Although tinted eye shields on football helmets are "flashy" and are thought to give those who wear them a competitive advantage because their opponents may not be able to follow their eyes, their use can be dangerous if not medically necessary.

The use of eye shields in football is becoming a more common part of the protective equipment used by these athletes. In 1998, the NCAA Football Rules Committee enacted a rule that stated that all protective shields must be clear. The following season, this rule was met with some concern because some institutions' sports medicine staffs believed that some athletes required the use of a tinted shield.

Subsequently, the football rules committee allowed for an exception to the rule that required the submission of a one-page waiver form and any other supporting documentation. For athletes with medical problems that necessitate a tinted shield, the request is often granted without much delay, and the process is fairly straightforward.

It may not be obvious why the use of a tinted shield should be restricted. However, the concern voiced by athletic trainers and other medical professionals caring for injured athletes is that if a tinted visor is worn, it makes it difficult to evaluate an athlete's eyes. This, in turn, makes it more difficult to diagnose head and neck injuries accurately. For this reason, the use of these tinted shields is restricted to athletes who demonstrate a valid medical necessity for them.

It is important to note that most individuals have some degree of difficulty with glare and sensitivity to bright light, so a simple diagnosis of photophobia in the absence of additional symptoms or sequelae is not enough to warrant the use of a tinted shield.

If an athlete's eyes simply need protection from trauma, such as in the case of one eye with significant visual loss necessitating the protection of the other eye, then a transparent shield is recommended. However, athletes who already have sustained eye trauma or have other medical conditions requiring a tinted shield will most often have their requests granted.

Submitting a request for the use of a tinted shield is not difficult, and requires that an eye specialist, preferably an opthamologist, examine the athlete and provide documentation regarding the eye problem. This information is then submitted along with the waiver form to the NCAA, and a physician representative from the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports reviews the request.

The number of requests has increased steadily over the past several years, including a nearly 100 percent jump from 2001 to 2002 (65 to 125). Athletes need to submit requests every year with an updated examination and required documentation. If an initial request is denied, additional information may be provided and the request can be reviewed again.

While the football rules committee understands the necessity for some football players to wear tinted eye shields, it also is committed to the goal of restricting their use to protect the overall health and safety of these student-athletes.

Margo Putukian is team physician at Pennsylvania State University and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.