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4/13/18 Financial Disclosures Sports Vision 101 -C. Light Technologies • Clinical Research Consultant, NIH SBIR Jacqueline Theis, OD, FAAO COA OptoWest – Sacramento April 15, 2018 Who is an Athlete? Outline Who defines themselves as an athlete versus who we consider an athlete can vastly differ • Lets Talk Sports - How sports can be a practice builder? – Epidemiology of athletes What defines a sport? • Physical strength – Role of athletics for kids • Speed • Endurance • What is Sports Vision? – The Basics – Primary Care How proficient must a person be to • Refractive considerations be considered an athlete? • Ocular health in athletics – Advanced – Tertiary Care • Sports performance enhancement Percentage of population engaged in sports and exercise on an average day, by state, 2009-2015 Epidemiology of Athletes and your Patients Woods RA. Sports and Exercise. US Bureau of Labor Statistics – American Time use Survey. May 2017 Report. https://www.bls.gov/spotlight/2017/sports-and-exercise/home.htm 1 4/13/18 Percentage of population engaged in sports and exercise on an average day, by sex 2003-2015 Percentage of population engaged in sports and exercise on an average day, by educational attainment, 2003-2008 and 2009-2015 Woods RA. Sports and Exercise. US Bureau of Labor Statistics – American Time use Survey. May 2017 Report. Woods RA. Sports and Exercise. US Bureau of Labor Statistics – American Time use Survey. May 2017 Report. https://www.bls.gov/spotlight/2017/sports-and-exercise/home.htm https://www.bls.gov/spotlight/2017/sports-and-exercise/home.htm Walking Percent distribution by age Weight lifting group of people who Using cardiovascular equipment Yoga Running engaged in sports and Swimming, surfing, water skiing exercise on an average day, Walking by specific activity, 2009-2015 Percentage of people Basketball Aerobics Golfing aged 15 and older Using cardiovascular equipment Cycling who engaged in Yoga Hiking sports and exercise Aerobics Golfing on an average day, by Soccer Racquet sports specific activity, Baseball, softball 2009-2015 Bowling Cycling Dancing Swimming, surfing, water skiing Football Bowling Racquet sports Hiking Weight lifting Volletball Running Rollerblading Dancing Skiing, ice skating, snowboarding Equestrian sports Baseball, softball Martial arts Woods RA. Sports and Exercise. US Soccer Hockey Bureau of Labor Statistics – Football Gymnastics American Time use Survey. May 2017 Report. Wrestling Basketball Woods RA. Sports and Exercise. US Bureau of Labor Statistics – https://www.bls.gov/spotlight/ American Time use Survey. May 2017 Report. 0% 5% 10% 15% 20% 25% 30% 35% 2017/sports-and-exercise/ 0% 20% 40% 60% 80% 100% https://www.bls.gov/spotlight/2017/sports-and-exercise/ home.htm home.htm Percentage of people who engaged in sports and exercise on a given day, by hour of day when exercising, 2009-2015 Sports Statistics – What about Kids? • A lot of people play sports. 30% • 2011- Sports and Fitness Industry Association (SFIA) estimated 21.5 million 20% kids 6-17yo played team sports 10% 0% 4:00AM 8:00AM 12:00PM 4:00PM 8:00PM 12:00PM Woods RA. Sports and Exercise. US Bureau of Labor Statistics – American Time use Survey. May 2017 Report. https://www.bls.gov/spotlight/2017/sports-and-exercise/home.htm 2 4/13/18 Kelley B, Carchia C. “Hey, Data data – swing!” ESPN The Mag. Jul 2013 Kelley B, Carchia C. “Hey, Data data – swing!” ESPN The Mag. Jul 2013 Downside of Sports • Injury! – #1 Fear of Sports Parents • CDC: 2.6 million kids under 20 years old are treated in the ER for sports and recreation-related injuries each year • CDC: From 2001-2009, ER visits for TBIs rose from 19% to 62% – Football concussions among 10-14 year olds doubled from 4,138 (2000) to 10,759 (2010) Centers for Disease Control and Prevention. Protect the Ones you Love – Child Injuries are Preventable: Sports Safety. www.cdc.gov/safechild/sports_injuries/index.html Accessed November 28, 2016 Centers for Disease Control and Prevention. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged < 19 Years – United States 2001-2009. MMWR 2011: 60(39):1337-1342 Kelley B, Carchia C. “Hey, Data data – swing!” ESPN The Mag. Jul 2013 What is Sports Vision? Vision in Athletes What we know • Athletes have better visual abilities than non athletes • Better athletes have better visual abilities than poorer athletes • Visual abilities are trainable • Visual training is transferable to performance – So we say Stone CD, Arterburn MR, Stern NS J am Optom Assoc - Vision and sports: a review of the literature - 1982: aug 53(8):627-33 Christenson GN, Winkelstein AM - Visual skills of athletes versus nonathletes: development of a sports vision testing battery. J Am Optom Assoc. 1988, 59 (9):666-75 3 4/13/18 Relevant Visual Abilities • Larger extent of visual fields • Larger fields of recognition • Larger motion perception fields (peripheral awareness) • Lower amounts of heterophoria THE SPORTS VISION EXAM • More consistent simultaneous vision • More accurate depth perception • Better dynamic visual acuity • Better ocular motilities (vergence facility, saccades, NPC) • Visual reaction time Stone CD, Arterburn MR, Stern NS J am Optom Assoc - Vision and sports: a review of the literature - 1982: aug 53(8):627-33 Christenson GN, Winkelstein AM - Visual skills of athletes versus nonathletes: development of a sports vision testing battery. J Am Optom Assoc. 1988, 59 (9):666-75 Patient History - Sport Patient History – Ocular Symptoms • Blurry vision • Sport(s) • Double Vision • Competition Level • Difficulty following/tracking a ball/moving objects • Position(s) • “Gaps” in their vision • Frequency/Season played? • Difficulty with timing • What visual correction is • Inconsistent play - Too early/too late to hit or catch the ball currently worn for sports? • Difficulty changing focus from different distances • When do they play their • Light Sensitivity sport? • Difficulty playing at night • Where they play? • Easily distracted from visual target • Difficulty concentrating in visually crowded areas • Difficulty judging distances/depth perception • Headaches • Difficulties/eyestrain/fatigue with close work (CISS) You play WHAT Sport?!? You play WHAT Sport?!? • Dare I say… Google it !? • Ask enough questions to ask the visual demands of the sport – Is the athlete still (static) or moving (dynamic)? – Is the object/target stationary or moving? – What type of environment/contrast demands? • Weather, lighting, shadows, glare, background, type of object (ball, target, etc) – Timing demands on the visual system • Baseball batter (rapid saccades/pursuits) vs. Golfing (fixation) – Distance of targets – Direction of targets – Cognitive, Cardiovascular, Balance demands – Visual Attention Demands 4 4/13/18 Case Example – Bob the Billiards Guy 12pd Vertical prism ground in Pupil Centers Bob the Billiards Guy • S/p ischemic stroke in right occipital lobe and midbrain – Left Hemianopsia – Right CNIII Palsy Fresnel Prism Visual Acuity • Static Visual Acuity – At Least 20/15 The Sports Vision Examination – Snellen vs. Landolt C – Glare Acuity Zimmerman AB, Lust KL, Bullimore MA. Visual Acuity and Contrast Sensitivity Testing for Sports Vision. Eye & Contact Lens. 2011;37:153-159. Contrast Sensitivity E Visual Acuity • Tests – Vistech • Dynamic Visual Acuity – Mentor BVAT – VOR/Horizontal Sweeps – Vector Vision 1000 – Rotating Chart – Pelli-Robson – M&S Sports Performance – MARS – M&S Sports Performance E • Can be reduced by higher-order aberrations from CLs, E refractive surgery, as well as retinal conditions Erickson G. Sports Vision: Vision Care for the Enhancement of Sports Performance. Butterworth-Heineman. Philadelphia. 2007. Zimmerman AB, Lust KL, Bullimore MA. Visual Acuity and Contrast Sensitivity Testing for Sports Vision. Eye & Contact Lens. 2011;37:153-159. 5 4/13/18 Stereo Acuity Stereo Acuity • Where is it in space? • Judgment of distance is based on our perception of Monocular Cues Binocular Cues depth • Pictorial • Retinal Disparity • Tests – Size, linear perspective, • Convergence – Lateral Disparity vs. Random Dot texture, interposition, – Near vs. Distance clarity, lighting, shadow – Howard Dolman • Motion Parallax – Brock String • Accommodation – Fields of Gaze • Angular declination – Suppression Prescribing for Different Refractive Correction Guidelines Distances/That Darn Presbyope! • Myopia -0.25D or more • Most dynamic ball sports • Target Shooting • Hyperopia +1.00D or more – SVD – Shotgun • • • Astigmatism 0.50D or more Golf SVD – Small, low set segment – Rifle • Anisometropia 0.50D or more – Short corridor, narrow • SVD – mild overplus PAL with lower set seg +0.50/+0.75 • Best time to experiment is off season height • Telescopic sight • Scuba Divers • Sports Performance Prescription may be – Pistol different from Habitual Rx – MF CL or insert • Pinhole • Goggles – The benefits of over-minusing • BF – Executive/FT40 – Rx or insert Erickson G. Sports Vision: Vision Care for the Enhancement of Sports Performance. Erickson G. Sports Vision: Vision Care for the Enhancement of Sports Performance. Butterworth-Heineman. Philadelphia. 2007. Butterworth-Heineman. Philadelphia. 2007. Contact Lenses – High Performance Fitting Contact Lenses – High Performance Fitting Daily Disposable Larger Soft Diameter Factors to Consider Tighter Base Curve Modality Gas Fit Environment Permeable Hard Ortho-K Lens UV Time of Toric? Season Terrain Stability Protection Day Scleral Lenses • Unstable lenses can degrade CS even when VA
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