Key word
rugby - goggles - eye injury - spectacles - monocular - visual impairment
Introduction
Sport is a significant cause of eye injury. The proportion of new eye injuries
presenting to hospital that are sports-related range from 12.9% [1] to 40% [2].
Also, when they arise, sports-related eye injuries are often serious. In the UK, for
example, 12.5% to 25–40% of sports-related eye injuries are
severe enough to require hospital admittance [3]
[4]. Furthermore, 11% of cases of presenting
to hospital with sport-related eye injury cause permanent visual disability [1] and in the USA, sport may account for almost
one-third of eye injuries that lead to blindness [5].
Cass [6] suggests that ~90% of all
sports-related eye injuries can be prevented with adequate eye protection, a view
shared by several other authors [4]
[5]
[6]
[7]. Protective eyewear is now available for a large
range of sports [8] and is mandatory in several sports
(e. g., ice hockey [1]). There is evidence
that the increased use of protective eyewear has reduced the incidence of eye
injuries in certain sports (e. g., field hockey [9], ice-hockey [10], and squash [11]).
The need for optical correction of refractive errors of the eye is common, with over
50% of the adult population in Europe [12],
and 32% children [13] requiring refractive
correction by spectacles or contact lenses in order to see clearly.
Rugby Union is played in 121 countries with ~8.5 million players worldwide
[14]. In many sports, there is a safety risk from
wearing spectacles in terms of breakage and injury from the spectacles (both for the
wearer and other players), and in Rugby Union, spectacles are not permitted under
World Rugby Laws 4.5c [15]. This impacts those who
cannot wear contact lenses, have an increased risk of potential for ocular damage
(e. g., history of retinal detachment, post-LASIK surgery), have a visual
impairment, or are blind in one eye (e. g., amblyopia, past injury) and who
do not wish to risk the sight of their remaining eye. Individuals with uniocular
visual impairment are particularly encouraged to wear eye protection when
participating in high-risk sports [16].
Recognizing that certain individuals would not be able to play the game because of
the lack of suitable eyewear, World Rugby, the global governing body for the laws
of
Rugby Union, teamed up with a manufacturer to produce goggles suitable for use while
playing rugby [17]. The primary aim of introducing the
goggles was to enable corrective lenses to be worn on the field by those unable to
wear contact lenses, as opposed to developing protective equipment. The first
version of these goggles (Rugby Goggles 1.0) was piloted in 2013. In 2017, an
updated version was produced (Rugby Goggles 2.0). Before deciding whether the
goggles could be added to the laws of the game, World Rugby commissioned a trial to
assess the performance and suitability for play of the goggles from the
wearer’s perspective. The present study reports the results from this trial
(full report available [18]). [Fig. 1] is a photograph of the rugby goggle worn
during an international match.
Fig. 1 Rugby Goggles worn during international match play by Ian
McKinley. Italy vs. Ireland; August 10, 2019. Photograph credit: Federazione
Italiana Rugby.
Materials and Methods
Unlike the first version, Rugby Goggles 2.0 is made available in two sizes, with a
new smaller size goggle being produced. The study was conducted in accordance with
international ethical standards for sport and exercise science research [19], received ethical approval from the University
Research Ethics Committee, and started in August 2017.
Participants who had purchased Rugby Goggles 1.0 were invited to take part in the
trial of Rugby Goggles 2.0. They are referred to as Category A participants and they
were offered the Rugby Goggles 2.0 free of charge between August 2017 and January
2018.
Participants who had previously expressed an interest in, but who did not purchase,
the goggles previously were invited to purchase the Rugby Goggles 2.0 directly from
the manufacturer (Raleri) and to take part in this trial. World Rugby issued a press
release and tweets to raise awareness of the trial. Any individual affiliated with
a
Union participating in the trial was permitted to sign up via the World Rugby
website and to purchase Rugby Goggles 2.0 directly from Raleri. Participants who
received goggles for the first time are referred to as Category B participants.
All trial participants received a unique purchase code from World Rugby, which
anonymised the data they provided while ensuring the authenticity of the responses
because only those who had received Rugby Goggles 2.0 were eligible to provide
feedback.
An online questionnaire (available as supplementary material) was developed to
request detailed information on participants’ experiences of using Rugby
Goggles 2.0. The questionnaire contained 75 items relating to goggles wear including
getting used to the goggles, comfort, fit, field of vision, fogging, dirtying,
suitability in different weather conditions, ease of cleaning, scratching, strap
performance, foam performance, and use of the prescription insert. Items were
answered through a checklist of options, a five-point Likert scale, and free text
responses. The questionnaire also asked about any injuries that took place to the
wearer or another player as a result of wearing the goggles.
The questionnaire was available from June to September 2018. In the case of children,
a parent or guardian was permitted to complete the questionnaire. The online
questionnaire was made available to participants in four languages: English, French,
Spanish, and Italian.
Results
Questionnaire response rate
Of the 387 people who received a pair of Rugby Goggles 2.0 in the time frame of
the study, questionnaire data were obtained from 188 (49%) participants,
hereafter called the ‘respondents’. Of the 188 respondents, 129
(69%) were category A participants and 31% were category B
participants.
Comparing the profile of participants who signed up for the trial but who did not
complete the questionnaire to those that did, the respondents were
representative of the overall cohort of individuals in terms of age, gender, and
level of rugby played (one-way ANOVA, all p>0.05).
Twenty-three Rugby Unions took part in the trial. The Federazione Italiana Rugby
and the Irish Rugby Football Union had the most respondents (n=34
[18.1%] and 33 [17.6%] respondents, respectively), followed by
the Fédération Française de Rugby (n=23
[15%]), the USA Rugby Football Union (n=15 [8%]), and
the Welsh Rugby Union (n=14 [7.4%]).
Characteristics of respondents and pattern of goggle wear
[Table 1] summarizes the characteristics of
respondents and aspects of goggles wear. The most commonly reported age range
for respondents was under 14 years (45%), and 68% of respondents
were under the age of 18 years. Of the 188 responses, 11 were female
(6%).
Table 1 Characteristics of respondents and reasons and
duration of Rugby Goggle wear.
|
Response Categories
|
Number (%)
|
|
Age
|
Under 14 years
|
84 (44.7%)
|
|
14–18 years
|
43 (22.9%)
|
|
19–23 years
|
9 (4.8%)
|
|
24–30 years
|
20 (10.6%)
|
|
31–40 years
|
18 (9.6%)
|
|
41–50 years
|
10(5.3%)
|
|
50+years
|
4 (2.1%)
|
|
Gender
|
Male
|
177 (94.1%)
|
|
Female
|
11 (5.9%)
|
|
Reasons for wearing goggles (primary choice)
|
- Normally need to wear glasses or contact lenses to correct
your vision (e. g., for long- or
short-sightedness);
|
132 (70.2%)
|
|
- Limited useful vision in one eye (i. e., due to
accident or disease);
|
28 (14.9%)
|
|
- Unable to wear contact lenses;
|
8 (4.3%)
|
|
- Concerned about the risk of injury;
|
7 (3.7%)
|
|
- Other reasons
|
13 (6.9%)
|
|
Level of rugby played
|
Elite
|
5 (2.7%)
|
|
Sub-elite
|
12 (6.4%)
|
|
Community (adult)
|
44 (23.4%)
|
|
Under-age
|
122 (64.9%)
|
|
Non-contact under-age
|
4 (2.1%)
|
|
Tag and Touch
|
1 (0.5%)
|
|
Goggle size chosen
|
Regular
|
154 (82%)
|
|
Small
|
34 (18%)
|
|
Length of time wearing goggles
|
2–6 months
|
(83%)
|
|
6 months +
|
(16%)
|
|
Number of games/training sessions played with
goggles
|
1–4 sessions
|
10 (5.3%)
|
|
5–10 sessions
|
15 (8.0%)
|
|
11–20 sessions
|
23 (12.3%)
|
|
20+sessions
|
115 (61.5%)
|
|
Other
|
24 (12.8%)
|
|
How many games/training sessions did it take to get
used to goggles
|
1–2 sessions
|
56 (41.2%)
|
|
3–6 sessions
|
61 (44.9%)
|
|
7–10 sessions
|
10 (7.4%)
|
|
11–15 sessions
|
4 (2.9%)
|
|
15+sessions
|
5 (3.7%)
|
|
Are respondents used to wearing goggles
|
Yes
|
73%
|
|
No
|
8%
|
|
Partially
|
19%
|
Respondents were asked about their reason(s) for wearing the goggles. The
majority of respondents reported that they wear the goggles because they
normally need to wear glasses or contact lenses to correct their vision
(70%). Limited useful vision in one eye was indicated by 15% as
the primary reason for wearing the goggles, and an additional eight
(4.3%) respondents chose this as a secondary option. Concern about the
risk of injury was given as a primary reason by 7 respondents (4%), and
an additional 15 (8.0%) chose this as a secondary option. Thirteen
respondents (7%) reported ‘other’ reasons, which
included ocular disease (e. g., corneal disease), previous injury to eye
(e. g., retinal detachment and wear of a prosthetic eye).
The majority of respondents reported that they played non-contact, under-age
rugby (65%), followed by community adult rugby (23%). The larger
goggles were selected by 82% of respondents and only 18% the
small goggles. Of those under 14, 76% chose the larger goggle size.
The majority (61%) of participants reported having worn the goggles in at
least 20 games or training sessions.
Injuries
Respondents were asked about injuries that had occurred as a result of goggles
wear. Although we cannot be certain that the injuries would not have arisen in
the absence of the goggles, our assumption is that they were caused by goggles
wear. Of the five injuries reported (3% of respondents), four were to
the person wearing the goggles and one was to an opponent. The body areas
injured were: cheekbones, nose, above the nose between the eyebrows, and eye.
Injuries mostly consisted of bruising and cutting of the skin on or near the
nose. Medical assistance was required on the pitch in two cases and in hospital
in one case. Those who reported injury were male and were represented across the
age ranges.
In only one case was poor visibility through the goggles mentioned as a possible
cause. The description of the injuries appeared to indicate that they had
resulted from the goggles pressing onto the face following a tackle. Problems
with the foam (i. e., becoming detached, not absorbing the impact) were
mentioned in three out of five cases of injury. Despite the injuries, there were
no cases where the injured players decided to stop playing rugby altogether or
to continue playing rugby without the goggles.
Adjusting to the goggles
For the 27% of respondents (n=51) who reported they had not fully
adjusted to the goggles, ([Table 1]), the main
reasons given were the limited vision due to fogging of the goggles and the
limited field of view. Of these respondents, 30 (59%) felt that they
would adjust in time, but 15 (29%) reported that they had stopped
wearing the goggles. Thus 15 of 188 (8%) ‘failed’ with
the goggles to the point that they gave up wearing them because they were not
able to get used to playing in them.
Fogging, dirt, and weather
Three important areas are highlighted in [Fig. 2].
They concern the goggles fogging, getting dirty, and being unsuitable for all
weather conditions. For these three statements, the majority of respondents had
a negative or neutral response, indicating that problems were noted in relation
to these issues. In particular, respondents reported dissatisfaction with the
fogging of the goggles (49.7%) and their suitability for all weather
conditions (34.7% negative). In terms of getting dirty, 32.6%
saw this is an issue.
Fig. 2 Responses to statements regarding the goggles’
fogging, getting dirty, and their suitability in all weather conditions.
(n=187).
A follow-up question was asked regarding the issue of fogging, with n=149
respondents. The majority consider fogging of the goggles to be a significant
issue, with 63.8% responding negatively or neutrally. Some reported they
could not use the goggles when they were fogged and the fog that forms in
between the outer screen and the optical insert is difficult to clear.
Respondents noted, in particular, that fogging happens in cold and or humid
weather conditions and owing to perspiration.
Prescription insert
A total of 73% (n=137) of respondents reported wearing the
goggles with the optical insert. The majority (81%) reported that it was
“easy” or “very easy” to have the insert glazed.
Those who raised concerns mentioned that it was difficult to find an optician
who could prepare the insert. Others reported they had difficulty fitting or
removing the insert due to the ‘delicate attachment mechanism’,
and that the insert is easily dislodged from its position. When respondents were
asked whether the optical insert had ever become dislodged while wearing the
goggles during play, 14% (n=19 of 137) reported that it had. A
total of 32% of respondents reported problems with the insert mainly due
to fogging issues between the outer screen and the insert.
The strap and foam padding
The vast majority (87%, n=160) of respondents did not report any
problems with the strap. Of those who did (13%, n=23), comments
included that the grip and fit were compromised especially from sweat and dirt
adhering to the strap. A substantial proportion (40%, n=73) of
respondents reported problems with the foam padding, in particular indicating
that the foam became detached and worn out, especially owing to rain and sweat.
In a number of instances, (n=19, 10%), they reported they had to
replace or re-glue the foam padding.
Stability of goggles on the face
While 68% (n=125) of respondents agreed that ‘the goggles
remain well placed, have not come off or been dislodged’, 23%
(n=42) reported that they had been dislodged during play, and in
9% of wearers (n=16), the goggles had come off altogether.
Respondents also noted that the goggles were slippery because of sweat and poor
strap performance, which contributed to them moving easily.
Scratching
Respondents were asked if the surface or insert of the goggles had become
scratched, and 48% respondents said that this was the case. The vast
majority of respondents reported that this occurred on the outside surface of
the lens and that it occurred during play. Comments from respondents confirmed
that the majority (80%) of scratches happened during play. However, some
also reported that the cleaning process and improper storage played a role as
well, as did the contact/friction between the insert and outer screen.
Overall performance of the goggles
[Fig. 3] shows that overall the majority of
respondents are satisfied with the performance of the goggles when it came to
comfort, fit, vision and the field of vision. In all cases, the majority of
respondents reported that they either “agreed” or
“strongly agreed” with the statements shown at the top of the
panels in [Fig. 3]. However, of note is that
field of vision was an issue for 16.0% of respondents and 10.7%
were not satisfied with their vision while wearing the goggles.
Fig. 3 Responses to statements regarding the comfort, fit, and
vision with the goggles. (n=187).
[Figure 4] summarizes a series of responses
relating to respondents’ overall satisfaction with the goggles, and
demonstrates mainly high levels of satisfaction. The majority of respondents
reported that the goggles allowed them to play rugby (91%), to see
(71%), and to feel safe (60%) playing rugby. A total of
87% of respondents ‘strongly agreed’ or
‘agreed’ that the goggles were beneficial and 75% were
happy with the performance of the goggles. Fifteen (8%) respondents
reported they had stopped wearing the goggles. When asked why, comments included
goggles fogging, limits to peripheral vision, and poor comfort/fit. Of
these 15 respondents, nine (66%) indicated that they
‘disagreed’ or ‘strongly disagreed’ with the
statement that they were ‘happy with the performance of the
goggles.’ Overall, only 1 in 10 respondents disagreed with the statement
‘I am happy with the performance of the goggles’.
Fig. 4 Responses to statements regarding participants’
satisfaction with the goggles. (n=187).
One of the final questions that respondents were asked was if they thought the
rugby goggles should be incorporated into the laws of the game. The vast
majority (93%, n=169) answered yes. Of those (7%,
n=12) who responded negatively to this question, none of them had
reported that they sustained an injury, and six wore the goggles with the ocular
insert. However, the majority (10 of the 12) had reported the goggles fogging up
was a big problem or unacceptable.
Discussion
For many sports, protective eyewear is available, but this was not the case for Rugby
Union. Recent efforts from World Rugby have developed a sports-specific rugby
goggle, and this report provides the only information on the wearers’
experiences. The response rate (49%), the duration of goggles wear, and the
detailed answers received represent a solid source of information to analyze the
performance of the rugby goggles from the wearers’ perspective.
There are a number of design issues with rugby goggles. These relate to fogging, foam
and strap performance, scratching, vision, and fit, and they should be addressed in
future design changes of the goggles to optimize performance and to reduce the risk
of injury. Although players acknowledged that these factors may be difficult to
address in future versions of the goggles, issues with fogging and the foam padding
performance, in particular, were commonly reported and appear to be the most
problematic of the issues they raised. In common with other performance
specifications for goggles/eyewear, the rugby goggles specification includes a
fogging test [20]. However, this test relates to the
lens alone and there is no satisfactory accepted test for a complete optical
appliance, i. e. the goggle. Better venting or increased anti-fogging
surface properties could help in this regard. The trial took place during the rugby
season in both hemispheres, but it is worth acknowledging that there were more
respondents from Northern hemisphere countries, and so potential fogging issues
could be different for rugby played at lower latitudes with differing humidity and
ambient temperatures.
Although the injuries reported in this study did not cause lasting effects, any
injury associated with the use of the goggles is a source of concern. A common
feature of the injuries reported was that the foam padding was not sufficient around
the nose to inhibit the edge of the visor of the goggle from contacting the
face/nose area. This highlights the importance of the foam/padding
issue for manufacturers in the future and respondents made several practical
suggestions including the need for better performing foam/rubberized padding
to withstand greater impact. Despite the primary purpose of the goggles being to
enable corrective lenses to be worn by those unable to wear contact lenses, rather
than for a protective purpose, the impact test cited in the performance
specification is not representative of the impacts generated in the sport of rugby,
and this could be reviewed to reduce injury risk.
Despite these problems, respondents were generally very positive about the goggles.
A
total of 91% of respondents stated that the goggles make it possible for
them to play rugby and 87% stated that they found the goggles beneficial. A
total of 75% were happy with the performance of the goggles. These positive
comments underline the value of this initiative by World Rugby to participants who
would otherwise be unable to play rugby. Indeed, the evidence from this trial
enabled the board of World Rugby to adopt their use into the Laws of the Game on
July 1, 2019.
A number of studies have examined the incidence, characteristics, and trends in rugby
injuries [21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30], but the data are sparse in relation to eye
injuries [31]
[32]
[33]. This is probably due to the fact that non-ocular
injuries are extremely common in rugby. A study by MacEwen [31] conducted in two eye casualty units in Glasgow, Scotland, over an
18-month period found that rugby was responsible for 9.8% of sports-related
eye injuries compared to 44.7% of injuries associated with soccer. A study
by Barr et al., [3] also conducted in Scotland,
reported no cases of eye injury attributable to rugby over a one-year period. A
study from Sussex Eye hospital in England reported 7% of sports-related
injuries to be due to rugby, compared with 24% for squash, 19%
soccer, 16% badminton, and 11% for tennis [34]. Conversely, Pandita & Merriman [35] followed cases of ocular trauma in an emergency department in New
Zealand and found rugby to be the most common cause of sport-related injury.
Differences in the proportion of eye injuries associated with rugby presumably
reflect the extent to which rugby is played in different countries.
Will the use of goggles in rugby reduce the risk of eye-injury? There are number of
reasons why the goggles are unlikely to have an impact on the incidence of eye
injuries in rugby. Firstly, the primary purpose of the goggles is to enable
corrective lenses to be worn on the field rather than being advocated by World Rugby
as protective equipment. The rationale for the introduction of rugby goggles was to
grow participation and develop the game without increasing the risks to any player.
This non-protective approach is similar to padded headgear and body padding which
are non-mandatory and are both restricted to protecting against cuts and abrasions
only. Secondly, serious eye injury appears to be quite rare in Rugby Union despite
the full-contact nature of the sport. Thus, given the relatively small proportion
of
players expected to wear the goggles, it is unlikely that it will be possible to
demonstrate any significant reduction in eye injures which results from the goggles
being worn now that their use has been incorporated into the laws of the game.
Because the need to correct vision with spectacles is common and contact lenses are
not worn by 80%+of spectacle wearers, [36] the new rugby goggles will widen participation for those who need to
wear refractive correction and for monocular individuals who cannot risk injury to
their remaining eye.
Based upon the results of the Rugby Goggles 2.0 trial, we conclude that goggles
represent a largely safe and effective item of equipment for those who, for whatever
reason, need eyewear to be able to participate in the sport of rugby.
