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May 10, 2021 – The real threats to your eyes

May 10, 2021 – The real threats to your eyes

The real threats to your eyes…

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Emailed to more than 42,000 ocean swimmers.


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I must go down to the seas again, to the lonely sea and the sky,
And all I ask is a thumping swell and a point to swim us by…

Look  below…

Tight goggles and the eye

The real threats to your eyes

The story in our last newsletter about a swimmer who suffered a detached retina (in the eye), which they suspected was caused by tight goggles, prompted us to seek out more information on a subject that's concerned us for many a yar. Tight gogs cause many problems, including making your gogs more prone to leak because the tightness breaks the seal. Tight gogs also increase pressure on the eye, according to a study by swimming optometrists in Perth 15 or so years back. So we went to ocean swimming opthalmologist and Maillot Jaune swimmer, Stuart Graham, to see what he could tell us…

Retinal detachment 400The potential for complications from wearing swimming goggles has recently been raised again with the recent experience of an ocean swimmer who developed a retinal detachment after swimming. I don’t have the full details of the case, but apparently the eye was red and painful after the swim, likely from ill-fitting goggles, and the detachment was diagnosed later. The question here is whether the two are definitely linked or are a co-incidence. I’ll give some background first on why this is a complex question.

Retinal detachments are painless and usually arise from a small tear or hole in the retina (the thin sensory membrane lining the back of the eye that contains all the rods and cones that detect light). They are far more common in people who are myopic (short-sighted) as the eyeball is relatively long and the peripheral retina gets thinner and more prone to breaks. If a hole or tear develops fluid can flow through it from the vitreous (the thicker gel-like fluid in the back part of the eye) and slowly lift the retina inwards off the outer wall – a retinal detachment. When it lifts that section of the retina, it cannot detect light and this will be apparent to the patient as a large black shadow in one sector initially, which can gradually move across the entire vision.

Floaters

However, as we age it is normal for the vitreous gel in the back of the eye to start to contract and liquefy (usually between 40-70 years), becoming more mobile, and to eventually separate from the retina, with some condensations and remnants moving around in the remaining saline-like solution that replaces it. These can give rise to shadows in the vision, which we call floaters. A young vitreous gel is about 25 per cent liquified while an old vitreous is close to 70 per cent. As a result of this process, many healthy normal people report seeing floaters, and they are often very apparent when you are swimming in a pool on a bright day when the contrast is high. Issues arise if the gel separates suddenly from the retina: the points where it was attached more firmly can give rise to flashes for a few weeks before settling down. If it is attached very firmly, though, a break can occur as it pulls free, causing a spontaneous retinal tear, some haemorrhage and potentially a detachment. There will usually be lots of flashes of light and floaters in this case. A sudden onset symptomatic vitreous detachment is associated with a retinal tear in about 10-15 per cent of cases – but the more floaters, the more likely there is a tear. Retinal tears can be sealed with laser, but if the retina is detaching it will usually need surgery with an intraocular gas tamponade to push the retina back into place, and laser or cryotherapy to stick it there.

A sudden strong blow to the eye can definitely cause a retinal tear – such as a punch, poke or eye gouge (eg NRL), or a squash ball or occy-strap injury. It is harder to see how prolonged slow pressure from tight goggles might cause a tear, and there do not seem to be reports of such association in the ophthalmic journals. Remember, people rub their eyes all the time and don’t cause themselves injury.

However, one could postulate that if the pressure on the eye was asymmetric and sufficient to precipitate the onset of a vitreous detachment process, this could then induce a tear in a pre-disposed eye – particularly a myopic eye. Not surprisingly, 10m platform and high springboard divers have a high incidence of retinal trauma – presumably as they hit the water with force. One of our Maillot Jaune swim colleagues put on his goggles, dived into the pool and immediately reported a large number of floaters – he was a myope and had induced a retinal tear on impact – this was lasered with good resolution and we also gave him instructions on his diving technique. Bungee jumping is a reported hazard for the eye as the sudden deceleration really stresses the ocular contents – it causes a lot of conjunctival and retinal haemorrhages but not as many retinal detachments as we might expect. Still, it is not generally recommended by eye specialists, particularly in highly myopic patients.

Retinal tear 300Intraocular

The other issue with tight swimming goggles which has been reported a few times in the literature is that of raising intraocular pressure. This has relevance to a condition called glaucoma. Glaucoma is a group of disorders that cause degeneration of the optic nerve with increasing blind spots and eventual blindness if untreated. It is more prevalent with increasing age. The most common cause is raised intraocular pressure, which seems to occur due to a failure of the internal drainage system inside the eye to drain away and recycle the intraocular fluid (called the aqueous humor). The eye needs some pressure (10-20mmHg) to maintain its shape and focus, and this fluid supplies nutrients to internal eye structures.

It was found that if you wear tight swimming goggles it puts the eye pressure up by a few points, presumably by compressing the tissues around the eye which raises venous pressure. Wider fitting goggles were seen to be less of a problem (Morgan et al 2008).

One problem with the design of this and subsequent studies is that they measured the eye pressure through a hole drilled in the goggles – so they are not actually measuring the pressure when the system is sealed. In fact, goggles actually seal partly by the slight negative pressure induced when you push them on – but don’t push hard – they should fit snugly but not too tight.

The good news is that a study in Perth where they sampled a large number of ocean swimmers found no increase in incidence of glaucoma among the punters (Mackey et al 2014). However, the general advice still remains that if you are known to have glaucoma you shouldn’t be wearing narrow-fitting, tight goggles. Also, swim goggles are not good for depth, as the water pressure goes up 1 atmosphere every 10 metres and you can’t equalise through the nose – so that pressure is transmitted to the rims of the goggle and would likely exacerbate the problem. In contrast, a similar study of SCUBA diving masks did not show a rise in intraocular pressure, but designing a study to test this at 20m depth might be tricky. SCUBA divers do not seem to have a higher incidence of glaucoma, so we assume it is safe as long as pressures are equalised slowly.

Gogs in space

Of further interest is that in prolonged space flight without gravity, such as in the International Space Station, the relatively higher intracranial pressure pushes forwards through the optic canal and causes optic nerve swelling and some induced hyperopia (long-sightedness). The syndrome is called space-flight associated neuro-ocular syndrome (SANS), affects about 75 per cent of astronauts and symptoms can persist after return to Earth. Researchers in collaboration with NASA (Scott et al JAMA Ophth 2019) tried getting subjects in space flight simulators to wear swimming goggles to see if it would counteract the effects. It did raise the eye pressure by 3mmHg but they were not able to demonstrate a definite improvement in the pressure gradient at the back of the eye, so they are not yet sure if it will work. We still may see our astronauts wearing swim goggles in some longer term and real-life trials. (NB Paul – potential marketing opportunity).

graham stuart head 200So it is true that tight goggles can cause eye problems and it makes sense to have a well-fitted pair that doesn’t compress the peri-ocular tissues. Although a direct connection with retinal detachment is not reported in the literature, there could be a theoretical risk particularly in myopic eyes prone to complications. Don’t dive into an oncoming 2m wave with your face up, and watch out for swinging fists of swimmers approaching from the opposite direction – a frequent problem at the popular Manly to Shelly stretch. If you do develop new floaters and flashes, you should definitely get your eyes checked.

Stuart Graham
Professor Ophthalmology and Vision Science
Macquarie University
Maillot Jaune

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Heron Island

New oceanswimsafari: October 18-23

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We've added another Heron Island oceanswimsafari later in 2021, this one running from Monday, October 18 through Saturday, October 23.

We have been overwhelmed with the positive response to our Heron Island oceanswimsafaris since we mentioned them in an ealier newsletter. We are adding this further oceanswimsafari so that more swimmers don't need to miss out.

These oceanswimsafaris won’t be in quite the same form as the Great Barrier Reef swims previously, in that we won’t be running formal swim events as part of a four-night package. Instead, we’ll be running a five-night package with four days of escorted swims to different parts of the reefs around Heron Island. (We always felt that four nights wasn’t quite enough.)

If you're interested, don't dilly-dally: spaces are filling.

More information and to book your spot… Click here

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New swims, established swims…

Plenty of autumn swimming on offer

Yes, the formal ocean swimming event season is winding down, but there remain plenty of opportunities to get wet in company. Be aware, in keeping with conventional practice under Covid restrictions, entries are online only. This means no new entries will be accepted on the beach on race day.

Mollymook: The Big M

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This is one of the prettiest swims you will ever do. Try to stay for Monday, or arrive early for Saturday, and maybe do an early morning swim around the rock shelf to the racecourse, and back, too. If you ever wonder why you get up to this caper, then come to Mollymook and it will answer all your questions. 

Two distances -- the 2.2km swim from the north end of Mollymook to the south end, and 500m. Note that the 500m swim is open to juniors (10-12 years old) and—and this is interesting—to "novices". The organisers don't define what constitutes a "novice", but in surf life saving terms, it refers to swimmers who've never won a surf race. In our context, it probably refers to new swimmers. What it means is, here is an ocean swim intended for less experienced punters who aren't keen on regular swimmers swimming over them and barging them out of the way. It should make for a rather more sedate experience for punters who would like to get some experience before submitting themselves to the rough and touble of a peloton out of control.

The 500m swim runs on a course in front of Mollymook surf club. The longer swim starts at the northern end of Mollymook beach and follows a course down to the southern end, where the Mollymook Golf Club beckons and the surf club sits. Shuttle buses will run punters from the surf club to the start.

More information and to enter online…Click here

South Head: Season epic

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Anyone who might do this swim already knows about it and has been planning and training for months. Anyone who hasn't been going through that process, then you shouldn't think about it for this season. 

This swim is one of the few things in ocean swimming life that deserves the appellation, "epic". It is an "epic" for its journey from Bondi, along the palisade to South Head, then into Sydney Harbour to finish at Watsons Bay, in front of the pub.

It's not for everyone. But for those who for whom it is, as it were, then you'll never forget it.

More information and to enter online… Click here

Celebration of a life

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Mona Vale surf club in Sydney has replaced its solstice swim with a new event on Sunday, May 23. The swim celebrates the life of Janice Mason, a long-serving club member and Bongin Bongin Dawnbusters swimmer who passed away during a morning swim a year ago. The Janice Mason Celebration Swim follows a similar format to the solstice swim, with a similar course (1.2km around the rock shelf at Mona Vale) and structure (only four categories: wettie and newd, male/female). Also, no prizes.But all entrants receive a roll with hot soup afterwards, in the tradition of Mrs June Dibbs, mum of swim awgie, Jon Dibbs, who began serving up her minestrone when Mona Vale started its solstice swim many years ago.

Don't be put off by the date: on May 23, swim day, the water will still be warm, and there's a good chance of a warmish sunny day with a gentle offshore breeze and very clear water. 

More info and to enter online… Click here

COWS @ Raby Bay

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A new swim in Queensland! Two distances in the sheltered waters of Raby Baby, in Brisbane's south-east. Event is run by Cleveland Open Water Swimmers (COWS) in support of Albatross Nippers—nippers with a disability—with the support of Nobbys Beach SLSC.

There are two swims available—a 1500m swim for swimmers 11 years and over; and 300m for 9-10 year-olds.

The venue at Raby Bay means it's accessible to Brisbane, the Goldy, and from northern NSW.

More information and to enter online… Click here

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Noel's Monster ANZAC Day swim

Swimming with real monsters

Just thought you might be interested in our ANZAC Day swim…

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Your most personal item…

Goggles: About straps...

V630ASA AMBK 300We reprint here our report on the importance of straps from an earlier newsletter, due to the focus in this newsletter on eyes. Straps are way under-rated and disrespected…

Straps are an important and integral component of swim gogs. We all know that. So why don’t more punters take the time to understand them?

The problem with straps is that they’re not front-of-mind. They are, by definition, in the background; behind you; out of mind. They can be fiddly, but deep down, we all know they’re important. But they’re not as important as lenses, are they? Or are they?

wide eyes strap slip 300Goggles are an ensemble: you need the straps as much as you need the lenses. And you need the clips that control the adjustment of straps, just as much as you need the other two. A well-fitting, clear lens is no good if the strap is not just so.

Left: Not that easy to see, perhaps, but notice how one side of the strap is not through the clip: This is a recipe for disaster.

The problems that you can face with lenses are clear, as it were. Usually it’s lens fog (more often than not caused by dirty and greasy lenses; which is caused by disrespect) and poor seals (which can be dealt with at the point of purchase by a sales person with some clue about what they’re doing, eg Mrs Sparkle). They can also be caused by rubbish lenses, but we have little experience of this kind of thing these days.

But straps. How do you deal with straps.

The biggest mistake swimmers make with straps is to make them too tight. Some people think, weirdly, that the tighter the strap, the better the seal. Actually, the reverse is true. A strap that’s too tight can disrupt a seal through the tension around your noggin. Straps should be just tight enough to hold the gogs in position. They don’t have to be tight; indeed, a strap that’s too tight might cut off blood supply around your head, which could lead to all sorts of other issues. And, of course, that would be the fault of the gogs, wouldn’t it.

selene strap length 250Left: There's a lot of slack left when one end of the strap comes out of the clip; it's not easy to lose the clip itself.

Gogs that you can don straight out of the box to fit perfectly are worth their weight in gold. When Mrs Sparkle fits a punter with gogs, she always gets them to place the lenses into the eye sockets without placing the strap, which just hangs there. If the lenses sit in place even momentarily, then we have a seal. The role of the strap, then, is simply to hold them in place on your head, not to create the seal itself. We don’t wish to brag here, but that’s the experience we have every time we take a new pair out of the box. Lenses fit, they’re clean, and the strap tension is just right. Maybe we just have a perfect head. Some have said that.

Not every gog on every head is that perfect, of course. And this leads to fiddling. Fiddling happens when punters feel the strap needs to be tighter, or it’s already too tight and they want to loosen it. In the process, they loosen it too much, or they loosen in carelessly or unevenly. What happens then?
This is where the clip becomes important. Gogs have different styles of clips and strap assemblies, so it’s difficult to be definitive. Essentially, though, the clip locks the strap in place. Sometimes, however, straps flip the clip and come loose, which means the gogs can come loose, and you can lose the gogs.

wide eyes strap tighten 300Straps have to thread through the clip and out the other side, with enough hanging out to provide security for when the strap inevitably is stretched, such as when it’s being donned or discarded. If the strap is adjusted unevenly, one end might have plenty of free strap through the clip, while the other end is only just poking out. The risk is that, when the strap is stretched, this short end can slip through the clip, the strap comes loose and the gogs are gone.

Right: When you adjust the strap, particularly if the end is short, lock it into place with a gentle stretch.

One precaution you can take is that, when you’ve adjusted the strap and it’s through the clip, grab the strap either side of the clip and pull the loose end gently so as to ‘lock’ it in place. You should try to ensure that the loose ends are through the clip evenly, and that, if you can, the clip has plenty of free strap available, such as by sliding the clip closer to the goggle lens, if possible. Some straps are shorter than others, of course, and you will have more or less strap to play with. Another reason to be careful when you adjust.

Look closely at clips, and you will see that it’s very difficult to lose a clip completely. Even if the loose end comes out, the clip is designed such that the strap is still well within the other side of the clip, so it’s hard to lose the clip completely. Certainly that’s the case with View gogs. We have had a report of a clip breaking completely, but with all the more than a thousand gogs we’ve sold, we’ve heard of that only once.

Some swimmers tell us that they lose their clip, it disappears, and they can reattach their gogs only by trying a knot. Absent a snapped clip, that can happen only if the strap has been adjusted ‘inappropriately’.

So the message: respect your straps. Don’t diss them just because you can’t see them.

Swipes available

There are Swipe Selenes available in five colours. Wide-Eyes non-mirrored come in four colours, and mirrored come in three colours.

Out of left field: One of the least popular, but we reckon the best colour is the Swipe Selenes BR. The BR means bronze or brown, not sure which. It’s not a popular colour, just like brown suits, but it’s actually a very soft, forgiving colour for swimming in harsh sunlight, and a warm colour for cooler water swimming, over winter, say. We use the BR about half the time these days (alternating with BLEM – Blue/Emerald) Wide-Eyes mirrored. They’re terrific for early morning swims when you spend half your time staring into the rising sun. Every swimmer needs a quiver of gogs.

But every swimmer also needs to look after their gogs; to respect them. If you don’t respect your gogs, they will not respect you. And don’t go blaming the gogs all the time (although plenty really are shite), it will all come down to how you manage them.

Find out more and order your View Swipes, and other View swim gogs and swim gear… Click here

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Controversy Corner...

What do you reckon about any of this stuff? We received a lot of feedback after our last newsletter. Check it out... Click here

Let us know and we'll facilitate the debate... Click here

(Also see posts at the end of this newsletter.)

Swims open to online entry…

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Morning swim

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Morning swim, Forster. Someone (a visitor) remarked to Mrs Sparkle recently that 'Forster has become the new Byron'. Heavens above!

Bits & pieces…


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Emergency!

Don't be an emergency eejit. It's 'strordnry how many punters enter swims online and list themselves as their own emergency contact. Just say something happens to you out in the sea, who are awgies going to contact? You? Get real. Think about it, and enter someone else as your emergency contact, event if it's your boss at work.

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For a quick idea of what's going on around your area -- formal events, informal swim groups -- check our swim maps. You'll find them for each area under Swims/Calendar on oceanswims.com.

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