To the Editor:
Use of helmets among skiers started to increase some 20 y ago, becoming mandatory for children under 16 y old in Austria in 2009.
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Today, 86% of skiers wear helmets.2
Helmet use has reduced the risk of head injuries by 35%.National Ski Areas Association
Helmet usage and safety fact sheet.
Helmet usage and safety fact sheet.
https://www.nsaa.org/NSAA/resources/Industry_Stats
Date accessed: November 11, 2020
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Widespread use of helmets implies thorough study of the possible adverse effects of wearing helmets that could offset their protective effects. Helmet use does not increase the risk of neck or cervical spine injury or the risk of compensation behavior.4
However, the 2 groups of head injuries, traumatic brain injury and other types of head injuries, are not equally prevented by ski helmets, and the number of traumatic brain injuries is not reduced to the same extent as the number of other types of head injuries.5
Over time, the protective effects of helmets have been somewhat reduced.6
A direct influence of ski helmets on hearing was investigated and established.7
In addition to helmets, usual head gear for skiers includes ski goggles. Their role is to prevent ultraviolet (UV) radiation (wavelengths smaller than 400 nm) from reaching the eye and the surrounding soft tissue; to reduce the total amount of light reaching the eye; to reduce the production of tears; to enhance contrast; and to provide mechanical protection of the eyes and the surrounding soft tissue. Optimal performance depends on ventilation of humid air. Proper ventilation prevents fogging and should not induce the overproduction of tears. Helmets tend to reduce goggle ventilation; therefore, goggles fog much more easily, and when skiers are moving at reduced speed or when they stop moving, fogging becomes almost inevitable. This is probably one of the principal reasons why many helmeted skiers remove their goggles when they stop moving; when using chair lifts, drag lifts, and gondolas; and sometimes during descent.
There are, however, skiers who use an extra pair of sunglasses in situations when goggles are removed, and a certain number who use sunglasses exclusively. All the aforementioned personal observations were confirmed by the inspection of photos from 12 large ski resorts in Austria, Italy, France, and Bulgaria. The largest proportion of skiers, more than 50%, remove their goggles at the base stations of lifts and approximately 30% when using chairlifts, whereas skiers in descent rarely remove them. At the top stations of ski lifts, the percentage of skiers with removed goggles is nearly the same as among chairlift users. Approximately 10% of skiers were wearing sunglasses and helmets (skiers with removed goggles included). There were no skiers with removed sunglasses. Goggles and sunglasses do not protect the eyes and the surrounding tissue to the same extent because goggles cover a larger area and have a tighter fit.
The effects on the eyes of removing goggles and not replacing them with sunglasses is that they are exposed to increased levels of UV radiation in situations when the UV index is usually very high. As a result, adverse effects of UV radiation are possible. The most notable adverse effects include snow blindness as an acute effect; cataract and macular degeneration are chronic effects.
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Owing to increased sensitivity to UV radiation among children, the removal of ski goggles could exacerbate such effects.9
Although eye injuries are just a fraction of head injuries, in the only identified study covering skiing, one-third of eye injuries were acute injuries caused by UV radiation.
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There are no data on the long-term effects of UV radiation to the eyes in skiing.The almost uniform habit of wearing ski helmets amplifies the importance of addressing possible adverse effects of UV radiation to the eyes of helmeted skiers who remove their goggles while skiing. The proportions of skiers with removed goggles in different situations suggest the possibility that many skiers remove their goggles after descent and put them on just before descent. Information about the high intensity of UV radiation at high altitudes and snow-covered slopes, as well as the need for permanent eye protection, should be promoted. Because chronic effects to the eyes emerge after many years and the effects are not immediately recognized as acute, it is important that skiers be aware of the risk.
References
- Impact of a ski helmet mandatory on helmet use on Austrian ski slopes.J Trauma. 2011; 71: 1085-1087
- Helmet usage and safety fact sheet.(Available at:)https://www.nsaa.org/NSAA/resources/Industry_StatsDate accessed: November 11, 2020
- The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: a meta-analysis.CMAJ. 2010; 182: 333-340
- An evidence-based review: efficacy of safety helmets in reduction of head injuries in recreational skiers and snowboarders.J Trauma Acute Care Surg. 2012; 73: 1340-1347
- Effect of helmet use on traumatic brain injuries and other head injuries in alpine sport.Wilderness Environ Med. 2018; 29: 151-158
- Helmet use and risk of head injuries in alpine skiers and snowboarders: changes after an interval of one decade.Br J Sports Med. 2017; 51: 44-50
- Effect of wearing a ski helmet on perception and localization of sounds.Int J Sports Med. 2014; 35: 645-650
- Ozone depletion and solar ultraviolet radiation: ocular effects, a United Nations environment programme perspective.Eye Contact Lens. 2011; 37: 185-190
- Ultraviolet radiation oxidative stress affects eye health.J Biophotonics. 2018; 11e201700377
- Sport associated eye injury: a casualty department survey.Br J Ophthalmol. 1987; 71: 701-705
Article info
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Published online: April 07, 2021
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©2021 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
