
Cricket. It’s inextricably linked to the antipodean summer… the sound of bat on ball, the sporadic cries of ‘howzat’, and the soothing drone of the commentary on the radio.
Every weekend on ovals across Australia and New Zealand, you’ll see men, women, and children taking their places around the pitch. Many of them will be clothed in long sleeves, wearing broad-brimmed hats, and slathered in zinc – testament to the success of the ‘slip, slop, slap’ message that has so permeated the collective consciousness.
But what of their eyes?
According to estimates from the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), by the time they reach their mid-teens, 80% of Australian children will have UV damage to their eyes, increasing their risk of developing serious eye diseases later in life.1
It’s something that has long troubled Sydney ophthalmologist Dr Shanel Sharma. With a special interest in paediatric ophthalmology, each summer she sees “more and more children presenting with red eyes akin to sunburns for the eyes”.
“So many of the diseases we treat in adulthood are UV-related eye diseases, wouldn’t it be amazing to truly reduce the rates of developing these diseases?”
This desire to protect children’s eyesight has led, in a roundabout way, to Dr Sharma’s latest passion project – assessing and protecting the eyes of Australia’s elite cricketers.
“As you know, I’m passionate about UV eye protection and I am working with Cricket New South Wales to try to get all cricket players protected when they’re spending time in the sun,” Dr Sharma told mivision.
“What better way to reduce the burden of UVrelated eye disease than protecting those who are out in the sun playing cricket for hours? That’s how this started. Doctors working with Cricket NSW and Cricket Australia are very proactive about UV-related skin damage because of the higher rates of melanoma in cricketers than the general population. They’ve had a very successful skin screening program, which has been running for many years, and they’re big on UV protection for skin.
“Well, my question was, ‘What about UV eye protection?’”
Challenged in return as to whether UV eye damage was even a problem among the cricketing elite, Dr Sharma was determined to find out.
MAMMOTH SCREENING OPERATION
With just a couple of weeks’ notice, Dr Sharma organised a mass screening day for Cricket NSW, providing comprehensive eye examinations to 41 of their contracted cricketers.
The screening was performed at Cricket NSW’s facility at Homebush, in Sydney’s west, with equipment and personnel donated for the day by equipment companies ZEISS, Optos, Optimed, and Eyetek. A team of 12 ophthalmic personnel was supported by the teams from both Cricket NSW and Cricket Australia.
As well as eye screening, routine skin screening was performed by dermatologists.
“The inspiration was purely to see what was going on,” Dr Sharma explained.
And it was more than UV damage that they were looking for.
“It is known that the high lux of outdoor light is protective against the development and progression of myopia. We expected that cricketers would have shorter axial lengths because they’ve spent so much time playing outdoors. To become professional players, they have been playing outdoors throughout their childhood.
“At the same time, we wanted to check their retinas, do their refractions, check the cornea, ocular surface looking for pingueculae and pterygium, and assess for signs of dry eye. We used the Canfield camera, which allows UV fluorescence photography of the skin.
“So that was the aim, to look for UV diseases and other diseases, but also expecting to find reduced myopic association.”
The results, Dr Sharma said, were both surprising and entirely predictable.
Despite spending more lengthy periods of time outdoors, on average, “we were surprised that a number of players were myopic, with higher-than-average axial lengths, which was not expected”.
“There were a few other things that were quite surprising,” Dr Sharma told mivision.
“We found ocular pathology that we had not anticipated. Going into this we expected young, healthy, fit people, who pretty much were selected for good vision, to have good visual acuities, normal corneas, normal retinal exams.
“But we found some very unexpected pathology. We found a patient to have FEVR, which is familial exudative vitreoretinopathy. We found a patient with progressive posterior keratoconus.
“A number of them had reduced monocular vision, but also a couple had reduced binocular vision. One player was wearing orthokeratology lenses and admitted he was having trouble with seeing the ball during the evening portion of the day-night games. So that was not expected.
“And then, of course, we expected large amounts of UV-related eye disease, which is what we saw.”
A NEW EMPHASIS ON VISION
While there are plans to repeat the screening, and roll out to other locations, the expensive and specialised equipment involved makes it logistically challenging. In short, the will is there, but the way is still to be sorted.
However, Dr Sharma said by identifying pathology that could threaten or compromise the vision of players, the results of the first testing day have put eyes on the agenda for both Cricket NSW and Cricket Australia.
“Eye screening hasn’t been a classic part of what (professional) cricket does for health… everybody understands that you have to have good vision, but I think that it’s an assumed prerequisite.”
There’s also a realisation that vision should be considered as a factor when player performance unexpectedly declines, she said.
“Cricketing doctors have been talking about how players will reach a certain level and then sometimes stop performing as well. They would consider whether it’s a mental health issue, or a muscle issue, but maybe for some of these players, it might be a vision issue. Perhaps they did have good vision, that’s how they got selected, but now their vision has dropped off.
“A number of players mentioned that they had seen optometrists, which is fantastic, but if someone comes in for a general eye check, they probably wouldn’t do the degree of screening we did. We did it knowing that they’re professional athletes and we wanted to look at all the components of vision and eye health from a professional athlete point of view as well.”
PARTNERSHIP WITH DERMATOLOGY
Dr Sharma believes the way forward is collaboration with other health disciplines.
“With regards to cricket, the benefit of working with dermatology and our sports physician colleagues is essential, not least because of the association between pterygium and malignant melanoma.”
A 2017 study out of the Lions Eye Institute, co-authored by Professor David Mackey, found a person with a pterygium on the eye is 24% more likely to develop malignant melanoma of the skin.2
“I’m working with our dermatology colleagues and sports physician colleagues as I actually think that is the way forward – we need to reach out to our colleagues in the other areas of health collaboratively, so that our messaging is heard and the eyes are not forgotten, despite the awareness around UV radiation and the damage it causes,” Dr Sharma said.
Brisbane dermatologist Dr Leona Yip is currently the Lead Dermatologist for Queensland Cricket, and Head Dermatologist of a national panel of dermatologists looking after elite athletes for Cricket Australia.
“Cricket is a tricky sport because, depending on the positions in the field that the players have to be in, they can’t necessarily wear sunglasses to protect the eyes. And in many of them in certain positions they can’t wear hats to protect themselves. They’ve got to wear protective helmets,” Dr Yip told mivision.
“So, sun damage is actually a real risk for cricketers and that’s why the eye screening and the skin screening is important; prevention may not always be possible.”
GETTING THE MESSAGE TO COMMUNITY SPORT
Dr Yip agreed on the need for multidisciplinary collaboration to protect players at the elite level but implored the optometric and ophthalmic community to ensure consistency in messaging filtered through to the community level. “With optometrists, ophthalmologists or any other eye screening program… if you detect pterygium, let your patient know to see the GP to get a dermatologist referral, or the GP can do a skin check. It’s that opportunity for counselling about sun protection.
“Skin cancers and sun damage; it’s just such an epidemic in Australia. And I always say… sun protection is not a choice for Australians. It’s our lifestyle. You just have to do it whether you like it or not, because it is an occupational risk, it’s a recreational risk.”
With the ‘slip, slop, slap’ campaign’s success in highlighting the dangers of sun exposure for skin, Dr Sharma hopes the same can be done for eyes.
And she hopes the collaboration with professional cricketing authorities can be another step towards raising community consciousness about the need for UV eye protection.
“The message got out that skin protection needed to be done and was a problem; that the diseases happen later on in life, but the exposure happens young.
“It is my belief that we need to change the trajectory of eye health. And yes, we are very good at treating these diseases – cataract, skin cancers, etc. But if we can reduce them, we can make a real difference to the future eye health of our community.
“I think that cricket is an ideal sport to test that. And this is where the collaboration with cricket and cricket doctors has started, because they also think that cricket is the ideal sport – their players are outdoors, they start young, and it’s part of the Australian culture.
References
- Royal Australian and New Zealand College of Ophthalmologists, Protect children’s eyes from sun damage – doctors warn (media release, 26 Jan 2024), available at: ranzco.edu/wp-content/uploads/2024/02/Media- Release-Protect-childrens-eyes-from-sun-damage-2025.pdf [accessed July 2024].
- Crewe JM, Threlfall T, Clark A, et al. Pterygia are indicators of an increased risk of developing cutaneous melanomas. British Journal of Ophthalmology 2018;102:496-501.
Images courtesy of Eyetek.
Perfectly Clear Now
While he knew he was myopic, he was unaware of any other problems, and the range of options available to him to improve his vision.
“They found that there was a little bit of damage from excess time in the sun, which is to be expected since I play cricket a lot. But the main thing she (Dr Shanel Sharma) told me was to try and wear sunglasses more when I play cricket, because it’s pretty damaging for the eye to be exposed to naked sun for extended periods of time.”
As a myope, Verma wore glasses off field, and at first wore disposable contact lenses while playing.
“I was playing a game of cricket, and I was batting, and my left disposable contact lens fell out, so I had to bat with one eye closed. Otherwise, it was just way too blurry to pick up from one eye to the other.”
Switching to wearing orthokeratology (OK) lenses got rid of that problem but created new ones.
“With OK, my vision tended to get worse as the day went on. So especially playing at night, I struggled quite a bit because if I had a nap in the daytime for example, then I’d wake up and my vision would be significantly worse than when I woke up in the morning.
“And on top of that, there’s always that risk of infection when you wear contacts.”
While laser surgery was always something in the back of his mind, Verma thought he was too young and was delighted when Dr Sharma suggested he would be a good surgical candidate.
He was referred to Dr Daya Sharma, from Eye and Laser Surgeons in Sydney, who perfomed SmartSight, a type of refractive lenticule extraction, earlier this year.
“I’m picking the ball up a lot easier, and it’s all a lot clearer as well… before it would take me an extra few seconds just to pick up where the ball is, because seeing things further away was pretty tough for me.
“But ever since having the surgery, I feel like I can pick it up almost instantly.
He said it took about a week to adjust after the surgery. “It actually took me a while to get used to seeing things so clearly, but once I got the hang of it, after that it was really good.”
“It’s unbelievable… it’s perfectly clear and I didn’t know I could see this good until I got laser. It’s been really, really good. And the best part is it doesn’t diminish as the day goes on, it stays clear 24/7. So I’m really, really happy with that.”
CHANGED HABITS
Importantly, Verma has taken on board the warnings about protecting his eyes from further UV damage.
When mivision spoke to him, he had just returned from intensive training sessions in India, in preparation for his upcoming season for Blacktown Cricket Club.
“Anytime I’m in the field, I tend to wear sunglasses now, especially this last two months training in India, it was extremely hot over there, so it came pretty naturally to me.
“But definitely wearing sunglasses more often in the cricketing field is something I’ll be taking forward into my games.”