Retinopathy applies to any damage to the blood vessels of the retina. An eye examination at the back of the eye enables a medical professional to look carefully at a sample of blood vessels and detect early signs of complications linked to diabetes or high blood pressure and other conditions. This eye disease comes in two forms: diabetic retinopathy and retinitis pigmentosa.
1. DIEBATIC RETINOPHAY
This form of retinopathy, caused by diabetes, is the most common cause of blindness in adults under 50 years. It presents itself in the form of lesions on the retinal capillaries that cause hemorrhages and retinal bleeding. There are several evolutions in diabetic retinopathy:
– EMERGING RETINOPATHY
Emerging retinopathy causes no functional symptoms but regular ophthalmologic monitoring is highly recommended,
– MORE ADVANCED RETINOPATHY
Advanced retinopathy can cause a loss in visual acuity impacting central vision due to macular bleeding. At this stage, people mostly notice difficulties in near vision with a permanent sensation of blurred vision. With intermediate vision, activities requiring precision – sewing, shaving, cooking… – become difficult,
– IN ADVANCED STAGES: DIABETIC RETINOPATHY
Diabetic retinopathy causes a significant decrease in visual acuity, increased sensitivity to light and a field of vision impacted by scattered scotoma (blind spots) due to retinal hemorrhages. This significantly impairs an individual’s vision.
2. RETINITIS PIGMENTOSA
Retinitis pigmentosa most often begins between the ages of 18 and 30, with increased prevalence between 40 and 50 years.
Retinitis pigmentosa is a genetic disease that results in dysfunction of the pigment epithelium and degeneration of the photoreceptors. Vision is disturbed by pigment forming in the eyes and can worsen until a person becomes blind. The field of vision is gradually reduced to become “tunnel vision”. The patient retains his/her central vision but loses peripheral vision. So far, no treatment is known although encouraging research possibilities are emerging.
Real talk: if you’re a regular contact wearer, chances are you’ve fallen asleep in your contacts at some point in time (or maybe even a few times). We all know it’s not recommended by eye doctors, but why, exactly? What’s actually happening in your eyes when you sleep with your contacts in?
To find out, we had to get a little familiar with how daily contact wearing actually affects your body. As with any foreign object or substance that you introduce to your body, whether it be a food or a drug, contacts take some time to get used to. “The FDA actually describes contacts as a drug,” says Russell Wohl, OD, from Farmingdale, New York. “No you’re not ingesting a contact, it’s just sitting on your eye, but your body has to get acclimated to it.” Contacts can also sometimes burn or cause dryness in the eye, too. Each individual’s tears are made up of a certain pH acidity, explains Wohl, and when you put a contact into your eye, the contact solution—not the actual lens— actually has a different pH, so your eye may tear to help wash that solution out. And if you have dry eyes to begin with, lenses may only exacerbate that. “When we blink, we’re wiping tears across the cornea to help keep things uniform and clear, because when the cornea is exposed to air, it can become irritating,” explains Wohl. “Contacts need moisture once they’re removed from the solution they come packaged in, and if you already don’t have enough tears or suffer from dry eyes, lenses might only make that worse.”
When we sleep, we lose ambient oxygen exposure to the cornea, which is needed to keep the cornea healthy. We are still able to get it in other ways—like through blood vessels—but we are getting less than we do when we’re awake. “What a contact lens does is limit the oxygen even more because it creates a barrier between the oxygen and the cornea,” explains Wohl. “Some lenses—extended wear ones—allow the oxygen through though,” says Wohl, but if not enough oxygen gets through, you can experience what is called hypoxia (oxygen deprivation in a region of the body).
You also increase your chances of developing an infection, because bacteria can get onto the cornea and when your eyes are closed, there’s nothing to flush it away. “The bacteria can then become opportunistic and literally start to eat away at your cornea,” says Wohl. “Worst case scenario from that is loss of vision.” Yikes!
If you fall asleep accidentally with your lenses in for just one night, you’re unlikely to experience any serious issues. But if it becomes a more frequent habit or you’re purposefully wearing lenses overnight that aren’t mean to be, you’re upping your chance of a serious health risk. If you start to notice that your eyes are extremely red (we’re talking very bloodshot), you feel like there’s something in your eye and it’s irritated all the time, your eye lid is looking inflamed, you aren’t seeing as well as you used to, or if when you look at an indoor lamp it feels like you’re looking directly at the sun, these are signs that you could have an infection and you should see your eye doctor right away. “The good news is that most of the time it’s an acute episode that can usually be corrected by not wearing the contact lens and allowing the body to heal itself,” says Wohl. “If it’s worse, your doctor may need to give you a prescription.”
So why even take a chance? Make it a routine to take your contact lenses out every night before you go to sleep. “I’m more on the conservative side of things,” says Wohl, “so even with my extended wear patients, if it isn’t too much hassle, I recommend that everyone try to take them out every single day. If you ask me, that’s the healthiest option.”
The end of daylight saving time next month will create a more dangerous evening commute as people find it harder to see on the streets, New York City officials say.
The earlier sunset and darkness have been linked to an increase in the number of pedestrians killed or seriously injured by vehicles, according to an analysis by the city’s Department of Transportation of data from 2010 to 2014, the most recent years available.
In the latest instance, a 58-year-old woman was fatally struck by a Metropolitan Transportation Authority bus on Friday evening as she walked in Lower Manhattan. The bus driver was arrested and charged with failure to yield to a pedestrian, according to the police.
As a result, the administration of Mayor Bill de Blasio will announce on Thursday a new $1.5 million “dusk and darkness” safety campaign that will include radio and television advertisements, signs on buses, and billboards to warn drivers as well as pedestrians to be more careful, especially at that time of day. In addition, the police will target drivers during those hours who speed, fail to yield to pedestrians, text on cellphones or block bike lanes.
The campaign is part of the city’s Vision Zero plan, a set of proposals that aims to eliminate fatalities and injuries caused by vehicles. This year, as of Monday, there have been 192 traffic fatalities, 114 of which involved pedestrians — the rest involved people in cars, bicyclists and people on motorcycles. In contrast, there were 177 traffic fatalities during the same period last year, of which 96 involved pedestrians.
“To meet our ambitious Vision Zero goals, especially during the more dangerous reality of this season’s evenings and nights, we have focused our efforts even further,” Mr. de Blasio said in a statement. “Our key Vision Zero agencies have teamed up to not only study crash data, but to work closely together and make critical adjustments that we believe will literally save lives.”
It is the first time that the city has adjusted traffic policy based on time and seasonal changes, though in the past, it has stepped up traffic enforcement at the beginning of the school year or during the winter holidays.
Nationally, a similar pattern has emerged, according to Michael Flannagan, an associate research professor at the University of Michigan, who has studied traffic safety nationally. “You do see a big jump in pedestrian fatalities and injuries in the evenings in the fall when the change back to standard time makes the evenings suddenly darker,” he said.
Dr. Flannagan added, however, that the increase was not caused by a disruption of sleep from the time change, but instead “simply because it was dark” and it becomes harder for drivers to see pedestrians. Conversely, in the spring, when the transition to daylight saving time makes the evenings suddenly lighter, there is a corresponding decrease in pedestrian fatalities and injuries nationally, he said.
The city’s traffic analysis showed that between 6 p.m. and 7 p.m. during the week — the prime commuting time — the weekday hourly average rate of severe injuries and fatalities involving pedestrians rose to 2.44 in mid-December, or nearly triple the average rate of 0.84 in August.
“It’s certainly much more dangerous at dusk both for pedestrians and motorists,” said Dr. Daniel M. Laby, the director of the Sports and Performance Vision Center at the State University of New York College of Optometry.
Dr. Laby added that even people with normal eyesight could not see as well at dusk because the human eye does not adapt well to decreasing light. Vision becomes less sharp, with less contrast and depth perception. In addition, he said, there is typically more glare from uneven lighting as the sun sets, and more visual distractions compared with nighttime, when headlights help to focus attention.
“You put this all together,” Dr. Laby said. “It almost makes you not want to go home at night. It’s risky.”
Amy Cohen, 51, a social worker in Park Slope, Brooklyn, said that, sadly, she was only too aware of the dangers on city streets at dusk. Her son, Sammy Eckstein, 12, was fatally struck by a van not long after 5 p.m. in October 2013 while retrieving a ball that had rolled into the street.
Ms. Cohen, who helped found the advocacy group Families for Safe Streets, said that while she supported the new campaign, the city also needed to take more steps to permanently redesign streets and slow traffic, such as widening sidewalks, increasing the crossing time at traffic lights, narrowing driving lanes and installing traffic cameras that record speeding vehicles. “Education is a good start but much more needs to be done,” she said.
The city’s traffic analysis found that dusk and evening crashes were often the result of drivers trying to make turns. In particular, there was a surge in severe injuries and fatalities from November to March, according to the analysis.
“Through education and enforcement with our sister agencies, every driver needs to learn about the limited visibility of this season and the dangers of fast turns, especially in the evening hours,” said Polly Trottenberg, the city’s transportation commissioner.
Ms. Trottenberg said the problem was underscored last year by a rash of nine pedestrian fatalities — three of which occurred during daylight hours — in the eight days after daylight saving time ended on Nov. 1. In total, there were 138 pedestrian fatalities in 2015, the lowest number since 1910.
As part of the new safety campaign, city officials will seek to publicize the dangers of dusk and darkness through radio ads that are timed to run during the evening commute, and cards that will be handed out urging drivers to slow down, especially when turning, and to “look closely” since “more pedestrians are hurt in crashes around sunset than any other time.” Pedestrians are also reminded to watch for turning cars.
In addition, the city is specifically contacting people at senior centers, and taxi and livery drivers.
Vanity has a price, and when it comes to wearing tinted contact lenses, it’s the eyes that often pay the bill.
A study published in the journal Optometry & Vision Science evaluated health markers in the eye after subjects wore a conventional clear lens, a tinted lens with the pigment embedded within the lens, and a tinted lens with the pigment on the surface. The results suggest that pigment on the surface could be harmful to your eyes.
After subjects wore each lens for eight hours, researchers evaluated the condition of the ocular surface and harvested tear samples to measure inflammation markers.
They found a significant difference between each lens type:
The clear lens left the ocular surface in the best condition
The two tinted lenses created more inflammation and conjunctival redness than the clear lens.
The model with pigment on the surface of the lens created a far worse effect in the eye than the other two lenses, with the greatest conjunctival redness, limbal redness, corneal staining and conjunctival staining.
In order to determine a defined metric, scientists measured the amount of cytokines—small proteins that are released during an immune response—within the tears of subjects. The lenses with surface pigments contained 122 percent more cytokines than the nontinted lenses and 71 percent more than the lenses with embedded pigments.
A rise in risk
Jeffrey Sonsino, O.D., chair of AOA’s Contact Lens and Cornea Section (CLCS) who practices in Nashville, Tennessee, assessed the study by saying, “It points to the fact that we should not be prescribing some of the first-generation tinted lenses—the ones with the pigment on the surface. Most doctors are not prescribing them anymore. My guess is that the majority of patients who are still wearing that technology are purchasing their lenses illegally without a prescription.”
Contact lenses sold to consumers without a prescription who are not under the care of a doctor of optometry present a genuine health hazard, says Dr. Sonsino.
According to a 2015 AOA survey, 16 percent of Americans have worn vanity contact lenses that have no corrective powers. Of that number, 26 percent purchased those decorative lenses without a prescription. Without the guidance of a doctor of optometry, unwitting shoppers can easily gravitate to the cheapest options, which are often those first-generation lenses with the pigment on the surface that increase ocular inflammation.
“Inflammation is when the cornea or the structures around it are put into physiologic stress. The result is that the body produces inflammation,” says Dr. Sonsino. “Any time the eye is put into physiologic stress, the risk for some kind of adverse event goes up.”
The doctor habit
Circumventing the doctor of optometry by purchasing contact lenses online can lead to bad habits and poor preventive health. “Bad actors will send more than a year’s supply of lenses to a patient, so the patient does not have a stimulus to see his or her doctor and get refreshed on all the proper techniques on keeping contact lenses safe,” says Dr. Sonsino. Nearly all of the potential dangers of contact lenses—rom using outmoded technology to maintaining poor ocular hygiene—can be mitigated with an annual, comprehensive eye exam.
AOA offers resources for decorative contact lens campaigns
October is a prime opportunity to reach the public about contact lens safety, which is why AOA has launched a public awareness campaign leading up to Halloween.
Representing a concerted approach to contact lens advocacy, the campaign reminds consumers about the dangers of illegal or improper contact lens use and stresses the importance of visiting their doctor of optometry before seeking decorative contact lenses.
When you meet someone new, the first thing you notice about them is probably their eyes—the shape, the color and sometimes their health….Curious? Eyes are more than just for show; doctors can diagnose a number of diseases or conditions just through an eye exam. The state of your eyes can give you major clues to what is happening to your body. These literal windows to your inner health can reveal 10 dangerous conditions:
There are a number of eye conditions that can indicate cancer somewhere in the body, or even in the eye. Lung cancer in men and breast cancer in women often spread to the eyes before a diagnosis is even made. Many doctors also first discover basal cell carcinoma (skin cancer) hiding under the eyelids or within brown spots that appear in the eye.
2. Autoimmune diseases
Autoimmune diseases like lupus, Chrohn’s disease or even some forms of arthritis can be diagnosed through the eye. If you are experiencing constant irritation and inflammation in your eyes (and yet you do not drink alcohol and you get a fair amount of sleep every night), the redness in your eyes can be a sign of inflammation happening elsewhere in your body, which is a common symptom of lupus.
Other symptoms such as eyelid droop or dry eyes can be symptoms of Sjogren’s syndrome, an autoimmune disease that destroys moisture glands in the body. Also, drooping eyelids indicate gradual muscle weakness that can stem from multiple autoimmune disorders.
3. High blood pressure
Signs of high blood pressure and other cardiovascular problems can be found in the eyes. According to Web MD, if the blood vessels in the whites of your eyes begin to twist, narrow or balloon, high blood pressure is most likely the cause. High blood pressure is especially dangerous as it puts people at high risk of having a devastating stroke.
4. Brain injury
Horner’s syndrome is a complication that often follows a head trauma, a stroke or an aneurysm that causes the pupils to become different sizes. Uneven pupils can also be an indicator of a tumor or growth in the neck area. Web MD has a list of circumstances that can cause this symptom. Regardless, if your pupils are uneven, this condition is a sign that something serious is happening to your body and should be checked out by a doctor immediately.
5. Liver problems
Jaundice is a condition that causes the skin and whites of the eyes to gain a yellow pigment. Jaundice is caused by too much bilirubin (a waste substance produced by the liver) flowing through the blood. Hepatitis (the inflammation of the liver) or other liver problems may cause jaundice when the liver is struggling to remove adequate amounts of bilirubin from the body.
6. Thyroid issues
Graves disease is a disorder of the thyroid that can cause the eyes to bulge and appear larger. This condition is triggered when the thyroid begins attacking the tissues in the eye socket. Protruding eyes are the most common sign of a thyroid problem.
Diabetes does more than just affect your blood sugar, it can severely impact the small capillaries in the eyes. High blood sugar (the primary symptom in diabetics) can cause these blood vessels to weaken in the retina, which then causes excess protein to flow into the macula, (the part of the eye that is responsible for focusing vision). If blood sugar is not monitored and properly managed over the years, this condition can cause severe vision loss.
8. High cholesterol
Another cardiovascular condition that can be diagnosed through a quick eye exam is high cholesterol. High levels of cholesterol can cause a gray ring to form around the cornea in the eye. High cholesterol can also cause small, yellow fat deposits to appear as bumps on the eyelids.
9. Multiple sclerosis
Multiple sclerosis often causes inflammation of the optic nerve, which causes excessive blurred vision or sometimes no symptoms at all. Over 75 percent of multiple sclerosis patients exhibit this symptom; often times it is the first symptom of the disease that comes to light.
If the inside of your lower eyelids are white or pale, it could indicate that your blood is lacking iron. Iron deficiency anemia is a common blood disorder that can usually be taken care of with oral supplements, but it can also be a sign of bleeding somewhere within the body.
Whatever the state of your eyes may be, never take them for granted. They are far more than what they seem and could potentially save you a lot of time when you and your doctor are trying to determine a diagnosis for your symptoms.
We are excited to announce that we are launching our in-house eyewear brand, “Envision”. These frames are 100% hand-made in Sabae, Japan by highly skilled Japanese artisans – and highly competitively priced so that our patients get maximum benefits of high-quality eyewear at a reasonable price.
Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in adults over age 50. The Centers for Disease Control and Prevention estimate that 1.8 million people have AMD and another 7.3 million are at substantial risk for vision loss from AMD.
Caucasians are at higher risk for developing AMD than other races. Women also develop AMD at an earlier age than men.
This eye disease occurs when there are changes to the macula, a small portion of the retina that is located on the inside back layer of the eye. AMD is a loss of central vision that can occur in two forms: “dry” (atrophic) and “wet” (exudative).
Most people with macular degeneration have the dry form, for which there is no known treatment. The less common wet form may respond to laser procedures and medication injections, if diagnosed and treated early.
Symptoms and Diagnosis of AMD
In its early stages, the following signs of macular degeneration can go unnoticed.
Gradual loss of ability to see objects clearly.
Shape of objects appears distorted.
Straight lines look wavy or crooked.
Loss of clear color vision.
A dark or empty area in the center of vision.
If you experience any of the above signs or symptoms, contact your doctor of optometry immediately for a comprehensive eye examination. Your optometrist will perform a variety of tests to determine if you have macular degeneration or any other eye health problems.
Central vision that is lost to macular degeneration cannot be restored. However, low-vision devices, such as telescopic and microscopic lenses, can maximize existing vision.
Treatment of AMD
With “dry” macular degeneration, the tissue of the macula gradually becomes thin and stops working properly. There is no cure for dry AMD, and any loss in central vision cannot be restored.
Less common, “wet” macular degeneration occurs when fluids leak from newly formed blood vessels under the macula. This leakage blurs central vision. Vision loss can be rapid and severe.
If detected early, wet AMD can be treated with laser treatment, which is often called photocoagulation. A highly focused beam of light seals the leaking blood vessels that are damaging the macula. Or in photodynamic therapy (PDT), a medication is injected into the bloodstream, which is then activated by shining a laser into the eye. Medication can also be injected into the back of the eye to slow the growth of leaky blood vessels. None of these are permanent cures, but they can help minimize vision loss.
Researchers have linked eye-friendly nutrients such as lutein and zeaxanthin, vitamin C, vitamin E and zinc to reducing the risk of certain eye diseases, including macular degeneration. For more information on the importance of good nutrition and eye health, please see the diet and nutrition section.
Eye Exam Detects Golf-Ball-Size Brain Tumor and Saves 8-Year-Old’s Life
An eight-year-old Atlanta girl had such severe headaches that she awoke screaming in the night. A doctor prescribed migraine medication, but decided a comprehensive eye exam was in order. The girl’s mother believes that decision may have saved her daughter’s life.
The eye exam indicated there was swelling on the brain and that something might be pressing on the optic nerve tract. At the emergency room, imaging tests revealed a golf-ball-sized tumor. It wasn’t malignant, but treatment kept the girl in the hospital for a month. She has since recovered and is now attending second grade.
In an interview with WSB-TV Atlanta, optometric physician Kristin Bender said that simple school vision screenings don’t catch potential health problems.
American Optometric Association (AOA) President Andrea P. Thau, O.D., agrees. In an interview with Care2, she said while tumors of that type aren’t common, they can be life threatening. As the tumor grows, it squeezes and presses on the brain and can cause stroke or other loss of function.
“The eye is an extension of the brain,” said Thau. “We’re able to pick up on problems by the appearance of nerves, pupil responses, and eye tracking. I’ve picked up on brain tumors and aneurysms in my practice. Most of the time, people only have mild symptoms when they come in for an exam, without realizing something significant is going on. A comprehensive eye exam can save or change someone’s life.”
Thau said she once detected a pituitary tumor based on her patient’s vision. She said there are many other neurological and health problems that can be detected during a comprehensive eye exam, including multiple sclerosis (MS).
Safety, quality of internet-purchased glasses subpar, study says
Choosing convenience over quality sets consumers up for a letdown when purchasing glasses online, not only in terms of product satisfaction, but also in overall safety of such generic eyewear.
Glasses enhance the visual information sent to our brains. It makes perfect sense that these devices must be perfectly fit and properly selected.
Caveat emptor, the Latin phrase for “let the buyer beware,” means the onus is on consumers to make informed decisions about their glasses. However, when online deals or vogue makers take precedence as purchasing deciders, consumers can become myopic to the real issue at hand: seeing clearly. A new study illustrates the consequences.
Released in a pre-print edition of October’s Optometry and Vision Science, a University of Bradford (United Kingdom) study determined eye glasses purchased online were more likely to be deemed unsafe or unacceptable due to poor frame fit, appearance or inaccurate, one-size-fits-all measurements than glasses purchased at a brick-and-mortar eye care practice.
This is particularly important to note, as the provision of bifocals or progressive-addition lenses require careful fitting according to current standards, and inaccurate measurements could heighten accident or fall risk in elderly patients.
The study enlisted three groups of participants—single vision, low prescription; single vision, high prescription; and presbyopes—to purchase glasses off a list of the top-10 online glasses retailers in the UK, as well as from regional eye care practices. Participants wore the glasses over a 2- to 3-day period and ranked them accordingly. Researchers found significantly more online-purchased glasses (30 percent) were determined to be unacceptable by participants than practice-purchased glasses, and 78 percent of those perceived as unsafe came from online suppliers.
Of the 308 pairs of glasses purchased overall, 58 (43 online/15 practice) were deemed unacceptable. Why were online-purchased glasses deemed unacceptable?
15 were due to fit/appearance
11 were due to optical centration distance outside tolerance
10 were due to poor fit causing symptoms
6 were due to fitting heights outside tolerance
4 were due to refractive correction outside international standards
2 were due to vertical prism
“Participants preferred practice spectacles, ranking them higher on average than those bought online, and 79 (percent) stated that they would purchase their next pair of spectacles from optometry/optician practices,” the study notes.
Buying glasses online may be no bargain
Online glasses retailers play to consumers’ sense of convenience, often likening the shopping experience to any other online retailer. Yet selecting glasses isn’t the same as buying a new accessory. Eyeglasses must be custom-fit, not only to comfortably suit a patient’s unique face, but also to meet his or her individual prescriptive needs.
Our eyes are a direct extension of our brains. In fact, scientists estimate 60 percent of the brain is used for visual processing. That’s why it makes perfect sense that the devices used to regulate this visual information must be perfectly fit and properly selected, says Andrew Morgenstern, O.D., clinical consultant to the AOA.
“If you view glasses this way then it seems quite silly buying them online without being properly fit or selected,” Dr. Morgenstern says.
“It is critically important for patients to see their doctors of optometry, have a complete and comprehensive, dilated eye examination, and be completely informed about the nuances of proper spectacle fit, measurement and materials before purchasing these devices that are responsible for the most critical information input into our brains.”
Patient education is paramount, which is why the AOA continues to generate public awareness about the pitfalls of purchasing such individualized products online—and doctors can, too. AOA members can access complimentary patient education brochures online to better inform their patients and community. These “Let the Buyer Beware” brochures provide a word of warning with statistics from an AOA study that reinforces the snares of online orders.
Click here to see the AOA’s public awareness campaign regarding purchasing glasses online.
Mac Krause, an 11-year-old defender, recently took an elbow to the head in a championship game and crumpled to the ground. “It looked to be on purpose,” said his father, Michael Krause of Maplewood, N.J. The boy was carried off the field and out of commission for six weeks with a concussion.
Youth soccer participation has surged in the past 25 years, and so has the risk of getting hurt while playing it. A new study of children’s soccer injuries released Monday in the journal Pediatrics found soaring rates of concussions, broken bones, lacerations, torn tendons and ankle sprains since 1990.
Part of the rise can be explained by increased awareness of concussion risks and higher reporting of head injuries, a trend that is common in most youth sports. But the data show that injuries like fractures, lacerations and sprains are also on the rise. That suggests that as more kids play soccer year round and the game gets more competitive, a child’s risk for injury has also increased.
“They’re just playing a lot more than they ever did before and in some cases more intensely than they ever did before,” said Tracy Mehan, manager of translational research in the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio, where the study was conducted. “All those things will contribute to the increase in injuries.”
For every 10,000 children who played soccer in 2014, 223 of them sustained an injury serious enough to be treated in a hospital emergency room. That represents a 74 percent increase from 2004, when the injury rate was 128.5 injuries per 10,000 kids. Clearly, some of that rise results from more parents taking children to hospitals to be checked for concussions. But when the researchers removed head injuries from the data, they found that injuries still increased by 60 percent, to 191 per 10,000 kids in 2014, up from 119 in 2004.
The data, from the National Electronic Injury Surveillance system and the National Sporting Goods Association, included children ages 7 to 17 who played soccer and had injuries that led to treatment at an emergency room between 1990 and 2014. The research is the first to evaluate soccer-related injury rates in such a wide age group over an extensive period of time.
The most common injuries sustained by players were strains and sprains, followed by broken bones and soft tissue injuries. The data includes only hospital emergency room visits and does not count visits to clinics, care centers and injuries treated at home, so the actual number of injuries is higher.
“Probably half of my patients are seen at an urgent care center first and the other half are seen at the emergency department before they see me,” said Dr. Daniel Green, a pediatric orthopedic surgeon at Hospital for Special Surgery in Manhattan, who said he has seen an increasing number of soccer-related injuries in children over the years, particularly anterior cruciate ligament (ACL) tears.
In 2014, more than three million players were registered in U.S. Youth Soccer — which is up nearly 90 percent from 1990 — and high school soccer participation has more than doubled in that time frame.
While there is no way to know exactly why soccer appears to be getting more dangerous, parents and coaches share anecdotal reports of children being encouraged to play more aggressively and less-experienced referees who are hesitant to call fouls and eject players from the game.
Brian Hafter, of San Bruno, Calif., who has been coaching and refereeing girls’ youth soccer leagues for eight years, said he has noticed a substantial difference in the way kids play soccer now compared with how he and his sister grew up playing it.
“There’s no question that nowadays the players are much more physical, challenging for the ball, and as a result, can put themselves and their opponents in situations that can lead to more serious injuries,” he said.
Dr. Daryl Osbahr, who is the chief medical officer of the Orlando City Soccer Club and a consultant for U.S. Soccer, confirmed that the sport is causing more injuries.
“We have younger athletes playing sports over the course of the year at a higher level, and those factors will result in increased injuries,” he said. He also noted that overuse injuries are common now because more children are specializing in one sport.
Mr. Krause, whose son took the elbow to the head, said some youth soccer teams have reputations for being more aggressive and more likely to jostle and foul, but even after complaining to officials, there’s little that can be done to curb the behavior. “When you get to a certain level of soccer, you start to see that,” he said. “I know one kid ending up breaking his leg in the tournament. It’s horrible.”
Dr. Green, the pediatric orthopedist, said his own study of ACL injuries in New York State showed that in the past 20 years, there is a threefold increase in the rate of surgery for childhood sports injuries. One reason for the rise may be that soccer has become a more competitive sport and a path to college for talented athletes. As a result, more kids are playing on both school and club teams, as well as attending college soccer camps.
“They’re going to become more aggressive the more opportunities they have to train and play competitively,” Dr. Green said.
Liz Masterson, head women’s soccer coach at Rochester Institute of Technology in New York, has noticed the same evolution at the college level. “I definitely think the game has changed. As players are getting more competitive and they’re able to play with more force, there’s a greater risk for injury,” she said.
Athletes today may also be getting away with bending the rules, which can lead to dangerous plays, said Dawn Comstock, a professor of epidemiology at the University of Colorado, Denver, who has also found a rise in the rate of concussions among youth soccer players in her research.
“If you watch the World Cup game from 20 years ago versus the last World Cup, it does appear that the governing bodies of soccer have allowed the game to become more physical over time in a way that increases the risk of concussion,” she said.
“If the vast majority of athlete-to-athlete contact were restricted according to the rules of the game, we’d have less concussion as well as fewer other injuries.”