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- What is Sports Vision?
- What is a Sports Vision Specialist?
- Goals of Sports Vision
- Providing Sports Vision Services
- Conducting a Sports Vision Screening
- Conducting a Complete Sports Vision Examination
- Special Ocular Risks in Sports
- Treatment Options for Athletes with Vision Problems
- Marketing your Sports Vision Practice
- Sports Vision Publications and References
- Appendix 1. Sources for Sports Vision Equipment
- Appendix 2. Suggested Case History Form
- Appendix 3. Suggested Contents of Ocular Trauma First Aid Kit
The practice specialty of sports vision has evolved into a diverse application of optometric, psychological, and medical skills. Not surprisingly, there are relatively few practitioners who have the backgrounds that allow them to offer a full range of sports vision services to athletes.
This course will describe some of the requirements for working with athletes and will provide an overview of ways in which the sports vision specialist can enhance the performance of his or her athlete patients.
Sports vision services typically include:
- Detection of visual problems that can affect performance,
- Correction of visual acuity and refractive error problems,
- Enhancement of ocular skills through vision training,
- Protection from ocular injury, and
- Assessment and management of any sports-related ocular traumas that may occur.
The basic premise of sports vision is that the eyes feed information to the brain, which interprets it and then activates the arms, hands, legs, feet, and balance system. This happens within a fraction of a second, over and over again for the duration of the game. When the eye’s message is inaccurate, incomplete, or not delivered at the correct time, performance can suffer.
Figure 1. Accurate and timely delivery of visual information is crucial for performance in all sports.
Many people call themselves sports vision specialists, which can mean as little as fitting contact lenses or providing protective eyewear for athletes, or it can mean that the doctor provides a comprehensive sports vision analysis along with vision enhancement training. The important thing is that sports vision specialists have the common goal of helping athletes to maximize their potentials and perhaps gain the elusive competitive edge.
There are some personal responsibilities for a doctor who provides sports vision services:
- There must be sincere interest in sports. If there is little of no interest, it cannot be faked. The lack of knowledge and interest will show right through and credibility will be lost.
- Doctors must know the "rules of the game" for the sport in which the patient will be competing. This information can be obtained by reading or watching the sport, either on television or in person. The best thing would be to play the sport yourself. That will give you first hand knowledge of how the game is played and what visual skills are needed to excel.
Sports vision specialists evaluate the following areas:
- Eye health We want to offer the athlete ways to protect his or her eyes that will have the least effect on sports performance. This might involve providing protective eyewear to prevent any eye trauma during the game; providing contact lenses or goggles to protect from ultraviolet (UV) radiation; or providing punctal plugs to enhance the tear layer and prevent dryness during an athletic event. The bottom line is that we are the one’s responsible for making sure the athlete’s eyes are safe and protected.
- Refraction The second goal of sports vision specialists is to provide the proper refractive correction that will allow the athlete to function with maximum visual acuity and contrast sensitivity. We have to be familiar with all types of vision correction including glasses, sports goggles, sports specific contact lenses, corneal refractive therapy/orthokeratology, and refractive surgery. We also have to know the advantages and disadvantages of each of these modalities for each sport in which the athlete might participate. It is further important to recognize that there is no one approach that works for every athlete and to tailor the application of vision correcting lenses or procedures for each particular sport and team/field position.
- Identify Problems The third goal of sports vision is to provide a series of tests that will help to identify certain visual conditions that may be affecting performance during a game. We need to have a battery of tests that will help to determine whether an athlete has a visual performance weakness. These tests need to evaluate: visual acuity, contrast sensitivity, depth perception, eye-hand-foot coordination, ocular motilities, accommodative flexibility, peripheral awareness, peripheral reflexes, speed and span of recognition, anticipation timing, and visual concentration.
- Interpretation of Information Interpretation of information obtained from testing is critical in determining whether the athlete’s eyes are affecting or limiting performance. Not only do we need a way detect visual limitations, but we need to have ways of rehabilitating these vision-limited skills. So, a fourth goal is to provide sports vision enhancement training to the athlete. A structured training or enhancement program is a definite part of the overall services that a sports vision office needs to provide.
As a sports vision provider, you need to have knowledge of all available treatment options, and you need to stay current on changes in technology to help the athlete excel.
If you want to add sports vision services to your practice, you need to identify the top participation sports in your area, and then find ways to market your services to potential patients who participate in these sports. Speak to runner’s clubs, the YMCA, the YWCA, fitness clubs, little league coaches' conferences, pistol shooting organizations, golfers' meetings, etc. It’s limitless to whom you can speak regarding the services you have to offer.
Time and Space Requirements
What are the time and space requirements needed to practice sports vision? Many sports-related tests can be done right in the exam room. They don’t have to take very much time or require special equipment, but they can provide very valuable information. Something as simple as a Brock string, dominant eye determination, or Maddox rod phoria assessment can be done in a matter of minutes right in the exam room.
Other tests require a little bit more space and may have to be done in another room such as a vision therapy room or a room specifically set aside for sports vision. Some doctors have very limited space but others have access to a large gym-type facility where all of the equipment is set up so the athlete can move from one station to the next. This is ideal, but not necessary to practice sports vision.
If a large room is available, then a careful plan is required as to where all of the equipment should go. Floor space for walking rails and balance boards, and wall space for instruments and testing equipment should be considered when planning a sports vision room.
When sports vision testing is carried out at a location away from the clinic, e.g., on the practice field on in a gymnasium, it is necessary to adapt testing equipment to the space allotted. Testing in strange places, such as the visiting team locker or shower room is relatively common. Things should be planned so that there is a smooth flow from one test to the next, with adequate lighting and clear markings as to where the athlete should stand during testing.
Sports Vision Equipment
The amount of money required to establish a sports vision practice can be as little as a few hundred dollars to get some basic vision therapy equipment for testing general skills, or it can be thousands of dollars to purchase high tech equipment that will provide detailed information about the athlete's visual skills. (A list of equipment suppliers is provided as Appendix 1.)
There are many instruments that can be used in a sports vision work-up that do not necessarily have to be sophisticated or expensive. A handful of simple tests using very inexpensive equipment can reveal significant information regarding how an athlete’s eyes are affecting his or her performance. If further information regarding the role of visual skills on the playing field is required, specialized sports vision equipment can be purchased or the athlete can be referred to a clinic where more equipment is available.
The battery of tests provided for an athlete should relate to the sport in which the he or she participates and the individual needs/concerns of the athlete. Athletes are highly goal-oriented, therefore the instruments should be as closely related to the sport as possible. Existing instruments can be adapted to meet the needs of each sport. The most effective testing should be performed in free space and in the athlete’s particular position (e.g., in the crouch position for a hockey goalie).
When undertaking a sports vision evaluation, an explanation should be given regarding the test being done and how it relates to the particular sport. This will help the test to make sense to both the athlete and the coach, and it will help to ensure maximum performance output from the athlete being tested.
How do you learn to use the sports vision equipment you have acquired and further your knowledge in the area of sports vision?
- You should read as much as you can about sports vision. There are many books and journal articles on this topic, some of which are listed in the References section of this course.
- You can attend sports vision conferences and meetings. Many times, you can get hands-on experience with equipment at these meetings.
- Perhaps you have a friend or colleague who practices sports vision. See if you can help him or her with a sports vision screening.
- The American Optometric Association Sports Vision Section also has sports vision screening projects that you can participate in. There is no better way to learn than to jump right in and work with athletes at one of these projects.
- You can go on-line and surf various sports and sports vision Web sites to get as much information as possible. There is a huge amount of information on the Web.
Sports vision evaluations can be provided either in the form of screenings or complete examinations. Although there can be a considerable overlap between these two modes of care delivery, they will be discussed separately.
Setting up a Screening
Holding a sports vision screening is one of the best ways of letting people know what a sports vision practice can offer.
Who should you contact to set up a screening?
- On the high school level, contact coaches and athletic directors.
- On the collegiate level, contact coaches, athletic directors and trainers.
- On the professional level, cover all bases and write to the owners, managers, and trainers. Trainers are really the key people at this level. They will be the ones that you will be working with because trainers coordinate all aspects of the athlete’s health.
Sometimes the hardest part of testing a team is convincing the coach regarding the importance of what you have to offer. Coaches tend to want to know everything and may be leery because they don’t know how sports vision fits in to their programs.
It would be very beneficial if you can run the coach or trainer through the sports vision work-up first. If this is not possible, then bring some hands-on equipment with you when meeting with them.
You must also relate to the specifics of the sport to the particular visual demands associated with it. For example, an archer should not be trained in peripheral awareness. Instead concentration and visualization should be emphasized.
Some other things to consider:
- Work with the coach's schedule and don’t interfere with his or her routine. You may have to test players between drills.
- Don’t be a threat to the coach and pretend that you have all of the answers for the team.
- If providing therapy or enhancement, don’t present the trainer or coach with 50 things to do. Just suggest one or two specific things to do first, and then add more later.
- If you have a player who has a problem that might be helped by training, it’s best to work with him or her in the off-season. Athletes can be very superstitious. If possible, don’t interfere with their concentration during the season. They probably have already compensated for the problem in their own way and you may have to break down this compensation before teaching new skills.
- Be careful how you present your program to the player. Don’t make it sound like he or she has a major problem. It may shake confidence and put doubts in his or her mind. Point out that things are good now but that training might make him or her even better.
- The bottom line is getting the coaches, trainers, and definitely the players to develop confidence in you. Then and only then will you be able to provide a worthwhile service.
How to Conduct a Screening
Sports vision screenings can be done in one of two ways: in the office or on location in the field.
In the Office
In the office, stations can be set up and staff members will be available to assist in testing. In this situation, to minimize confusion and maintain a smooth flow, we generally run 3 athletes at a time through the different testing stations.
Advantages of in-office screening include:
- All of the equipment is at your fingertips allowing a more in-depth analysis. Also extra tests beyond what was planned for are readily available.
- It gets the athlete to know the office location for any future eye care services that might be needed, and for referrals.
- It shows the athlete (and his or her parents) that the practice offers other things besides sports vision (e.g., contact lenses, low vision services, etc.)
Screenings On-Location in the Field
Sports vision screenings can also be done on-site at locations such as the school gym, playing field, or locker room. This may be more convenient for the team to fit it into its schedule. It also shows the coach or trainer that you take the screening seriously and that you are flexible and willing to accommodate the team within your practice’s busy schedule.
An advantage of screening on location is that other people in the area, such as parents, secretaries, administrative staff, etc., can see what is being done and may take an interest in your services.
However, there are also problems associated with screenings away from your office. For example, you will probably have to be more flexible in the order of testing players. What generally happens is that a group of athletes comes by between their practice sessions or drills for testing. There may be time spent just waiting around for the players to come, but once they arrive, you must be ready to go and get them through quickly so that they can quickly return to their practice. Another disadvantage of on-site testing is that not all of the equipment can be taken along, so there might be slightly less in-depth testing provided. However, athletes who have significant problems detected during a screening can be referred to your office for more extensive evaluation.
When the screening project is over and the results have been analyzed, prepare a straight-forwarded, easy to understand report for the coach and trainer. Have explanations for each testing area and how it relates to the specifics of the particular sport. Describe those players who have particular strengths and weaknesses. Then make realistic recommendations that the coach, trainer, parents - and particularly the athlete – can understand. It may is necessary and desirable to make somewhat different reports and recommendations to coaches, trainers, athletes, and parents. Allowing the coach or trainer to interpret screening results to athletes and parents can often be a good plan if the coach or trainer really understands what your screening has revealed.