Analysis of the Retinal Periphery of High-Performance Athletes: Incidentally Discovered Lesions in Contact Sports Players

Analysis of the Retinal Periphery of High-Performance Athletes: Incidentally Discovered Lesions in Contact Sports Players | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of the Retinal Periphery of High-Performance Athletes: Incidentally Discovered Lesions in Contact Sports Players Nicolas Arej, Hervé Treguer, Chloé Le Cossec, Benjamin Kakona, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4737487/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Jun, 2025 Read the published version in Sports Medicine-Open → Version 1 posted 5 You are reading this latest preprint version Abstract Background Ocular trauma is common in athletes, especially those practicing contact sports. Besides overt injuries, little is known about asymptomatic lesions resulting from repetitive head or ocular trauma. The prevalence of peripheral retinal lesions in elite athletes and the potential risk attributable to participation in contact sports were investigated in this monocentric retrospective study. Results The study enrolled 88 professional athletes, predominantly male (80%) with an average age of 26 years, who were screened at the Rothschild Foundation Hospital. All athletes had fundus examination and ultra-wide field retinal imaging (UWF) for both eyes, looking for lesions of the peripheral retina. The screening encompassed athletes from both contact and non-contact sports, with a majority (62%) engaging in contact sports, primarily rugby. The prevalence of peripheral retinal lesions among contact sport athletes was estimated at 36.4% [27.4% − 45.4%], significantly higher than that among non-contact sports athletes (6.1% [3.0% – 11.8%]). The diagnostic efficacy of UWF imaging in detecting these lesions was limited, with a sensitivity of 45.2% [34.1% − 56.2%]and specificity of 93.6% [88.2% − 99.0%] compared to dilated fundus examination. Conclusions These findings suggest that peripheral retinal lesions are more prevalent among high-performance athletes participating in contact sports, underscoring the importance of regular ophthalmological assessment in this population. Figures Figure 1 Key points Top-level athletes may be subject to head or ocular trauma especially when they practice contact sports. Peripheral retinal lesions can be found on fundus examination, sometimes without any related symptoms. This study shows that players of contact sports are more likely to exhibit peripheral retinal lesions compared to players of non-contact sports. A comprehensive ophthalmic examination remains the gold standard for the diagnostic of these lesions. 1. Background Elite athletes undergo rigorous training regimens and face a heightened risk of various injuries and medical conditions, including ocular manifestations [ 1 ]. The repetitive head and ocular trauma experienced during contact sports may predispose athletes to retinal abnormalities, including tears, degeneration, or vascular lesions. Additionally, factors such as increased intraocular pressure, ocular contusions, and sudden changes in acceleration or deceleration may contribute to the development or exacerbation of ocular lesions in athletes [ 2 ]. While ocular trauma is a well-recognized consequence of contact sports participation, the prevalence and characteristics of incidental retinal lesions in this population remain underexplored [ 3 ]. Although peripheral retinal lesions are often asymptomatic and do not require immediate intervention, they may carry long-term implications for visual health, including an increased risk of retinal detachment or other vision-threatening conditions [ 4 ]. Therefore, understanding the prevalence and risk factors associated with these lesions is crucial for optimizing athletes' ocular care. Comprehensive ocular evaluation, including dilated fundus examination, is essential for early detection and monitoring of peripheral retinal lesions in athletes. Additionally, awareness among sports medicine professionals, coaches, and athletes regarding the ocular risks associated with contact sports participation is crucial for promoting ocular health and implementing preventive strategies [ 5 ]. The diagnosis of peripheral retinal lesions in athletes can be challenging due to their location and often asymptomatic nature. While traditional methods such as fundus examination remain essential, advanced imaging techniques such as ultra-wide field (UWF) retinal imaging offer advantages in terms of field of view but may have limitations in sensitivity compared to dilated fundus examination [ 6 ]. Therefore, a comprehensive approach combining clinical assessment and imaging modalities is necessary for accurate diagnosis and management of peripheral retinal lesions in athletes. The purpose of the present study is to estimate the prevalence of peripheral retinal lesions in elite athletes and the excess risk due to the practice of contact sports. Through a thorough investigation of peripheral retinal lesions in elite athletes, this study aims to contribute to the growing body of literature on sports-related ocular health and inform evidence-based strategies for ocular injury prevention and management in athletic populations. 2. Methods This retrospective monocentric study analyzed data extracted from the ophthalmological records of professional athletes evaluated at the Rothschild Foundation Hospital. The study protocol was approved by the institutional ethics committee. Athletes who underwent both dilated fundus examination and UWF retinal imaging using the Optos® California® retinal camera were included in the analysis. Demographic characteristics such as age, gender, and sport participation details were recorded. Best corrected visual acuity (BCVA) in log MAR and refractive status, including spherical equivalent (SE) in diopters, were also documented for each athlete. A descriptive analysis of the data was performed, including frequencies and percentages for qualitative variables and means with standard deviations for quantitative variables. Missing data for each variable were presented. The following abnormalities have been identified as peripheral retinal lesions: lattice degeneration, snail-track degeneration, pigmentary changes, white without pressure, condensed vitreous, atrophy and hemorrhage. The prevalences of peripheral retinal lesions were calculated with a 95% confidence interval. The presence of at least one abnormality on the fundus and/or on Optos® UWF imaging was counted. The analysis was performed at patient level, and the presence of a lesion in at least one of the two eyes was considered. The performance of UWF in detecting peripheral retinal lesions was further evaluated in the subgroup of rugby players, all of whom underwent fundus examination under optimal conditions (using mydriatic eyedrops and a fundus contact lens) by the two same ophthalmologists (SoBo, SeBr) and UWF imaging in all four gaze directions. Given that peripheral retinal lesions are known to be more common in myopic eyes, logistic regressions were performed adjusting for the lowest SE between the two eyes. Odds ratios (OR) were calculated and presented with a 95% confidence interval. Additionally, diagnostic performance (sensitivity and specificity) of UWF imaging compared to dilated fundus examination at the slit lamp was calculated and presented with 95% confidence intervals. All statistical analyses were performed using R software (version 4.3.0). 3. Results A total of 88 top-level athletes were screened, with an average age of 26 years and the majority being men (80%). Among these athletes, 62% were engaged in contact sports, with rugby players comprising the vast majority of participants. On average, the athletes exhibited good visual acuity, with a SE close to emmetropia (Table 1) . Table 1 : Participants’ characteristics N (%) or mean (SD) Whole sample (N=88) Age (years) 25.8 (6) Men 70 (80%) Contact sport 55 (62%) Sports Badminton 1 (1%) Breakdance 1 (1%) Fencing 2 (2%) Gymnastics 1 (1%) Non-contact sports Paralympic shooting 1 (1%) Pentathlon 8 (9%) Shooting sports 13 (15%) Swimming 2 (2%) Table tennis 3 (3 %) Trampolining 1 (1%) Boxing 5 (6%) Contact sports Judo 8 (9%) Rugby 42 (48%) BCVA of the right eye (log MAR) -0.2 (0.1) BCVA of the left eye (log MAR) -0.2 (0.1) SE of the right eye (diopters) * 0 (0.7) SE of the left eye (diopters) * 0.1 (0.7) * 1 missing data (BCVA = Best Corrected Visual Acuity; SD = Standard Deviation;SE = Spherical Equivalent; log MAR = Logarithm of the Minimum Angle of Resolution) The prevalence of peripheral retinal lesions was estimated to be 6.1% [3.0% – 11.8%] in non-contact sport athletes and 36.4% [27.4% - 45.4%] among all contact sport athletes. Notably, rugby players showed a significantly higher prevalence of peripheral retinal lesions compared to athletes in non-contact sports (Table 2) . Table 2 : Estimated prevalences of peripheral retinal lesions by type of sport (N=88 athletes) Sport Prevalence [95%CI] Non-contact (all categories) 6.1 % [3.0% – 11.8%] Rugby 40.5 % [30.0% – 51.0%] Boxing 40.0 % [9.6% – 70.4%] Judo 12.5 % [0.0% – 28.7%] (CI = confidence interval) After adjusting for the lower SE between the two eyes, participation in contact sports was associated with an increased risk of peripheral retinal lesions in at least one of the two eyes (OR = 11.82 [2.88 - 48.52]). Although limited by small numbers, the risk was significantly increased at the 5% threshold for boxing athletes. Additionally, rugby players exhibited a significant excess risk at the 5% threshold of developing a peripheral retinal lesion in at least one eye (Figure 1) . Among the 55 contact sport athletes, 41 out of 110 eyes (37.3%) exhibited peripheral retinal abnormalities on fundus examination, while only 25 out of 110 eyes (22.7%) showed abnormalities on UWF imaging. The detailed distribution of lesions observed by each diagnostic modality is presented in Table 3 . It is important to note that one eye may present several different lesions. Table 3 : Types of peripheral retinal lesions and their observed frequencies as identified by fundus examination or Optos® ultra-wide field retinal imaging (UWF) (N=110 eyes) Fundus UWF Lattice degeneration 13 4 Pigmentary changes 11 7 Condensed vitreous 6 1 Atrophy 7 1 White without pressure 3 1 Snail-track degeneration 3 0 Hemorrhage 0 1 In the subgroup of rugby players consisting of 78 eyes in whom all examinations were performed under the most optimal conditions, the diagnostic sensitivity of UWF was 45.2% [34.1% - 56.2%], with a specificity of 93.6% [88.2% - 99.0%]. 4. Discussion The findings of this retrospective study shed light on the prevalence and characteristics of incidentally discovered peripheral retinal lesions in elite athletes, particularly those engaged in contact sports. The discussion will delve into the implications of these findings, potential mechanisms underlying the observed associations, limitations of the study, and avenues for future research. 4.1. Prevalence of Peripheral Retinal Lesions The observed prevalence of 36.4% among contact sport athletes is notably higher than previously reported rates in the general population [7], suggesting a potential association between athletic participation and retinal abnormalities. Notably, boxing and rugby players exhibited a significantly higher prevalence of peripheral retinal lesions compared to athletes in non-contact sports, indicating a potential link between the intensity or nature of sports activity and retinal health. Although most of the eyes were emmetropic or close to emmetropia, adjustment for SE helped in reducing the potential bias due to the known association between peripheral retinal lesions and myopia. 4.2. Risk Factors and Mechanisms The increased risk of peripheral retinal lesions associated with participation in contact sports, warrants further investigation into the underlying mechanisms. One potential explanation could be the repetitive head and ocular trauma experienced by athletes during contact sports, leading to microtrauma or vascular changes in the peripheral retina. The biomechanical forces exerted on the eyes and surrounding structures during collisions or impacts may predispose athletes to retinal abnormalities, including tears, degeneration, or vascular lesions [8]. Additionally, factors such as increased intraocular pressure, ocular contusions, and sudden changes in acceleration or deceleration may contribute to the development or exacerbation of peripheral retinal lesions in contact sports athletes [9]. Further studies incorporating longitudinal assessments and advanced imaging modalities are needed to elucidate the specific mechanisms underlying the observed associations and to identify potential modifiable risk factors for preventive interventions. 4.3. Pathophysiological Implications The pathophysiology of peripheral retinal lesions can vary depending on the specific type, but in general, they often involve weakening or thinning of the retinal tissue. For example, lattice degeneration is characterized by areas of retinal thinning and degeneration, often with visible white lines or lattice-like structures, believed to be related to abnormalities in the development of the retina. Although available evidence indicates that most of the peripheral retinal degenerations should not be treated except in rare, high-risk situation, it is important for individuals, especially athletes, with peripheral retinal lesions to undergo regular eye examinations to monitor for any signs of retinal tears or detachment and to receive appropriate treatment if necessary [10]. None of the latter complications were found in our population at the time of the screening; yet a longer follow-up is required to better assess this risk. 4.4. Diagnostic Challenges and Clinical Implications The diagnostic challenges highlighted by the study, particularly the limited sensitivity of UWF imaging in detecting peripheral retinal lesions compared to dilated fundus examination, emphasize the importance of comprehensive ocular assessment in athletes [11]. While UWF imaging offers advantages in terms of field of view and convenience, its lower sensitivity may result in missed or underdiagnosed peripheral retinal abnormalities, particularly in high-risk populations such as elite athletes. Similarly, Khan et al. have found that UWF imaging had a limited interest in detecting treatment-requiring peripheral retinal lesions and 360-degree scleral depressed examination should remain the gold standard [6]. Clinically, these findings underscore the need for regular ophthalmological evaluation, including dilated fundus examination, in athletes engaged in contact sports. Early detection and monitoring of peripheral retinal lesions are crucial for timely intervention and prevention of potential complications, such as retinal detachment or vision-threatening conditions. Additionally, awareness among sports medicine professionals, coaches, and athletes regarding the ocular risks associated with contact sports participation is essential for promoting ocular health and injury prevention strategies [12]. 4.5. Limitations and Future Directions Several limitations should be considered when interpreting the findings of this study. The retrospective design and single-center setting may limit the generalizability of the results to other athlete populations or settings. Additionally, the relatively small sample size and unequal distribution of athletes across sports disciplines, particularly in non-contact sports, may have influenced the observed prevalence estimates and associations. Thes limitations deserve to be addressed by conducting prospective, multicenter studies with larger and more diverse athlete cohorts. Longitudinal assessments incorporating advanced imaging techniques, such as wide field optical coherence tomography, may provide valuable insights into the progression and prognostic implications of peripheral retinal lesions in elite athletes. Furthermore, investigating potential protective factors, such as ocular protective gear or training modifications, may inform preventive strategies to mitigate the risk of ocular injuries and abnormalities in this population [13]. 5. Conclusions In conclusion, the present study contributes to our understanding of peripheral retinal lesions in elite athletes, highlighting the elevated prevalence among those engaged in contact sports. These findings underscore the importance of proactive ocular health monitoring and injury prevention strategies in optimizing the visual health and performance of elite athletes. Further research endeavors are warranted to elucidate the underlying mechanisms, identify modifiable risk factors, and develop targeted interventions aimed at promoting ocular health and safety in sports. Abbreviations - BCVA - Best Corrected Visual Acuity - CI - Confidence Interval - log MAR - Logarithm of the Minimum Angle of Resolution) - OD - Odds Ratio - SD - Standard Deviation - SE - Spherical Equivalent - UWF - Ultra-Wide Field Declarations All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Ethics approval: Institutional Review Board (Rothschild Foundation Hospital Ethics Committee) approval was obtained for this study. The study was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki. Consent for publication: Not applicable Competing interests: All authors declare that they have no conflict of interest. Authors’s contributions NA interpreted the data and wrote the manuscript. HT, BK and NM reviewed the partients’ charts and collected relevant data. CLC analyzed the data. VV, SLG, SyBl contributed to the conception of the work. SeBr and SoBo performed ophthalmic examinations. All authors read and approved the final manuscript. Funding: No funds, grants, or other support was received. Acknowledgements: Not applicable Availability of data and material: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Ohana O, Alabiad C. Ocular related sports injuries. J Craniofac Surg. 2021;32:1606–11. Li Y, Singman E, McCulley T, Wu C, Daphalapurkar N. The Biomechanics of Indirect Traumatic Optic Neuropathy Using a Computational Head Model With a Biofidelic Orbit. Front Neurol. 2020;11:346. Moe MC, Özmert E, Baudouin C, Binadra A, Crafoord S, Jo Y, et al. International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open Sport Exerc Med. 2023;9:e001644. Bianco M, Vaiano AS, Colella F, Coccimiglio F, Moscetti M, Palmieri V, et al. Ocular complications of boxing. Br J Sports Med. 2005;39:70–4. discussion 70–74. Capão Filipe JA, Rocha-Sousa A, Falcão-Reis F, Castro-Correia J. Modern sports eye injuries. Br J Ophthalmol. 2003;87:1336–9. Khan M, Kovacs K, Guan I, Goldblatt N, Foulsham W, Wu A, et al. EVALUATING ULTRA-WIDEFIELD IMAGING UTILITY IN THE DETECTION OF TREATMENT-REQUIRING PERIPHERAL RETINAL TEARS AND HOLES. Retina. 2024;44:71–7. Campagnoli TR, Smiddy WE. Peripheral Retinal Abnormalities. In: Medina CA, Townsend JH, Singh AD, editors. Manual of Retinal Diseases: A Guide to Diagnosis and Management [Internet]. Cham: Springer International Publishing; 2016 [cited 2024 Apr 21]. pp. 243–7. https://doi.org/10.1007/978-3-319-20460-4_49 . Giovinazzo VJ, Yannuzzi LA, Sorenson JA, Delrowe DJ, Cambell EA. The ocular complications of boxing. Ophthalmology. 1987;94:587–96. Lam MR, Dong P, Shokrollahi Y, Gu L, Suh DW. Finite Element Analysis of Soccer Ball-Related Ocular and Retinal Trauma and Comparison with Abusive Head Trauma. Ophthalmol Sci. 2022;2:100129. Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. 2003;136:155–60. Heinmiller L, Gunton KB. A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome. Curr Opin Ophthalmol. 2016;27:407–12. Mahan M, Purt B. Ocular Trauma Prevention Strategies and Patient Counseling. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Apr 21]. http://www.ncbi.nlm.nih.gov/books/NBK580537/ . Bailoor S, Bhardwaj R, Nguyen TD. Effectiveness of eye armor during blast loading. Biomech Model Mechanobiol. 2015;14:1227–37. Cite Share Download PDF Status: Published Journal Publication published 11 Jun, 2025 Read the published version in Sports Medicine-Open → Version 1 posted Reviewers agreed at journal 27 Jul, 2024 Reviewers invited by journal 25 Jul, 2024 Editor invited by journal 22 Jul, 2024 Editor assigned by journal 21 Jul, 2024 First submitted to journal 21 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4737487","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331930684,"identity":"eea6fc4e-8811-4821-b32e-2dfe4c018078","order_by":0,"name":"Nicolas 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07:44:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4737487/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4737487/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40798-025-00869-y","type":"published","date":"2025-06-11T15:57:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63374234,"identity":"3a2eb7d1-085c-42e9-80e1-e3851de9a37d","added_by":"auto","created_at":"2024-08-27 12:22:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43231,"visible":true,"origin":"","legend":"\u003cp\u003eOdds ratio plot, adjusted for the lower spherical equivalent between the two eyes, illustrating the excess risk according to the type of contact sport practiced, non-contact sports of all subtypes being set as a reference (N=87 athletes).\u003c/p\u003e","description":"","filename":"Plot.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4737487/v1/fc39ac2c79a793910095c3a2.jpg"},{"id":84726552,"identity":"0ea1cceb-a0f1-4553-bea9-e983c1b10e56","added_by":"auto","created_at":"2025-06-16 16:06:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":526797,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4737487/v1/6bde6410-197a-4e9c-a3d6-20ba15ab9b8e.pdf"}],"financialInterests":"","formattedTitle":"Analysis of the Retinal Periphery of High-Performance Athletes: Incidentally Discovered Lesions in Contact Sports Players","fulltext":[{"header":"Key points","content":"\u003cp\u003eTop-level athletes may be subject to head or ocular trauma especially when they practice contact sports. Peripheral retinal lesions can be found on fundus examination, sometimes without any related symptoms. This study shows that players of contact sports are more likely to exhibit peripheral retinal lesions compared to players of non-contact sports. A comprehensive ophthalmic examination remains the gold standard for the diagnostic of these lesions.\u003c/p\u003e"},{"header":"1. Background","content":"\u003cp\u003eElite athletes undergo rigorous training regimens and face a heightened risk of various injuries and medical conditions, including ocular manifestations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The repetitive head and ocular trauma experienced during contact sports may predispose athletes to retinal abnormalities, including tears, degeneration, or vascular lesions. Additionally, factors such as increased intraocular pressure, ocular contusions, and sudden changes in acceleration or deceleration may contribute to the development or exacerbation of ocular lesions in athletes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While ocular trauma is a well-recognized consequence of contact sports participation, the prevalence and characteristics of incidental retinal lesions in this population remain underexplored [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although peripheral retinal lesions are often asymptomatic and do not require immediate intervention, they may carry long-term implications for visual health, including an increased risk of retinal detachment or other vision-threatening conditions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, understanding the prevalence and risk factors associated with these lesions is crucial for optimizing athletes' ocular care.\u003c/p\u003e\u003cp\u003eComprehensive ocular evaluation, including dilated fundus examination, is essential for early detection and monitoring of peripheral retinal lesions in athletes. Additionally, awareness among sports medicine professionals, coaches, and athletes regarding the ocular risks associated with contact sports participation is crucial for promoting ocular health and implementing preventive strategies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe diagnosis of peripheral retinal lesions in athletes can be challenging due to their location and often asymptomatic nature. While traditional methods such as fundus examination remain essential, advanced imaging techniques such as ultra-wide field (UWF) retinal imaging offer advantages in terms of field of view but may have limitations in sensitivity compared to dilated fundus examination [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore, a comprehensive approach combining clinical assessment and imaging modalities is necessary for accurate diagnosis and management of peripheral retinal lesions in athletes.\u003c/p\u003e\u003cp\u003eThe purpose of the present study is to estimate the prevalence of peripheral retinal lesions in elite athletes and the excess risk due to the practice of contact sports. Through a thorough investigation of peripheral retinal lesions in elite athletes, this study aims to contribute to the growing body of literature on sports-related ocular health and inform evidence-based strategies for ocular injury prevention and management in athletic populations.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThis retrospective monocentric study analyzed data extracted from the ophthalmological records of professional athletes evaluated at the Rothschild Foundation Hospital. The study protocol was approved by the institutional ethics committee. Athletes who underwent both dilated fundus examination and UWF retinal imaging using the Optos® California® retinal camera were included in the analysis. Demographic characteristics such as age, gender, and sport participation details were recorded. Best corrected visual acuity (BCVA) in log MAR and refractive status, including spherical equivalent (SE) in diopters, were also documented for each athlete. A descriptive analysis of the data was performed, including frequencies and percentages for qualitative variables and means with standard deviations for quantitative variables. Missing data for each variable were presented.\u003c/p\u003e\u003cp\u003eThe following abnormalities have been identified as peripheral retinal lesions: lattice degeneration, snail-track degeneration, pigmentary changes, white without pressure, condensed vitreous, atrophy and hemorrhage. The prevalences of peripheral retinal lesions were calculated with a 95% confidence interval. The presence of at least one abnormality on the fundus and/or on Optos® UWF imaging was counted. The analysis was performed at patient level, and the presence of a lesion in at least one of the two eyes was considered. The performance of UWF in detecting peripheral retinal lesions was further evaluated in the subgroup of rugby players, all of whom underwent fundus examination under optimal conditions (using mydriatic eyedrops and a fundus contact lens) by the two same ophthalmologists (SoBo, SeBr) and UWF imaging in all four gaze directions.\u003c/p\u003e\u003cp\u003eGiven that peripheral retinal lesions are known to be more common in myopic eyes, logistic regressions were performed adjusting for the lowest SE between the two eyes. Odds ratios (OR) were calculated and presented with a 95% confidence interval. Additionally, diagnostic performance (sensitivity and specificity) of UWF imaging compared to dilated fundus examination at the slit lamp was calculated and presented with 95% confidence intervals. All statistical analyses were performed using R software (version 4.3.0).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 88 top-level athletes were screened, with an average age of 26 years and the majority being men (80%). Among these athletes, 62% were engaged in contact sports, with rugby players comprising the vast majority of participants. On average, the athletes exhibited good visual acuity, with a SE close to emmetropia \u003cem\u003e(Table 1)\u003c/em\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 1\u003c/u\u003e: Participants\u0026rsquo; characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.64174454828661%\" colspan=\"2\" valign=\"bottom\" style=\"width: 52.2075%;\"\u003e\n \u003cp\u003e\u003cem\u003eN (%) or mean (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" rowspan=\"2\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003eWhole sample\u003c/p\u003e\n \u003cp\u003e(N=88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"54.37616387337058%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.905027932960895%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.71880819366853%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e25.8 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e70 (80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eContact sport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e55 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" rowspan=\"13\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eSports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eBadminton\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eBreakdance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eFencing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eGymnastics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003eNon-contact sports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eParalympic shooting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003ePentathlon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e8 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eShooting sports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e13 (15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eSwimming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eTable tennis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e3 (3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eTrampolining\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eBoxing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e5 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003eContact sports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eJudo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e8 (9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.142857142857146%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\n \u003cp\u003eRugby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e42 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eBCVA of the right eye (log MAR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e-0.2 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eBCVA of the left eye (log MAR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e-0.2 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eSE \u0026nbsp;of the right eye (diopters) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e0 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.482866043613704%\" valign=\"bottom\" style=\"width: 36.5265%;\"\u003e\n \u003cp\u003eSE of the left eye (diopters) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.1588785046729%\" valign=\"top\" style=\"width: 18.7184%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.003115264797508%\" valign=\"bottom\" style=\"width: 22.8753%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"16.35514018691589%\" valign=\"bottom\" style=\"width: 23.3864%;\"\u003e\n \u003cp\u003e0.1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* 1 missing data\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e(BCVA = Best Corrected Visual Acuity; SD = Standard Deviation;SE = Spherical Equivalent; log MAR = Logarithm of the Minimum Angle of Resolution)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of peripheral retinal lesions was estimated to be 6.1% [3.0% \u0026ndash; 11.8%] in non-contact sport athletes and 36.4% [27.4% - 45.4%] among all contact sport athletes. Notably, rugby players showed a significantly higher prevalence of peripheral retinal lesions compared to athletes in non-contact sports \u003cem\u003e(Table 2)\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 2\u003c/u\u003e: Estimated prevalences of peripheral retinal lesions by type of sport (N=88 athletes)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.19565217391305%\" valign=\"top\"\u003e\n \u003cp\u003eSport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"53.80434782608695%\" valign=\"top\"\u003e\n \u003cp\u003ePrevalence [95%CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.19565217391305%\" valign=\"top\"\u003e\n \u003cp\u003eNon-contact (all categories)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"53.80434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e6.1 % [3.0% \u0026ndash; 11.8%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.19565217391305%\" valign=\"top\"\u003e\n \u003cp\u003eRugby\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"53.80434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e40.5 % [30.0% \u0026ndash; 51.0%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.19565217391305%\" valign=\"top\"\u003e\n \u003cp\u003eBoxing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"53.80434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e40.0 % [9.6% \u0026ndash; 70.4%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.19565217391305%\" valign=\"top\"\u003e\n \u003cp\u003eJudo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"53.80434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e12.5 % [0.0% \u0026ndash; 28.7%]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e(CI = confidence interval)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAfter adjusting for the lower SE between the two eyes, participation in contact sports was associated with an increased risk of peripheral retinal lesions in at least one of the two eyes (OR = 11.82 [2.88 - 48.52]). Although limited by small numbers, the risk was significantly increased at the 5% threshold for boxing athletes. Additionally, rugby players exhibited a significant excess risk at the 5% threshold of developing a peripheral retinal lesion in at least one eye \u003cem\u003e(Figure 1)\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eAmong the 55 contact sport athletes, 41 out of 110 eyes (37.3%) exhibited peripheral retinal abnormalities on fundus examination, while only 25 out of 110 eyes (22.7%) showed abnormalities on UWF imaging. The detailed distribution of lesions observed by each diagnostic modality is presented in \u003cem\u003eTable 3\u003c/em\u003e. It is important to note that one eye may present several different lesions.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTable 3\u003c/u\u003e: Types of peripheral retinal lesions and their observed frequencies as identified by fundus examination or Optos\u0026reg;\u0026nbsp;ultra-wide field retinal imaging (UWF) (N=110 eyes)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"470\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\" valign=\"bottom\"\u003e\n \u003cp\u003eFundus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\" valign=\"top\"\u003e\n \u003cp\u003eUWF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eLattice degeneration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003ePigmentary changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eCondensed vitreous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eAtrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eWhite without pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eSnail-track degeneration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.51063829787234%\"\u003e\n \u003cp\u003eHemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.425531914893618%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.06382978723404%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the subgroup of rugby players consisting of 78 eyes in whom all examinations were performed under the most optimal conditions, the diagnostic sensitivity of UWF was 45.2% [34.1% - 56.2%], with a specificity of 93.6% [88.2% - 99.0%].\u003c/p\u003e"},{"header":"4.\tDiscussion ","content":"\u003cp\u003eThe findings of this retrospective study shed light on the prevalence and characteristics of incidentally discovered peripheral retinal lesions in elite athletes, particularly those engaged in contact sports. The discussion will delve into the implications of these findings, potential mechanisms underlying the observed associations, limitations of the study, and avenues for future research.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1.\u0026nbsp; \u0026nbsp;Prevalence of Peripheral Retinal Lesions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe observed prevalence of 36.4% among contact sport athletes is notably higher than previously reported rates in the general population\u0026nbsp;[7], suggesting a potential association between athletic participation and retinal abnormalities. Notably, boxing and rugby players exhibited a significantly higher prevalence of peripheral retinal lesions compared to athletes in non-contact sports, indicating a potential link between the intensity or nature of sports activity and retinal health. Although most of the eyes were emmetropic or close to emmetropia, adjustment for SE helped in reducing the potential bias due to the known association between peripheral retinal lesions and myopia.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2.\u0026nbsp; \u0026nbsp;Risk Factors and Mechanisms\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe increased risk of peripheral retinal lesions associated with participation in contact sports, warrants further investigation into the underlying mechanisms. One potential explanation could be the repetitive head and ocular trauma experienced by athletes during contact sports, leading to microtrauma or vascular changes in the peripheral retina. The biomechanical forces exerted on the eyes and surrounding structures during collisions or impacts may predispose athletes to retinal abnormalities, including tears, degeneration, or vascular lesions\u0026nbsp;[8]. Additionally, factors such as increased intraocular pressure, ocular contusions, and sudden changes in acceleration or deceleration may contribute to the development or exacerbation of peripheral retinal lesions in contact sports athletes\u0026nbsp;[9]. Further studies incorporating longitudinal assessments and advanced imaging modalities are needed to elucidate the specific mechanisms underlying the observed associations and to identify potential modifiable risk factors for preventive interventions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.3.\u0026nbsp; \u0026nbsp;Pathophysiological Implications\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe pathophysiology of peripheral retinal lesions can vary depending on the specific type, but in general, they often involve weakening or thinning of the retinal tissue. For example, lattice degeneration is characterized by areas of retinal thinning and degeneration, often with visible white lines or lattice-like structures, believed to be related to abnormalities in the development of the retina. Although available evidence indicates that most of the peripheral retinal degenerations should not be treated except in rare, high-risk situation, it is important for individuals, especially athletes, with peripheral retinal lesions to undergo regular eye examinations to monitor for any signs of retinal tears or detachment and to receive appropriate treatment if necessary\u0026nbsp;[10]. None of the latter complications were found in our population at the time of the screening; yet a longer follow-up is required to better assess this risk.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.4.\u0026nbsp; \u0026nbsp;Diagnostic Challenges and Clinical Implications\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnostic challenges highlighted by the study, particularly the limited sensitivity of UWF imaging in detecting peripheral retinal lesions compared to dilated fundus examination, emphasize the importance of comprehensive ocular assessment in athletes\u0026nbsp;[11]. While UWF imaging offers advantages in terms of field of view and convenience, its lower sensitivity may result in missed or underdiagnosed peripheral retinal abnormalities, particularly in high-risk populations such as elite athletes. Similarly, Khan et al. have found that UWF imaging had a limited interest in detecting treatment-requiring peripheral retinal lesions and 360-degree scleral depressed examination should remain the gold standard\u0026nbsp;[6]. Clinically, these findings underscore the need for regular ophthalmological evaluation, including dilated fundus examination, in athletes engaged in contact sports. Early detection and monitoring of peripheral retinal lesions are crucial for timely intervention and prevention of potential complications, such as retinal detachment or vision-threatening conditions. Additionally, awareness among sports medicine professionals, coaches, and athletes regarding the ocular risks associated with contact sports participation is essential for promoting ocular health and injury prevention strategies\u0026nbsp;[12].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.5.\u0026nbsp; \u0026nbsp;Limitations and Future Directions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSeveral limitations should be considered when interpreting the findings of this study. The retrospective design and single-center setting may limit the generalizability of the results to other athlete populations or settings. Additionally, the relatively small sample size and unequal distribution of athletes across sports disciplines, particularly in non-contact sports, may have influenced the observed prevalence estimates and associations. Thes limitations deserve to be addressed by conducting prospective, multicenter studies with larger and more diverse athlete cohorts. Longitudinal assessments incorporating advanced imaging techniques, such as wide field optical coherence tomography, may provide valuable insights into the progression and prognostic implications of peripheral retinal lesions in elite athletes. Furthermore, investigating potential protective factors, such as ocular protective gear or training modifications, may inform preventive strategies to mitigate the risk of ocular injuries and abnormalities in this population [13].\u003c/p\u003e"},{"header":"5.\tConclusions ","content":"\u003cp\u003eIn conclusion, the present study contributes to our understanding of peripheral retinal lesions in elite athletes, highlighting the elevated prevalence among those engaged in contact sports. These findings underscore the importance of proactive ocular health monitoring and injury prevention strategies in optimizing the visual health and performance of elite athletes. Further research endeavors are warranted to elucidate the underlying mechanisms, identify modifiable risk factors, and develop targeted interventions aimed at promoting ocular health and safety in sports.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- BCVA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Best Corrected Visual Acuity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- CI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Confidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- log MAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Logarithm of the Minimum Angle of Resolution)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- OD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- SD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Standard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- SE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Spherical Equivalent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e- UWF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e- Ultra-Wide Field\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eEthics approval:\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e Institutional Review Board (Rothschild Foundation Hospital Ethics Committee) approval was obtained for this study. The study was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e \u003cp\u003eAll authors declare that they have no conflict of interest.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eAuthors’s contributions\u003c/h2\u003e \u003cp\u003eNA interpreted the data and wrote the manuscript. HT, BK and NM reviewed the partients’ charts and collected relevant data. CLC analyzed the data. VV, SLG, SyBl contributed to the conception of the work. SeBr and SoBo performed ophthalmic examinations. All authors read and approved the final manuscript.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funds, grants, or other support was received.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and material:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOhana O, Alabiad C. Ocular related sports injuries. J Craniofac Surg. 2021;32:1606\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Singman E, McCulley T, Wu C, Daphalapurkar N. The Biomechanics of Indirect Traumatic Optic Neuropathy Using a Computational Head Model With a Biofidelic Orbit. Front Neurol. 2020;11:346.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoe MC, \u0026Ouml;zmert E, Baudouin C, Binadra A, Crafoord S, Jo Y, et al. International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports. BMJ Open Sport Exerc Med. 2023;9:e001644.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBianco M, Vaiano AS, Colella F, Coccimiglio F, Moscetti M, Palmieri V, et al. Ocular complications of boxing. Br J Sports Med. 2005;39:70\u0026ndash;4. discussion 70\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCap\u0026atilde;o Filipe JA, Rocha-Sousa A, Falc\u0026atilde;o-Reis F, Castro-Correia J. Modern sports eye injuries. Br J Ophthalmol. 2003;87:1336\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan M, Kovacs K, Guan I, Goldblatt N, Foulsham W, Wu A, et al. EVALUATING ULTRA-WIDEFIELD IMAGING UTILITY IN THE DETECTION OF TREATMENT-REQUIRING PERIPHERAL RETINAL TEARS AND HOLES. Retina. 2024;44:71\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampagnoli TR, Smiddy WE. Peripheral Retinal Abnormalities. In: Medina CA, Townsend JH, Singh AD, editors. Manual of Retinal Diseases: A Guide to Diagnosis and Management [Internet]. Cham: Springer International Publishing; 2016 [cited 2024 Apr 21]. pp. 243\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-319-20460-4_49\u003c/span\u003e\u003cspan address=\"10.1007/978-3-319-20460-4_49\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiovinazzo VJ, Yannuzzi LA, Sorenson JA, Delrowe DJ, Cambell EA. The ocular complications of boxing. Ophthalmology. 1987;94:587\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam MR, Dong P, Shokrollahi Y, Gu L, Suh DW. Finite Element Analysis of Soccer Ball-Related Ocular and Retinal Trauma and Comparison with Abusive Head Trauma. Ophthalmol Sci. 2022;2:100129.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. 2003;136:155\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeinmiller L, Gunton KB. A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome. Curr Opin Ophthalmol. 2016;27:407\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahan M, Purt B. Ocular Trauma Prevention Strategies and Patient Counseling. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Apr 21]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK580537/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK580537/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailoor S, Bhardwaj R, Nguyen TD. Effectiveness of eye armor during blast loading. Biomech Model Mechanobiol. 2015;14:1227\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4737487/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4737487/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOcular trauma is common in athletes, especially those practicing contact sports. Besides overt injuries, little is known about asymptomatic lesions resulting from repetitive head or ocular trauma. The prevalence of peripheral retinal lesions in elite athletes and the potential risk attributable to participation in contact sports were investigated in this monocentric retrospective study.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study enrolled 88 professional athletes, predominantly male (80%) with an average age of 26 years, who were screened at the Rothschild Foundation Hospital. All athletes had fundus examination and ultra-wide field retinal imaging (UWF) for both eyes, looking for lesions of the peripheral retina. The screening encompassed athletes from both contact and non-contact sports, with a majority (62%) engaging in contact sports, primarily rugby. The prevalence of peripheral retinal lesions among contact sport athletes was estimated at 36.4% [27.4% \u0026minus;\u0026thinsp;45.4%], significantly higher than that among non-contact sports athletes (6.1% [3.0% \u0026ndash; 11.8%]). The diagnostic efficacy of UWF imaging in detecting these lesions was limited, with a sensitivity of 45.2% [34.1% \u0026minus;\u0026thinsp;56.2%]and specificity of 93.6% [88.2% \u0026minus;\u0026thinsp;99.0%] compared to dilated fundus examination.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest that peripheral retinal lesions are more prevalent among high-performance athletes participating in contact sports, underscoring the importance of regular ophthalmological assessment in this population.\u003c/p\u003e","manuscriptTitle":"Analysis of the Retinal Periphery of High-Performance Athletes: Incidentally Discovered Lesions in Contact Sports Players","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-27 12:22:31","doi":"10.21203/rs.3.rs-4737487/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-07-27T05:15:34+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-26T01:23:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Sports Medicine-Open","date":"2024-07-22T07:54:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-22T01:33:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sports Medicine-Open","date":"2024-07-21T05:35:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sports-medicine-open","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"smoa","sideBox":"Learn more about [Sports Medicine-Open](http://sportsmedicine-open.springeropen.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/smoa/default.aspx","title":"Sports Medicine-Open","twitterHandle":"@SpringerOpen","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18691867-b277-4277-96d5-7f1be8e2e9f1","owner":[],"postedDate":"August 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-16T16:02:29+00:00","versionOfRecord":{"articleIdentity":"rs-4737487","link":"https://doi.org/10.1186/s40798-025-00869-y","journal":{"identity":"sports-medicine-open","isVorOnly":false,"title":"Sports Medicine-Open"},"publishedOn":"2025-06-11 15:57:54","publishedOnDateReadable":"June 11th, 2025"},"versionCreatedAt":"2024-08-27 12:22:31","video":"","vorDoi":"10.1186/s40798-025-00869-y","vorDoiUrl":"https://doi.org/10.1186/s40798-025-00869-y","workflowStages":[]},"version":"v1","identity":"rs-4737487","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4737487","identity":"rs-4737487","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}