By Alex Andrich, OD, FCOVD

Not much happens in sports until the visual system provides the hands, feet, and body with information about “where” to go and “when” to go.  Knowing where and when are key in sports.  Where is the puck?  When is it going to arrive?  Our visual system is the time machine for “where and when.”  Athletes must be quick and strong, but this does not help the where/when system.  Vision is the key to judging space and time.  One of optometry’s pioneers in sports vision, Dr. Robert Sanet, states “The accuracy and consistency of visual information processing determines the accuracy and available time for the appropriate motor (athletic) response.”

Many athletes and coaches are unaware of the tremendous role vision plays in athletic performance and are limited to the myth of visual acuity at the level of 20/20 or better being the main visual skill.  The field of sports vision has gained increased visibility in recent years with the advancement of sports vision training equipment for testing and training.  These modern tools for testing and training vision have allowed athletes to learn about the many skills involved in visual input and visual processing.

An athlete often has to compete in an overly complex environment that requires visual input regarding awareness of the ball or puck, other players, and the surroundings.  This visual information undergoes visual processing that results in motor output through movement of the hands, feet, and body.  Even athletes in static sports like shooting and archery must have highly refined visual skills to judge distance and direction.

Vision Skills of Athletes

Making the link between vision skills and sports performance begins with the understanding that athletes possess superior vision skills to non-athletes.  The next premise is that these visual skills can be trained.  There is a growing body of evidence in the optometric and neuroscience literature showing that vision training can improve skills like eye teaming, eye focusing, depth perception, and eye tracking.  The final premise is that improved vision skills lead to improved athletic performance.  This area of research has seen the most growth in recent years.  High level athletes are very in-tune with their mind and body.  Those that are committed to incorporating vision drills into their normal workout will see the benefit of improving their vision.  Most athletes and coaches are unaware of the multiple visual skills involved in athletic performance.  They need to be educated that these visual abilities can be trained, and that improved visual abilities will lead to improved sporting performance.  There are over twenty visual skills needed to perform at a high level in sports.  Listed below are several key vision skills used by athletes.

Static Visual Acuity: This is a measurement of how clearly the athlete can see in the distance and at near while standing still.  This is the most common measurement of visual acuity; however, most sports require excellent visual acuity while the athlete is in motion.  Archery would be an example of stationary visual information where the visual image is steady.

Dynamic Visual Acuity: This measurement of acuity considers movement of the athlete in a non-static environment.  Although the eyes cannot always see fast moving objects perfectly clear, this is a skill that can be improved.  An example of a non-static visual demand would be the moving visual information ski racers have to see and process as they go down a steep and icy racecourse.

Oculomotor – Saccades: The athlete must be able to accurately move the eye from one point to another.  Good peripheral awareness is a key component to an accurate saccade.  A hockey player must scan the ice to find a player to whom to pass the puck.  Making an accurate saccadic eye movement in hockey can help the player get their feet in better position to make a more accurate shot.

Binocularity (eye teaming):  An efficient binocular system supports the precision of stereopsis (depth perception) and is the result of both eyes seeing clearly while being in perfect alignment.  The athlete must have both eyes working simultaneously in synergy.  It takes only a very small inefficiency in alignment to throw off binocularity and stereopsis.  This deviation could result in conflicting information coming through the two eyes that misguides the body.  When the athlete does not have efficient binocularity, the brain can suppress visual information resulting in the brain getting less data than it needs to make accurate spatial judgements.  Inaccurate spatial judgement will then hinder performance.

Peripheral Awareness:  This is the athlete’s ability to be aware of what is around them in space and process data from peripheral vision.  Low resolution information such as color, motion, and shape can all be detected from the peripheral visual field.  Sports vision exercises can be used to teach athletes how to maximize their field of vision and expand awareness of their surroundings.  When an athlete learns to detect peripheral information, their reactions are quicker and more accurate, giving them an advantage over athletes who are reacting to a smaller visual field.

Visual Skill Performance Testing

The purpose of visual skill performance testing is to identify athletes with visual skill deficits.  Sports vision testing should be an integral part of every team’s total health program.  It also allows coaches to obtain a better understanding of each athlete’s performance so they can put the best athletes on the field or ice.

Testing of visual skills can be performed on-site in the athletic facility or in the optometrist’s office.  The decision on where to perform the testing will depend on the optometrist’s goals and some logistics.  On-site testing is a great way to see a lot of athletes and identify those that would benefit from a comprehensive in-office evaluation.  An advantage to on-site testing is that the athletes are already present at the facility.  An in-office comprehensive evaluation will allow the optometrist to get a detailed picture of the athlete’s visual skill functions and the ability to plan a more comprehensive vision training program. 

The athlete’s refractive status and ocular health are vital areas of performance.  Proper glasses or contact lenses are necessary to maximize visual skills like acuity, contrast sensitivity, and stereopsis.  Often an athlete will wear a contact lens for a small refractive condition.  It is encouraged that athletes wear their eyewear or contact lenses for all athletic activities, including practices.  Daily disposable contact lenses are preferred by most athletes.

Visual Skill Training

Vision training is based on the specific visual skills that are needed for the athlete in their position or sport.  It is also based on the performance vision testing results.

Success in most sports requires four key ingredients: high level athleticism, excellent mechanics, a strong mental game, and good vision.  Athletes, coaches, and trainers understand athleticism, mechanics, and mental game well, but very few have more than a basic understanding of vision.  The myth of 20/20 visual acuity is still fairly common in sports.  When we speak of vision beyond 20/20, that may be confused with eyesight sharper than 20/20.  Once the concept of vision being something deeper than 20/20 visual acuity is introduced, addressing the many visual skills need to perform at a high level, the first question from many is “can it be trained?”  Athletes and coaches can easily relate to the visual skills needed in their sport when they are explained in terms that apply to their specific sport.

In a key study at the University of Cincinnati, Clark et al.¹, showed that a vision training program for the university baseball team can improve batting performance.  It is also noted that “High performance vision training can be instituted in the pre-season and maintained throughout the season to improve batting parameters.”

Vision Rehabilitation

This area deals with recovery from sports related concussions.  Many athletes will require vision rehabilitation after a concussion.  Some of the most commonly seen areas of visual skill deficits after a concussion are eye tracking, eye teaming, eye focusing, and visual-vestibular integration.  Research Ciuffreda et al. shows that most individuals who suffer a traumatic brain injury (90%) show oculomotor dysfunction².  Because of the vast neural visual networks involved, it is common to have visual symptoms after a concussion that can prevent the athlete from safely returning to play.   

One of the first sports vision rehabilitation cases to get national attention was the work that Dr. Paul Harris did with Brian Pothier, a hockey player in the NHL.  Brian suffered a concussion in 2008 and spent 3-4 months working closely with Dr. Harris.  Brian authored an article describing his journey of vision rehabilitation ³ and was also featured in a 1 on 1 interview with Dr. Harris on the iheartvt.org platform. ⁴ This type of national attention helped put a spotlight on neuro-optometric rehabilitation.

Clark et al. found that initiating vision training team wide reduced the incidence of concussion in players who participated in vision training compared to those players who did not receive vision training. ⁵ The sports vision optometrist plays a key role on the concussion team and collaborates closely with the team physicians and athletic trainers.

Summary

The future of sports vision training is expanding and very bright.  Advances in technology will see all athletes incorporating virtual reality and augmented reality into their training.  The sports vision optometrist functions as both a consultant on vision, and a vision coach. Many teams use coaches for strength, speed, nutrition, etc.  Having a vision coach working on sport specific vision skills will give the athlete and team a competitive edge. 

Dr. Andrich is a graduate of The Ohio State University College of Optometry and is in private practice in Cleveland, Ohio. In addition to serving as the immediate past-president and co-founder of the International Sports Vision Association, Dr. Andrich is a vision coach for the Cleveland Monsters and Cleveland Indians.

Sidebar

The International Sports Vision Association (ISVA) is an interdisciplinary group of optometrists, ophthalmologists, and athletic trainers dedicated to advancing the field of vision training for athletes of all ages and levels to help them achieve peak athletic performance.  Website:  www.sportsvision.pro.  Email: info@sportsvision.pro. Follow ISVA on Facebook and Twitter (@SportsVisionDrs)

1. J.F. Clark, J.K. Ellis, J. Bench, J. Khoury, P. Graman.  High performance vision training improves batting statistics for University of Cincinnati  baseball players.  PLoS One 2012  7;1:e29109
2. K.J. Ciuffreda, N. Kapoor, D. Rutner, I.B. Suchoff, M.E. Han, S. Craig. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.  Optometry 2007;78:155-61
3. B. Pothier. Editorial: Traumatic Brain Injury and Vision Therapy: A Personal Perspective. Optometry & Visual Performance 2015;3:104-105
4. B. Pothier. August Kick-off Event – Vision Therapy Changes Lives – One on One with Brian Pothier.  Iheartvt.org August 1, 2020
5. J.F. Clark, A. Colosimo, J.K. Ellis, R. Mangine, B. Bixenmann, K. Hasselfeld, P. Graman, H. Elgendy, G. Myer, J. Divine.  Vision training methods for sports concussion mitigation and management.  J Vis Exp 2015;99:e52648