Testing and Improving Sports Vision

TESTINGTESTING ANDAND IMPROVINGIMPROVING SPORTSSPORTS VISIONVISION

Presented by NORMANNORMAN PHILPHIL EINHORNEINHORN O.D.,O.D., M.S.,M.S., F.A.A.O.F.A.A.O. PerformingPerforming aa ComprehensiveComprehensive SportsSports VisionVision ExaminationExamination WHOWHO AREARE YOURYOUR ATHLETES?ATHLETES? The individual who can process more visual information in a shorter period and make the proper response will have an advantage in competition. As athletes tap out their potential in other aspects of their performance, like speed, power or strength, what will they turn to next to increase their performance? The trend seems to be that they will turn to vision training. UnderstandingUnderstanding thethe RoleRole ofof VisionVision inin AthleticsAthletics SightSight:: TheThe clarityclarity ofof thethe imageimage onon thethe retinaretina andand anan intactintact retinaretina MotorMotor:: pursuitpursuit && saccadicsaccadic eyeeye movements,movements, accommodation,accommodation, vergencevergence andand fusion.fusion. InformationInformation ProcessingProcessing:: quickquick interpretationinterpretation andand visualvisual perceptualperceptual processingprocessing YourYour eyeseyes areare holdingholding youyou backback if:if:

YouYou showshow littlelittle improvementimprovement inin sports,sports, eveneven withwith practicepractice YouYou makemake thethe samesame mistakemistake timetime andand againagain inin competitioncompetition YouYou havehave difficultydifficulty judgingjudging ballball rotationrotation oror knowingknowing wherewhere thethe ballball oror otherother playersplayers areare YourYour eyeseyes areare holdingholding youyou backback if:if:

DoDo youyou experienceexperience lossloss ofof concentrationconcentration duringduring sportssports performance?performance? DoDo youyou everever noticenotice decreaseddecreased peripheralperipheral visionvision duringduring sportssports performance?performance? DoDo youyou everever noticenotice sensitivitysensitivity toto lights,lights, oror difficultydifficulty recoveringrecovering visionvision afterafter lookinglooking intointo brightbright lights?lights? INCONSISTENCYINCONSISTENCY ININ PERFORMANCEPERFORMANCE AreasAreas ofof SportsSports VisionVision

RefractiveRefractive compensationcompensation –– SpectaclesSpectacles vsvs ContactContact LensesLenses (CRT?)(CRT?) vsvs RefractiveRefractive surgerysurgery Assessment/remediationAssessment/remediation ofof functionalfunctional visualvisual inefficienciesinefficiencies AssessmentAssessment ofof sportsport--specificspecific visualvisual abilitiesabilities EnhancementEnhancement VisionVision TrainingTraining ConsultationConsultation THREETHREE PARTSPARTS

VisualVisual TaskTask AnalysisAnalysis VisualVisual SkillsSkills ToTo EvaluateEvaluate VisualVisual SkillsSkills thatthat areare ““ImprovableImprovable”” KnowledgeKnowledge ofof Sport/ActivitySport/Activity

PersonalPersonal ParticipationParticipation PatientPatient ObservationObservation // InteractionInteraction ExpertExpert InteractionInteraction PersonalPersonal ObservationObservation AOAAOA SportsSports VisionVision SectionSection (SVS)(SVS) GuidebooksGuidebooks *Available online FREE to SVS members, as a benefit of membership, at www.aoa.org EnvironmentalEnvironmental AnalysisAnalysis inin SportsSports

OcularOcular HazardsHazards OcularOcular ProtectionProtection FacialFacial ProtectionProtection HeadHead protectiveprotective wearwear (visibility(visibility && mechanicalmechanical forces)forces) LightingLighting && glareglare TemperatureTemperature EnvironmentalEnvironmental AnalysisAnalysis inin SportsSports

HumidityHumidity AltitudeAltitude DustDust && ForeignForeign BodyBody PotentialPotential SweatSweat FoggingFogging PrecipitationPrecipitation EnvironmentalEnvironmental VariabilityVariability SportsSports VisionVision EvaluationEvaluation

VisualVisual AcuityAcuity –– SnellenSnellen AcuityAcuity –– LandoltLandolt cc’’ss LiteratureLiterature SupportSupport

MostMost studiesstudies sincesince 19421942 havehave foundfound betterbetter staticstatic VAVA inin athletesathletes comparedcompared toto nonathletes.nonathletes. However,However, itit isis notnot uncommonuncommon toto findfind somesome athletesathletes performingperforming atat aa highhigh levellevel despitedespite havinghaving reducedreduced VAVA’’s.s. –– ConsiderConsider thethe tasktask demandsdemands SportsSports VisionVision EvaluatioEvaluationn

VisualVisual AcuityAcuity –– ContrastContrast SensitivitySensitivity LiteratureLiterature SupportSupport

TheThe generalgeneral resultsresults suggestsuggest elevatedelevated CSFCSF acrossacross allall spatialspatial frequenciesfrequencies forfor athletes.athletes. ItIt hashas beenbeen demonstrateddemonstrated thatthat contactcontact lenseslenses cancan degradedegrade CSFCSF ifif thethe lenseslenses areare notnot optimal.optimal. CSFCSF shouldshould alsoalso bebe assessedassessed withwith anyany performanceperformance tintstints usedused forfor titititi SportsSports VisionVision EvaluationEvaluation

DynamicDynamic VisualVisual AcuityAcuity (Method?)(Method?) –– Rotators,Rotators, horizontalhorizontal sweeps?sweeps? LiteratureLiterature SupportSupport

VariabilityVariability inin measurementmeasurement parametersparameters hashas createdcreated significantsignificant difficultydifficulty inin determiningdetermining performanceperformance characteristics.characteristics. MostMost studiesstudies foundfound betterbetter DVADVA inin athletesathletes comparedcompared toto nonathletes.nonathletes. StandardizedStandardized methodologymethodology isis needed.needed. SportsSports VisionVision EvaluationEvaluation

RefractionRefraction –– RetinoscopyRetinoscopy –– AutoAuto RefractorRefractor AAUAAU JUNIORJUNIOR OLYMPICSOLYMPICS

31%31% worewore eyeweareyewear routinelyroutinely

13.2%13.2% worewore contactcontact lenseslenses toto schoolschool

<1%<1% worewore protectiveprotective eyeweareyewear SportsSports VisionVision EvaluationEvaluation

FixationFixation DisparityDisparity –– Method?Method?

SportsSports VisionVision EvaluationEvaluation

OcularOcular AlignmentAlignment –– DistanceDistance CoverCover TestTest –– NearNear CoverCover TestTest –– MaddoxMaddox RodRod TestTest –– ThoringtonThorington CardCard –– FixationFixation DisparityDisparity LiteratureLiterature SupportSupport

EarlyEarly studiesstudies foundfound lowerlower amountsamounts ofof heterophoriaheterophoria inin athletesathletes (especially(especially atat far),far), butbut moremore recentrecent studiesstudies havehave notnot confirmedconfirmed thesethese findings.findings. SomeSome suggestsuggest thatthat measurementmeasurement ofof fixationfixation disparitydisparity maymay bebe aa betterbetter assessmentassessment ofof thethe accuracyaccuracy andand stabilitystability ofof eyeeye alignment.alignment. SportsSports VisionVision EvaluationEvaluation

Dominant Hand / Dominant Eye – Implication of Crossed Dominance 41%41% CrossedCrossed inin GeneralGeneral PopulationPopulation 40%40% CrossedCrossed inin AthleticAthletic PopulationPopulation 4%4% NoNo EyeEye PreferredPreferred LeftLeft HandedHanded -- HigherHigher IncidenceIncidence CrossedCrossed LiteratureLiterature SupportSupport

ThereThere havehave beenbeen manymany theoriestheories concerningconcerning thethe advantages/disadvantagesadvantages/disadvantages ofof crossedcrossed eyeeye andand handhand dominancedominance inin sportssports performance.performance. CorenCoren && PoracPorac foundfound thatthat thethe dominantdominant eyeeye processedprocessed visualvisual informationinformation ~14msec~14msec fasterfaster thanthan thethe nondominantnondominant eye,eye, fuelingfueling speculations.speculations. Eye/HandEye/Hand DominanceDominance inin SportsSports

TheThe preponderancepreponderance ofof evidenceevidence suggestssuggests thatthat therethere isis nono relationshiprelationship betweenbetween eyeeye dominancedominance patternspatterns andand battingbatting performance.performance. TheThe onlyonly sportssports wherewhere ipsilateralipsilateral dominancedominance offersoffers anan advantageadvantage isis inin ““sightingsighting”” sportssports suchsuch asas targettarget shootingshooting (quicker(quicker skillskill acquisition).acquisition).

SportsSports VisionVision EvaluationEvaluation

EyeEye TeamingTeaming && SpatialSpatial LocalizationLocalization –– LateralLateral DisparityDisparity vs.vs. RandomRandom DotDot AOAO VectographicVectographic SlideSlide MentorMentor BVATBVAT RandomRandom DotDot SportsSports VisionVision EvaluationEvaluation EyeEye TeamingTeaming && SpatialSpatial LocalizationLocalization –– SpeedSpeed ofof StereopsisStereopsis Timed Random Dot Mentor BVAT SportsSports VisionVision EvaluationEvaluation

EyeEye TeamingTeaming && SpatialSpatial LocalizationLocalization –– HowardHoward DolmanDolman ApparatusApparatus LiteratureLiterature SupportSupport

StudiesStudies havehave demonstrateddemonstrated thatthat binocularbinocular visionvision cancan improveimprove performanceperformance onon certaincertain taskstasks comparedcompared toto oneone--eyedeyed performance.performance. ResearchResearch comparingcomparing staticstatic stereopsisstereopsis performanceperformance hashas hadhad mixedmixed resultsresults withwith athletes,athletes, somesome differencesdifferences duedue toto differencesdifferences inin testingtesting proceduresprocedures used.used. DynamicDynamic StereoacuityStereoacuity

ItIt hashas beenbeen suggestedsuggested thatthat thethe lacklack ofof correlationcorrelation betweenbetween depthdepth perceptionperception andand athleticathletic performanceperformance isis duedue toto thethe staticstatic naturenature ofof thethe testing.testing. DynamicDynamic stereopsisstereopsis assessmentassessment proceduresprocedures havehave beenbeen suggestedsuggested toto discriminatediscriminate differentialdifferential performanceperformance relatingrelating toto sports.sports. SportsSports VisionVision EvaluationEvaluation

VergenceVergence FunctionFunction –– VergenceVergence RangesRanges –– VergenceVergence FacilityFacility AccommodativeAccommodative FunctionFunction –– NearNear--FarFar FacilityFacility (Haynes)(Haynes) LiteratureLiterature SupportSupport -- VergenceVergence RangesRanges

OnlyOnly 22 publishedpublished studiesstudies havehave comparedcompared vergencevergence rangesranges inin athletesathletes toto nonathletes.nonathletes. OneOne studystudy foundfound nono statisticalstatistical differencedifference inin performance,performance, andand oneone foundfound narrowernarrower rangesranges inin athletesathletes (speculated(speculated toto correspondcorrespond toto moremore accurateaccurate spatialspatial judgmentsjudgments viavia EOMEOM action).action). LiteratureLiterature SupportSupport -- NearNear pointpoint ofof ConvergenceConvergence

ThereThere havehave beenbeen mixedmixed resultsresults onon studiesstudies ofof NPCNPC abilityability andand sportssports performance.performance. ItIt isis theorizedtheorized thatthat thethe moremore dynamicdynamic naturenature ofof thethe testingtesting assessassess vergencevergence functionfunction moremore ““globallyglobally”” thanthan staticstatic procedures.procedures. LiteratureLiterature SupportSupport -- VergenceVergence FacilityFacility ThereThere havehave beenbeen mixedmixed resultsresults onon studiesstudies ofof vergencevergence facilityfacility usingusing prismsprisms andand sportssports performance.performance. ItIt hashas beenbeen suggestedsuggested thatthat aa nearnear--farfar methodmethod ofof assessmentassessment moremore closelyclosely simulatessimulates ““realreal worldworld”” accommodativeaccommodative-- vergencevergence facilityfacility demands.demands. LiteratureLiterature SupportSupport -- AccommodativeAccommodative FacilityFacility StudiesStudies usingusing lenseslenses toto assessassess accommodativeaccommodative facilityfacility inin athletesathletes foundfound nono differencedifference inin performanceperformance comparedcompared toto nonathletes.nonathletes. SimilarSimilar toto vergencevergence facility,facility, itit hashas beenbeen suggestedsuggested thatthat aa nearnear--farfar methodmethod ofof assessmentassessment moremore closelyclosely simulatessimulates ““realreal worldworld”” accommodativeaccommodative--vergencevergence facilityfacility demands.demands. SportsSports VisionVision EvaluationEvaluation

OculomotorOculomotor FunctionFunction –– SubjectiveSubjective QualitativeQualitative AssessmentAssessment –– ProjectedProjected teststests (DEM,(DEM, KingKing--Devick)Devick) –– ObjectiveObjective EyeEye MovementMovement RecordingRecording ((OberOber VisagraphVisagraph)) LiteratureLiterature SupportSupport -- ShorterShorter Latencies/Trainable?Latencies/Trainable? StudiesStudies havehave foundfound thatthat athletesathletes dodo NOTNOT havehave shortershorter latencieslatencies forfor initiatinginitiating pursuitpursuit oror saccadicsaccadic eyeeye movements.movements. However,However, ifif thethe targettarget trajectorytrajectory isis predictable,predictable, thethe latencylatency periodperiod bebe reducedreduced throughthrough aa learninglearning effecteffect (e.g.,(e.g., initiatinginitiating thethe correctcorrect pursuitpursuit eyeeye movementmovement toto tracktrack aa baseballbaseball pitch).pitch). SportsSports VisionVision EvaluationEvaluation

SpeedSpeed ofof RecognitionRecognition –– TachistoscopeTachistoscope PresentationPresentation Limitation of Eye Movements LiteratureLiterature SupportSupport

ThereThere havehave beenbeen mixedmixed resultsresults whenwhen comparingcomparing speedspeed andand spanspan ofof recognitionrecognition inin athletesathletes toto nonathletesnonathletes (speed(speed isis usuallyusually betterbetter thanthan span).span). TheThe useuse ofof numbernumber sequencessequences forfor recallrecall maymay bebe thethe confoundingconfounding factor,factor, andand thisthis maymay bebe overcomeovercome byby thethe useuse ofof moremore ergonomicallyergonomically appropriateappropriate targetstargets (sport(sport-- specific).specific). InspectionInspection TimeTime

ItIt isis thethe psychophysicalpsychophysical measurementmeasurement ofof visualvisual processingprocessing time,time, withwith shortershorter inspectioninspection timestimes allowingallowing accurateaccurate decisiondecision toto bebe mademade fromfrom shortershorter stimulusstimulus durations.durations. MostMost studiesstudies havehave foundfound thatthat experiencedexperienced athletesathletes cancan evaluateevaluate relevantrelevant visualvisual informationinformation moremore rapidlyrapidly thanthan inexperiencedinexperienced observers.observers. VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE

MotorMotor ResponseResponse TimeTime

VisualVisual--MotorMotor ReactionReaction TimeTime LiteratureLiterature SupportSupport –– MotorMotor ResponseResponse TimeTime SimpleSimple motormotor responseresponse timestimes havehave beenbeen demonstrateddemonstrated toto bebe fasterfaster inin athletesathletes thanthan nonathletes.nonathletes. LiteratureLiterature SupportSupport -- VisualVisual MotorMotor ReactionReaction TimeTime SimpleSimple visualvisual--motormotor reactionreaction timetime studiesstudies havehave hadhad mixedmixed results.results. ––SeveralSeveral studiesstudies foundfound fasterfaster RTRT’’ss inin athletesathletes inin variousvarious sports,sports, andand itit waswas aa goodgood discriminatordiscriminator ofof expertiseexpertise level.level. ––OtherOther studiesstudies havehave notnot foundfound thisthis correlation.correlation. SportsSports VisionVision EvaluationEvaluation

EyeEye FootFoot SpeedSpeed LiteratureLiterature SupportSupport

SimpleSimple eyeeye--footfoot visualvisual--motormotor reactionreaction timetime studiesstudies havehave foundfound fasterfaster RTRT’’ss inin athletesathletes inin variousvarious sports,sports, andand itit waswas aa goodgood discriminatordiscriminator ofof expertiseexpertise level.level. VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE

EyeEye--HandHand CoordinationCoordination

LiteratureLiterature SupportSupport

UsingUsing differentdifferent evaluationevaluation methodsmethods andand equipment,equipment, thethe resultsresults ofof eyeeye-- handhand coordinationcoordination inin athletesathletes hashas beenbeen demonstrateddemonstrated toto bebe betterbetter thanthan nonathletesnonathletes inin mostmost studies.studies. LightingLighting LevelsLevels

TheThe levellevel ofof ambientambient roomroom lightinglighting hashas beenbeen shownshown toto effecteffect performanceperformance onon thethe WayneWayne SaccadicSaccadic FixatorFixator andand thethe AcuvisionAcuvision.. –– LowerLower ambientambient illuminationillumination improvesimproves performanceperformance VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE VisualVisual CoincidenceCoincidence-- AnticipationAnticipation SkillsSkills LiteratureLiterature SupportSupport

PerformancePerformance onon thethe BassinBassin AnticipationAnticipation TimerTimer diddid notnot correlatecorrelate withwith battingbatting performanceperformance inin baseballbaseball oror softball.softball. TimingTiming accuracyaccuracy waswas foundfound toto improveimprove withwith increasingincreasing targettarget velocity,velocity, decreasingdecreasing rangerange ofof movement,movement, andand lengthlength ofof thethe runway.runway. VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE PeripheralPeripheral VisionVision –– ThresholdThreshold VisualVisual FieldField LiteratureLiterature SupportSupport -- ExtentExtent ofof VisualVisual FieldField

StudyStudy resultsresults indicateindicate thatthat athletesathletes havehave aa largerlarger extentextent ofof horizontalhorizontal andand verticalvertical visualvisual fieldsfields thanthan nonathletes.nonathletes. However,However, itit waswas NOTNOT foundfound toto bebe aa sensitivesensitive discriminatordiscriminator ofof skillskill levellevel withinwithin aa sportssports populationpopulation (Varsity(Varsity vs.vs. JVJV collegiatecollegiate football).football). LiteratureLiterature SupportSupport –– FormForm RecognitionRecognition inin PeripheryPeriphery

StudyStudy resultsresults indicateindicate thatthat athletesathletes havehave betterbetter formform recognitionrecognition atat moremore peripheralperipheral locationslocations thanthan nonathletes.nonathletes. LiteratureLiterature SupportSupport -- PeripheralPeripheral Awareness/ReactionAwareness/Reaction

OnlyOnly normativenormative datadata havehave beenbeen publishedpublished forfor measurementsmeasurements ofof peripheralperipheral awareness/reactionawareness/reaction usingusing thethe WayneWayne P.A.T.T.P.A.T.T. inin athletes.athletes. VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE

EyeEye--BodyBody CoordinationCoordination VisionVision && BalanceBalance FieldField DependenceDependence-- IndependenceIndependence VisualizationVisualization

VISUALVISUAL SKILLSSKILLS TOTO EVALUATEEVALUATE OcularOcular HealthHealth ProceduresProcedures OtherOther considerationsconsiderations forfor thethe RxRx

TimingTiming ofof firstfirst prescriptionprescription ValueValue ofof overminusingoverminusing PrescribingPrescribing forfor twilighttwilight PrescribingPrescribing forfor specificspecific distancesdistances PrescribingPrescribing modalities:modalities: –– SpectaclesSpectacles –– ContactContact lenseslenses –– RefractiveRefractive surgerysurgery SpectacleSpectacle ConsiderationsConsiderations

ANSIANSI standardsstandards andand thethe sportsport WrapWrap designsdesigns ContactContact sportssports WeatherWeather andand atmosphericatmospheric conditionsconditions PrescribingPrescribing tintstints ConsiderationsConsiderations forfor presbyopespresbyopes VISUALVISUAL TASKTASK VISUALVISUAL TASKTASK

FiltersFilters && VisualVisual InformationInformation ProcessingProcessing DrivenDriven byby informationinformation providedprovided fromfrom visualvisual inputinput (VA,(VA, CSF,CSF, Stereopsis,Stereopsis, etc.)etc.) SpecificSpecific skillsskills affectedaffected byby filters:filters: –– VisualVisual DiscriminationDiscrimination –– VisualVisual FigureFigure--GroundGround FiltersFilters andand LightingLighting VariationsVariations

IncandescentIncandescent lightinglighting FluorescentFluorescent lightinglighting SodiumSodium lightinglighting DaylightDaylight (clear(clear vs.vs. cloudy)cloudy) OutdoorOutdoor nightnight lightinglighting FiltersFilters andand PerformancePerformance FactorsFactors VISUALVISUAL SKILLSSKILLS THROUGHTHROUGH FILTERSFILTERS

VisualVisual AcuitiesAcuities RefractiveRefractive StatusStatus ContrastContrast SensitivitySensitivity DynamicDynamic VAVA VISUALVISUAL SKILLSSKILLS THROUGHTHROUGH FILTERSFILTERS

PhoriasPhorias && VergencesVergences (stance(stance && facility)facility) FixationFixation DisparityDisparity SpeedSpeed && AccuracyAccuracy ofof DepthDepth PerceptionPerception VISUALVISUAL SKILLSSKILLS THROUGHTHROUGH FILTERSFILTERS

VisualVisual--MotorMotor ReactionReaction TimeTime EyeEye--HandHand CoordinationCoordination VISUALVISUAL SKILLSSKILLS THROUGHTHROUGH FILTERSFILTERS

VisionVision AnticipationAnticipation SkillsSkills SpeedSpeed ofof RecognitionRecognition FILTERFILTER TYPESTYPES && SPORTSSPORTS

Polarizing filters –– SuppressesSuppresses reflectedreflected lightlight (horizontal)(horizontal) –– BestBest withwith reflectedreflected glareglare (water,(water, roadroad surfaces)surfaces) –– TransmitTransmit aa maximummaximum ofof 50%50% (usually(usually ~40%)~40%) –– ActAct asas neutralneutral filtersfilters forfor unwantedunwanted reflectionsreflections –– SportsSports applicationsapplications * Fishing, water sports, driving/cycling (wet surfaces) * May remove important details in skiing, golf, etc.

FILTERFILTER TYPESTYPES && SPORTSSPORTS

Photochromic filters – Transmission characteristics actively change – Usual range is 20% to 80% transmission* – Usually neutral or brown tint – Sports applications * Changing light levels (e.g., golf, tennis) FILTERFILTER TYPESTYPES && SPORTSSPORTS

NeutralNeutral greygrey filtersfilters –– FiltersFilters wavelengthswavelengths equallyequally –– KeepsKeeps colorscolors moremore ““naturalnatural”” –– SportsSports applicationsapplications * When subtle color differences matter … * Golf, mountaineering, skiing * Mountaineering: blocks yellow light in whiteout FILTERFILTER TYPESTYPES && SPORTSSPORTS

RedRed rangerange filtersfilters –– EnhancesEnhances objectsobjects inin thethe redred spectrumspectrum –– SportsSports applicationsapplications ** OrangeOrange clayclay shootingshooting ** SkiingSkiing (contrast(contrast changeschanges ofof reflectedreflected light)light) FILTERFILTER TYPESTYPES && SPORTSSPORTS

Yellow range filters – Transmits only longer wavelengths – Ocular media scatters short wavelength light more - improves contrast by eliminating some of this “internal glare” – May enhance contrast differences (contours) – Sports applications * Shooting sports, Snow sports, Driving, Flying * Blue backgrounds (tennis, baseball, golf, etc.)

FILTERFILTER TYPESTYPES && SPORTSSPORTS

SpecialtySpecialty filtersfilters -- MirrorMirror CoatingsCoatings –– LimitsLimits glareglare andand increasesincreases absorptionabsorption –– ReducesReduces InfraInfra--RedRed -- reducingreducing heatheat buildbuild--upup –– SportsSports applicationsapplications ** SnowSnow SportsSports ** WaterWater SportsSports ** Cycling/RunningCycling/Running FILTERFILTER TYPESTYPES && SPORTSSPORTS

SpecialtySpecialty filtersfilters -- AntiAnti--reflectivereflective coatingcoating –– MinimizesMinimizes reflectionsreflections -- especiallyespecially backback surfacesurface –– SportsSports applicationsapplications ** RacquetRacquet sportssports ** FishingFishing ** Shooters/ArcheryShooters/Archery LENSLENS DESIGNDESIGN FACTORSFACTORS

GoggleGoggle designsdesigns –– SkiSki gogglesgoggles –– SwimmingSwimming gogglesgoggles –– DivingDiving masksmasks PerformancePerformance ContactContact LensesLenses

FactorsFactors toto consider:consider: –– GazeGaze positionspositions (ex:(ex: upgazeupgaze forfor cyclists)cyclists) –– SpeedSpeed ofof eyeeye movementsmovements (re(re--orientation)orientation) –– LengthLength ofof competitioncompetition –– EnvironmentEnvironment (humidity,(humidity, temperature,temperature, altitude,altitude, debris,debris, wind,wind, UVUV exposure)exposure) –– ReplacementReplacement possibilitiespossibilities –– TintTint possibilitiespossibilities CONTACTCONTACT LENSLENS CONSIDERATIONSCONSIDERATIONS

Material: water content Diameter Handling Characteristics Stability Replacement : ease and frequency – spare lenses on sidelines – solutions on hand – 1-day lenses ImportanceImportance toto WearersWearers-- MAXMAX EYESEYES

OcularOcular HealthHealth inin PerformancePerformance Vision:Vision: – Reduce UVA, UVB – Reduce visual fatigue – Eliminate potential – “Device” hazard – Minimizes blue – Light hazard

100 50 East West 0 1s t 3rd No rth Qt r Qtr COMPLIANCECOMPLIANCE ISSUESISSUES

100%100% nonnon--compliantcompliant withwith atat leastleast oneone stepstep 95%95% eithereither dondon’’tt disinfectdisinfect oror cleanclean regularlyregularly 94%94% dondon’’tt keepkeep casecase cleanclean 53%53% failfail toto washwash handshands EMERGENCYEMERGENCY KITKIT FORFOR THETHE ATHLETICATHLETIC TRAINERTRAINER

Non-preserved saline Lubricating drops Several clean contact lens cases DMV lens removers Fluo strips Sterile swabs Anesthetic? SportsSports EyeEye InjuryInjury PreventionPrevention

EducateEducate thethe generalgeneral publicpublic ProperProper coachingcoaching forfor safesafe playplay ModifyModify regulationsregulations PromotePromote properproper eyeweareyewear SportsSports EyeEye InjuryInjury PreventionPrevention

Comprehensive patient care Regular visits Thorough case history Legal/ethical responsibility to identify & warn Verify habitual sports/recreational eyewear: –– AppropriateAppropriate for risk(s) –– MeetsMeets relevantrelevant standardsstandards –– InadequateInadequate conditioncondition PrevalencePrevalence (all(all trauma)trauma)

2.52.5 millionmillion casescases perper yearyear inin U.S.U.S. 40,00040,000--45,00045,000 casescases ofof permanentpermanent visualvisual impairmentimpairment AccountsAccounts forfor 20%20% ofof unilateralunilateral blindness;blindness; 7%7% ofof bilateralbilateral 70%70% malemale SportsSports relatedrelated ocularocular trauma=100,000+trauma=100,000+ perper yearyear SportsSports EyeEye InjuryInjury PreventionPrevention

PrePre--existingexisting conditionsconditions thatthat increaseincrease risk:risk: –– PostPost--refractiverefractive surgerysurgery –– HighHigh myopiamyopia –– VisualVisual fieldfield defectsdefects –– IOLIOL implantsimplants –– OtherOther surgicalsurgical proceduresprocedures toto eyeeye tissuestissues –– AmblyopiaAmblyopia andand Strabismus?Strabismus? EyeEye InjuriesInjuries AssociatedAssociated WithWith SportsSports Prevent Blindness America

The use of protective eyewear for the face and eyes could effectively reduce the frequency and severity of sports related eye injuries by 90%. DeterminationDetermination ofof RiskRisk –– ClassificationClassification ofof VariousVarious SportsSports

ByBy PhysicalPhysical Contact:Contact: ––Contact/CollisionContact/Collision ––LimitedLimited ContactContact ––NoNo ContactContact HighHigh Contact/CollisionContact/Collision SportsSports

BasketballBasketball HockeyHockey (Field(Field andand Ice)Ice) AmericanAmerican FootballFootball SoccerSoccer RugbyRugby WaterWater PoloPolo WrestlingWrestling BoxingBoxing LimitedLimited ContactContact

Baseball Skiing (Snow & Water) Squash/Racquetball/Hand ball Volleyball Windsurfing/Surfing Kayaking Cycling Gymnastics NoncontactNoncontact

ArcheryArchery && RifleryRiflery Crew/RowingCrew/Rowing TrackTrack && FieldField GolfGolf RunningRunning SailingSailing SwimmingSwimming && ScubaScuba DivingDiving Tennis,Tennis, BadmintonBadminton && TableTable TennisTennis WeightWeight liftinglifting SportsSports EyeEye InjuryInjury DemographicsDemographics

TrueTrue incidenceincidence isis unknownunknown NoNo reliable,reliable, fastfast && completecomplete datadata collectioncollection systemssystems inin placeplace MustMust relyrely onon incompleteincomplete datadata fromfrom variousvarious datadata gatheringgathering systemssystems DataData doesdoes showshow aa majormajor publicpublic healthhealth problemproblem SportsSports EyeEye InjuryInjury DemographicsDemographics

EyesEyes == 0.25%0.25% ofof bodybody surfacesurface EyesEyes accountaccount forfor ~2%~2% ofof sportssports injuriesinjuries ~10%~10% ofof patientspatients havehave hadhad anan eyeeye injuryinjury 10%10% ofof allall ERER--treatedtreated eyeeye injuriesinjuries areare sportssports ~27%~27% chancechance ofof hospitalhospital admissionadmission inin ERER--treatedtreated eyeeye injuryinjury (compared(compared toto 2%2% rate)rate) InjuriesInjuries inin SportsSports byby AgeAge

5-14 year olds 15-24 year olds Basketball 16.5% Basketball 34.0% Baseball 15.5% Baseball 7.2% Swimming & pool sports 12.5% Racquetball & Ct. sports 8.1%

25-64 year olds Basketball 19.6% Swimming & pool sports 14.9% Racquetball & Ct. sports 6.7% Total injuriesinjuries allall agesages 39,29739,297 Risk of Blindness for the One Eyed Athlete 1.75 ±.30 / 1000 Risk of Blindness for the General Population .11 / 1000 One Eyed Athlete • • One Eyed Athlete More than 150x more likely to go blind Trauma causes more than 50% of this blindness • • PrePre--ParticipationParticipation PhysicalPhysical ExamExam

Clearance can be divided intointo 33 categories:categories: –– UnrestrictedUnrestricted –– ClearanceClearance afterafter furtherfurther evaluation/rehabilitationevaluation/rehabilitation –– NotNot clearedcleared forfor allall oror certaincertain sportssports Does condition(s) limit participation due to: –– IncreasedIncreased riskrisk ofof injuryinjury –– PutsPuts othersothers atat riskrisk ofof injuryinjury –– CanCan itit bebe treatedtreated toto allowallow safesafe participationparticipation VTVT TechniquesTechniques RelatedRelated toto SportsSports PerformancePerformance

RelateRelate techniquetechnique toto sportssports taskstasks StressStress awarenessawareness ofof responseresponse && strategystrategy AchieveAchieve qualityquality ofof responseresponse initiallyinitially PushPush speedspeed ofof responseresponse whenwhen readyready BuildBuild automaticityautomaticity ofof responseresponse DiscussDiscuss strategiesstrategies toto assistassist transfertransfer ofof skillsskills toto thethe playingplaying fieldfield THANKTHANK YOUYOU FORFOR YOURYOUR TIMETIME ANDAND INTERESTINTEREST

NORMANNORMAN PHILPHIL EINHORNEINHORN O.D.,M.S.,F.A.A.O.O.D.,M.S.,F.A.A.O.