Narrative review: Clinical evaluation of ophthalmic findings in active, amateur, adult, competitive male boxers in India

Why this study matters

Punches in boxing land on the face, so the eyes are exposed. The article describes boxing as a high-risk activity for eye injury. It cites earlier reports that between 41% and 76% of boxers show signs of eye injury. It also says that boxers lack systematic long-term follow-up, which makes the lasting effects of eye injuries hard to assess. The authors state that, to the best of their knowledge, no earlier research had identified eye complications linked to boxing in India.

What the researchers did

This was a cross-sectional study, meaning each person was examined once. It took place at a tertiary care centre in Pune, India, from August 2020 to January 2022. The researchers enrolled 100 active amateur male boxers, so 200 eyes were examined. To take part, a boxer had to be aged 18 to 35 and have at least three years in competitive sport. Boxers with earlier eye disease, with eye disease in the family, or who used anabolic steroids or other banned substances were left out. The youngest boxer was 18 and the oldest was 29.

The examination covered visual acuity (sharpness of sight), the pressure inside the eye, the front of the eye and the retina at the back of the eye. It also included gonioscopy, a test that looks at the drainage angle where fluid leaves the eye. A subset of boxers had optical coherence tomography (OCT), a scan of the macula and the optic disc. The article does not give the size of that subset. The researchers recorded each boxer’s age, years of boxing and number of fights. A chi-square test was used to see whether eye findings were associated with these factors.

What they found

Of the 100 boxers, 51 had a finding in at least one eye and 49 had normal eyes. Healed scars on the eyelids were the most frequent finding, seen in 25 boxers. Bleeding under the clear surface of the eye (subconjunctival haemorrhage) was seen in 12. Seven had posterior synechiae, where the iris sticks to the lens. Five had traumatic mydriasis, a pupil left enlarged after injury. Four had abnormalities of the drainage angle. Three had a traumatic cataract (clouding of the lens after injury), three had a lens partly out of position, and three had raised eye pressure. Two had peripapillary atrophy, a thinning of tissue around the optic disc. No damage to the macula, the central part of the retina, was found. All 100 boxers had unaided visual acuity of 6/6.

Age group was associated with having a finding. Findings were present in 32 of the 49 boxers aged over 25 and in 19 of the 51 aged 18 to 25 (p = 0.006). The association with years of boxing was not statistically significant (p = 0.478). Neither was the association with number of fights (p = 0.140). Findings were recorded in 23 of the 37 boxers with 50 or fewer fights and in 6 of the 19 with more than 200. The authors suggest that boxers with more fights may have learned ways to avoid injury. Thirteen boxers were kept under follow-up because of their findings.

Strengths and limits

The authors report a 100% participation rate. They name two main limits: the limited sample size and the young age of the boxers. They point out that professional boxers, whose fights are longer, were not included.

Each boxer was examined once, so the study cannot show when a finding arose or what led to it. There was no comparison group of people who do not box, so the study cannot show how much more common these findings are in boxers. The article describes the examination only briefly and does not define each finding. The abstract contains a sentence saying that none of the findings could be attributed to boxing, while the conclusion calls them boxing-related. The article does not explain this difference.

What it adds to research on fighter health

This study gives a count of eye findings in a group of active amateur boxers in India, a setting the authors say had not been studied before. About half of the boxers had at least one finding, although all had 6/6 unaided vision. The authors describe traumatic cataract, lens subluxation and angle abnormalities as the main sight-threatening findings. Each was present in three or four boxers. The figure of 51% is lower than the 66% and 76% reported in two earlier studies the authors cite. It is close to the 51.42% reported in a study of Cameroonian boxers. The authors call for larger studies and recommend regular, thorough eye examinations for all boxers.