Sports Vision. Vision Care for the Enhancement of Sports Performance

313 Pages·2007·14.437 MB·English

by  Graham Erickson, OD, FAAO, FCOVD (Eds.)

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SPORTS VISION:VISION CARE FOR THE ENHANCEMENT OF SPORTS ISBN:978-0-7506-7577-2
PERFORMANCE
Copyright © 2007 by Butterworth-Heinemann,an imprint ofElsevier Inc.
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responsibility ofthe treating practitioner,relying on independent expertise and knowledge ofthe patient,
to determine the best treatment and method ofapplication for the patient.
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ISBN:978-0-7506-7577-2
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Contributors
Jason Brumitt,MSPT,SCS,ATC,CSCS,OD
Laboratory Instructor
School ofPhysical Therapy
Pacific University
Forest Grove,Oregon
Peter Shaw-McMinn,OD
Assistant Professor
Southern California College ofOptometry
Fullerton,California
v
To my wife, Dina, and children, Alexander and Maya,
for their enduring love and support,
and to students and practitioners
of sports vision for their inspiration
Preface
The role of visual performance in sports has received considerable attention over the years.
With the increasing participation rates in sports and recreational activities,interest in vision
care services for athletes has intensified among eye care practitioners and sports personnel.
Sports vision can be defined as vision care and consultation designed to protect,correct,and
enhance vision to make sports and athletic competition safe,enjoyable,and more successful.
It encompasses a broad scope of professional skills,including the prevention and manage-
ment ofsports-related eye injuries,the determination and delivery ofappropriate refractive
correction,the determination ofappropriate protective eyewear,the understandingof filters
and their potential application in sports, assessment and remediation of functional vision
inefficiencies, assessment of sports-specific vision skills, vision training to enhance visual
performance,and consultation with athletes and other sports personnel.Vision is the guid-
ing sense for most sports performance,and sports vision is one ofmany disciplines that can
contribute to the achievement ofpeak performance.
In searching for the role sports vision may play for athletes, previous surveys have
suggested that there remains an unmet need in vision care services,with an increasing interest
in the sports vision field.As athletes continue to reach new heights,many efforts have been
made to enhance performance by optimizing skills in every area pertinent to a given sport.
The surveys have shown both an interest by team personnel and optometrists to include
vision screenings,proper ocular health care,refractive evaluation and correction,and remedial
and/or enhancement vision training to optimize visual performance.However,the available
literature in this area is scattered and varies tremendously in quality.
Personally,I have been involved in both the provision ofsports vision services in a variety
ofclinical settings,and the teaching ofsports vision to optometry students and practitioners.
This combination of experiences obligated me to not only develop the requisite clinical
skills,but also to develop an understanding ofthe relevant professional and research literature.
For teaching purposes,I have found that the published texts on sports vision are either very
limited in scope, out of date, or out of print. This text reviews the main elements of the
vision care services provided to athletes by eye care practitioners,all ofwhich begin with an
analysis ofthe visual demands that are critical to success in sports.I have attempted to build
a foundation from vision science research to guide the application of clinical care, an
evidence-based approach.I am indebted to the many practitioners and researchers who have
shared their ideas and insights on the burgeoning area ofsports vision,for the concepts and
procedures discussed in this text are the culmination of those collective contributions.
Although there are many areas where numerous questions remain unanswered,the combi-
nation ofcareful task analysis,review ofrelated research findings,and logical deduction can
guide the practitioner in determining appropriate vision care.
There are several items on the accompanying CD that can help the practitioner to
incorporate sports vision services in a variety of clinical settings. Although this text is
viii
Preface ix
primarily addressed to eye care practitioners,other sports personnel may find useful infor-
mation for assisting athletes with visual performance needs.
The pursuit of sport and recreational activities is a multibillion-dollar-a-year industry
that has seen tremendous growth in the past 30 years.As I like to point out to students and
practitioners,almost every patient is a sports vision patient.The ability to understand their
needs and provide specialty services to meet these individual needs is a fundamental attribute
ofevery successful practice.
Graham B.Erickson,OD,FAAO,FCOVD
Acknowledgments
I gratefully acknowledge the following individuals for their contributions to the develop-
ment ofthis publication:Drs.Bradley Coffey,Alan Reichow,Karl Citek,Stephen Beckerman,
Steven Hitzeman, Alan Berman, Lorne Yudcovich, and Dina Erickson. I thank Pacific
University for the encouragement and support on this project,and the Vision team at Nike
for their conceptual and pragmatic assistance.My students and research assistants have my
enduring appreciation for the role each of them plays in my professional growth. I thank
Christie Hart and Laura Kudowitz of Elsevier for their assistance and flexibility in develop-
ment and production.
x
1
Introduction to Sports Vision
CHAPTER OUTLINE
Overview of Terminology Overview of a Clinical Model of Sports Vision
Historical Perspective The Future of Sports Vision
Have you ever wished you could improve your batting average,lower your golfscore,or just
play your favorite sport better? Most people who participate in sporting activities love to win
or at least improve their performance.Athletes at all levels ofcompetition spend a substantial
amount ofmoney on sports,including equipment and clothing.Yet many performances that
fail are not caused by poor equipment or clothing,or even the wrong physical movement,
but by the movement being performed at the incorrect time or in the incorrect place.
A significant percentage of the general population in developed nations participate at some
level in sporting activities.The National Sporting Goods Association produces yearly estimates
ofparticipation by sport and gender for the United States (available at www.nsga.org).The eye
care practitioner must recognize that sports participation crosses all lines ofage,gender,race,and
socioeconomic status;every patient is potentially a sports vision patient.In addition,a significant
percentage ofthe population may not actively participatein sports but are avid spectators.
Considerable debate has taken place concerning the role ofvision in sports.Vision is the sig-
nal that directs the muscles of the body to respond. The legendary football coach Blanton
Collier is credited for developing the concept that “the eyes lead the body.”1Vision provides the
athlete with information regarding whereand whento perform.Superior size,strength,speed,
and agility cannot completely make up for inefficient processing of visual information. For
example,ifthe eyes do not tell a batter where the ball is,he or she is not going to hit it no mat-
ter how perfect the swing.Even for the discriminating spectator,excellent visual functionallows
improved opportunity to enjoy watching sports.Little debate exists that vision is a critical fac-
tor in sports performance;however,conflicting evidence shows that successful athletes possess
superior visual function that allows them to see and perform better than novices in sports.
The athletic community should be educated about the aspects of vision that potentially
affect sports performance.To clearly communicate these aspects,the following visual elements
should be discussed:
● Sight:The clarity ofthe image on the retina and ocular health
● Motor/sensory:Fixation stability and eye movements,accommodation,vergence,and fusion;
visually guided motor performance
● Information processing:Quick and accurate visual processing,interpretation,and decision making
1
2 CHAPTER1 Introduction to Sports Vision
Understanding the relevance of these aspects to performance provides an avenue for
effective communication ofspecific vision care recommendations.A better-informed sports
community benefits by improved access to services that potentially make sports and athletic
competition safe,enjoyable,and more successful.
OVERVIEW OF TERMINOLOGY
The term sports visionhas been used to describe many vision care services provided to athletes.
The mission ofthe American Optometric Association Sports Vision Section is to advance the
quality and delivery of optometric sports vision care through education,injury prevention,
and enhancement of the visual performance of athletes.Practitioners working in this area
usually are involved with one or more ofthe following professional activities2:
● Prevention and management ofsports eye injuries
● Assessment and remediation of functional vision inefficiencies that may negatively impact
competitive consistency
● Specialized contact lens services with emphasis on environmental factors in sports,position
ofgaze factors,emergency care,and attainment ofmaximal visual acuity
● Performance-based ophthalmic eyewear services that address visual and environmental demands
● Assessment ofspecific sports-related visual abilities
● Enhancement training of specific visual abilities considered to be essential for competitive
consistency for a specific sport activity
● Consultation with athletes,coaches,trainers,and teams regarding visual factors and strategies
related to consistent peak athletic performance
Many in the global community are dedicated to the pursuit ofathletic excellence.A critical
but often neglected aspect ofpeak human performance is vision.The information presented
in this text should help stimulate the inclusion ofthese specialized services in the care ofathletes,
no matter what level ofsports participation.
In North America, the term sports vision has been associated with vision therapy
designed for the enhancement of sports performance. The areas of sports vision defined
above clearly demonstrate that many ofthese services are basic primary vision care services
that are modified to address specific task demands.All eye care practitioners should consider
visual performance factors when providing vision care services to athletic patients.
HISTORICAL PERSPECTIVE
The use of special eyewear for sports is perhaps the oldest application of vision factors to
performance.Daland described the early use ofstenopeic slit masks by Eskimos for hunting,3
and many other special-purpose optical appliances have been described in the literature.4
Optical protection from solar radiation and glare have been used to some degree for
centuries.The use of optical refractive compensation for sports has not been as frequently
used,most likely for a combination ofpractical and aesthetic reasons.The available eyewear
was not typically appropriate for use in sports;contact lens technology did not emerge as a
reasonable option for most athletes until the later halfofthe twentieth century;and refractive
surgery options did not become advantageous until the late 1990s. Today the benefits of
significant advances in technology and designs for the correction and protection of vision
are enjoyed by athletes (see Chapter 6).
CHAPTER1 Introduction to Sports Vision 3
The evaluation ofvision skills in athletes has also been an area ofintense interest.The ear-
liest literature citation found is an account of the sensory and motor gifts of the legendary
baseball player Babe Ruth in 1921.5This report was followed later by an article discussing the
role ofvision in baseball.6These early articles produced suggestions for procedures to assess
performance potential in baseball on the basis of vision skill analysis.Interestingly,debate
in the literature exists concerning the actual vision profile of the great Babe Ruth.Despite
the early report that Ruth had eyesight that was 12% faster than the average person,5a 1991
article reported that an ophthalmologic examination revealed amblyopia ex anopsia in his
left eye.7The potential role of depth perception in batting is challenged by these discrepan-
cies in Ruth’s visual status;either he performed so well because he had superior vision skills,
or he was successful despite having degraded stereopsis as a result ofa congenital amblyopia.
Although no definitive resolution can be made from these contradictory reports,some have
speculated that the unilateral vision loss was likely the result of a complication of his
nasopharyngeal carcinoma rather than an undetected congenital condition.8 The exact
role of vision in sports performance is still hotly debated, and many vision evaluation
procedures have been suggested over the years in an attempt to discover the nature of this
aspect ofsports performance.
Because vision skills are generally recognized as a critical element to most sports performance,
significant interest has been expressed in improving sports performance by using training
procedures to enhance vision. Many of the visual attributes that have been identified as
important in sport are amenable to training.The relevant questions are whether sport-specific
visual abilities can indeed be trained and whether any improvements in visual skills transfer
to improved sports performance by the athlete. Although the literature has few reports
supporting sports vision training,and these reports often have significant flaws,enhancement
of visual skill performance can be logically predicted to provide the athlete with a potential
advantage when preparing for competition.
The increasing interest in sports and the role of vision in sports has produced the
impetus for the formation of organizations to facilitate professional communications.The
United States was the first to form an entity through the establishment of the Sports
Vision Section of the American Optometric Association (AOA) in 1978.Like many similar
organizations,the AOA Sports Vision Section affords practitioners a venue for continuing
education,updates through an e-newsletter,a referral network through a member directory,
and access to professional materials such as the Sports Vision Guidebooks and the Sports
Vision Bibliography.The section has also been active in interprofessional relations with other
organizations, such as the U.S. Olympic Committee, Special Olympics, Amateur Athletic
Union (AAU) Junior Olympics, American College of Sports Medicine, National Athletic
Trainers’Association,and the National Collegiate Athletic Association.The section provides
practitioners and students opportunities to participate in sports vision activities, such as
the sports vision screening program at the annual AAU Junior Olympic Games.Ultimately
the AOA Sports Vision Section offers practitioners an opportunity to collaborate and
advance the profession.
Organizations dedicated to sports vision have also been created outside the United States.
The Canadian Association of Optometrists formed a Sports Vision Section in 1987, the
European Academy of Sports Vision was formed in Italy in 1989,Optometrists Association
Australia established its Sports Vision Section in 1992,and the Sports Vision Association was
formed in the United Kingdom in 1993.4These organizations perform similar functions to
4 CHAPTER1 Introduction to Sports Vision
the AOA Sports Vision Section in their respective regions and have helped facilitate the
growth ofsports vision globally.
In 1979 Pacific University College of Optometry began providing an elective course on
sports and recreational vision in the optometry curriculum. All schools and colleges of
optometry in North America now offer some degree ofeducation in sports vision as part of
the curriculum.The AOA Sports Vision Section has been supplementing this education with
an education program called Sports Vision University. Sports Vision University provides
optometry students the opportunity to receive a comprehensive overview of the many
aspects of sports vision in one course delivered by two recognized experts in sports vision
(one academic practitioner and one private practitioner). The course covers the topics of
correcting and protecting athletes,managing sports eye injuries,evaluating visual performance
skills in athletes,enhancing visual performance skills in athletes,and marketing and building
a sports vision practice.Every 4 years the program will be delivered at each of the schools
and colleges ofoptometry in North America.
OVERVIEW OF A CLINICAL MODEL OF SPORTS VISION
Vision care for athletes should begin with the identification ofvisual factors that potentially
contribute to peak human performance so that these specific functions can be isolated and
measured ifpossible.The visual demands critical to success in sports can vary tremendously.
Chapter 2 details an approach to the task analysis process,a process essential to providing
appropriate vision care for athletes in any sport or position. Because sports performance
generally requires the athlete to process visual information and execute an appropriate
motor response,the practitioner should also understand how visual information is processed
to understand the exact nature of the processes occurring in skilled motor performance.
A model ofinformation processing in skilled motor performance is presented in Chapter 3 to
provide a useful approach for understanding the relevant aspects ofsports performance.
Once the practitioner has identified the vision factors essential to performance of the
visual tasks critical for success in a sport, an evaluation should be created to measure the
quality of those skills in the most appropriate,accurate,and repeatable manner.The visual
skills that correlate with successful sports performance have not been definitively identified
yet, so the practitioner must rely on the available literature and professional judgment to
determine the most appropriate evaluation for each athlete.Chapter 4 provides an evidence-based
description ofeach potential vision assessment area and the relative value ofeach assessment
area in an evaluation. Chapter 5 presents recommendations for performing team vision
screenings and the unique challenges associated with providing vision care to a team.The
results ofa screening or evaluation should be summarized for the patient,and a performance
profile is recommended in Chapter 5 to highlight areas ofstrength or weakness and communicate
vision recommendations.
A fundamental role ofthe vision care practitioner is to provide expert consultation services
to athletes regarding vision correction and the potential uses and benefits of ophthalmic
products.Each athlete has specific variables that will affect ophthalmic recommendations.
The gender,age,level ofparticipation,combination ofsports activities,and previous history
ofproduct use influence the choice ofavailable options.Some athletes seek a single product
to meet all visual performance needs,and others seek the optimal products for a variety of
highly specific uses. The eye care practitioner should advise athletic patients about the