EW IN OTHER NEWS
98
August 2017
refractive surgery seems to vary by
sport, from Dr. Toyos' perspective.
For example, he's had some bas-
ketball players who, even though
they're seeing 20/50, refuse to wear
goggles or contact lenses, let alone
consider a low-risk surgery that
could greatly improve their eyesight.
Those who are amenable to LASIK
require more hand-holding.
Baseball players, on the other
hand, seem far more likely to opt
concussions.
3,4
Dr. Hersh said that
in professional football, the team
internist and neurologist take the
lead in concussion evaluation. Team
ophthalmologists, he said, are also
responsible for determining ocular
conditions requiring specialized
equipment such as tinted helmet
visors.
Then there's the aspect of refrac-
tive surgery. An athlete's interest in
for LASIK, according to Dr. Toyos,
who has worked with the AAA major
league St. Louis Cardinals and minor
league Memphis Redbirds.
"The difference between a major
league baseball player and a minor
league player is razor thin. If they
can get an advantage doing any-
thing, they're going to do it," he
said.
Dr. Hersh has treated many
professional basketball and football
players and advises those who are
candidates for refractive surgery
to wait until the off-season for the
procedure. He also considers the ath-
lete's field position in the discussion
of refractive surgery.
"There is always the question
with refractive surgery of what are
the benefits going to be and what
position do they play; depending on
position, there are different toler-
ances of vision, whether they're a
wide receiver, who you would expect
would require the best vision, or a
lineman, who might require less.
You want to select the candidates
properly but also treat them so they
are ready for the season," Dr. Hersh
said.
In the proper candidates, Dr.
Hersh recommends LASIK over PRK
because he finds it more accurate in
his hands and easier to retreat. As
for flap dislocation, he's only seen
this occur in very severe accidents.
While a team ophthalmologist
might be on hand for every home
game, depending on the sport, and
on-call for others, Dr. Toyos said
he only sees an ocular injury one
out of every five games, on average.
Dr. Hersh said he'll treat an ocular
injury with the Jets once or twice a
season, and often a day or so after
game day.
Team ophthalmologists don't
just treat the players. If there's an
injury in a fan or other staff mem-
ber during a game or practice, the
physician might be called in to look
at that person, Dr. Toyos said.
"My advice for anyone who is
close to the action is … you've got
to be as aware as the players because
you never know what's going to
come at you," he said.
As a perk, the team and staff
send many of their family members
your way, but one of the drawbacks
to being a team ophthalmologist,
Dr. Toyos pointed out, is higher
malpractice premiums.
In the end, whether you're a
team ophthalmologist or treating
professional athletes as part of your
everyday patient base, Dr. Hersh said
you've got to remember "they're
regular people and regular patients."
"The key when doing surgery
is to make sure they're routine;
don't do anything different because
they're a professional athlete. Set
proper expectations. You don't want
to overpromise, and you want to set
the tempo of improvement so that
they have plenty of time to adapt
and get used to the vision and to
any minor fluctuations that might
happen, as with any patient," Dr.
Hersh said. "Just like with a family
member, treat them like regular pa-
tients and do your standard routine.
But remember that professional ath-
letes are smart, aggressive, at the top
of their field, and they want to get
things done quickly and done well.
During pre-season physicals, they
compete to have the best vision of
anyone on the team, so even there
you can see what makes them tick as
pros." EW
References
1. Kalberer D, et al. Peripheral awareness and
visual reaction time in professional football
players in the National Football League (NFL).
Optometry & Visual Performance. Article
accepted for publication.
2. NHL, NHLPA agree on mandatory visors.
www.nhl.com/news/nhl-nhlpa-agree-on-man-
datory-visors/c-672983. Accessed April 27,
2017.
3. Ventura RE, et al. The concussion toolbox:
The role of vision in the assessment of con-
cussion. Semin Neurol. 2015;35:599–606.
4. Pillai C, et al. Vision testing in the eval-
uation of concussion. Semin Ophthalmol.
2017;32:144–52.
Editor's note: Drs. Toyos and Hersh
have no financial interests related to
their comments.
Contact information
Hersh: phersh@vision-institute.com
Toyos: rostar80@gmail.com
Ophthalmologist continued from page 97
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