eyelashes, whether from staphylococcal bacteria or Demodex mites, can unload toxins into the tear film and create an inflammatory response, exacerbating inflammatory DED. Lid Scrub Plus Platinum (OcuSoft), which is an extra-strength eyelid cleanser containing phytosphingosine, has both antibacterial and antiinflammatory properties. The use of hypochlorous acid (HOCl) has also been advantageous for patients with staphylococcal blepharitis. It can be obtained via a prescription for Avenova with Neutrox (HOCl 0.01%, NovaBay) or over the counter as Hypochlor Gel (HOCl 0.02%, OcuSoft).5


One of the best television commercials I have seen during the Olympics, for Under Armour sports apparel, celebrates the hard work and dedication of swimmer Michael Phelps. He is shown practicing in the pool from day until night, and inspiring all of us. The tagline of the ad is, “It’s what you do in the dark that puts you in the light!”

Likewise, by adding the latest eye care advances to our arsenal, what eye doctors prescribe in the darkened exam room can help student athletes with their sight and performance in the light of the sports arena.

It’s what eye doctors do in the dark that puts student athletes’ sight in the best light! n

1. Christopher G. How many hours should youth athletes train and play each week? Accessed August 22, 2016.

2. The Aspen Insititute: Project Play. Facts: Sports Activity and Children. 2015. Accessed August 22, 2016.

3. NCAA. Estimated probability of competing in college athletics. April 26, 2015. Accessed August 22, 2016.

4. NCAA. NCAA sports sponsorship and participation rates report. October 2015. Accessed August 22, 2016.

5. Karpecki PM. The dry eye deluge. Review of Optometry. January 15, 2016. Accessed August 22, 2016.

6. The Vision Council. Digital eye strain report 2016. Accessed August 22, 2016.

7. Heiting G. When were contact lenses invented? May 2015. Accessed August 22, 2016.

8. American Optometric Association. Through the eyes of the 21st-century child. 2015. Accessed August 22, 2016.

9. American Optometric Association. AOA alerts parents: Back-to-school eye exams more essential than ever. July 15, 2015. Accessed August 22, 2016.

10. The Vision Council. What is digital eye strain? Accessed August 22, 2016.

11. Blue light has a dark side. Harvard Health Letter. May 2012. Accessed August 22, 2016.

12. van der Lely S, Frey S, Garbazza C, et al. Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers. J Adolesc Health. 2015;56(1):113-119.

13. Kaufman LB. Are we missing dry eye in children? EyeNet Magazine. August 2016. Accessed August 22, 2016.

14. Caceres V. Dry eye diagnosis in children takes some detective work. EyeWorld. June 2013. Accessed August 22, 2016.

Bridgitte Shen Lee, OD
• Cofounder and CEO, Vision Optique, Houston, Texas
• Founder, iTravelCE
• Financial disclosure: speaker for Shire; consultant to Johnson & Johnson Vision Care, Essilor, Bausch + Lomb, OCuSOFT, and Guardion Health Sciences