TESTING AND IMPROVING TESTING AND IMPROVING SPORTS VISION SPORTS - - PowerPoint PPT Presentation

TESTING AND IMPROVING TESTING AND IMPROVING

SPORTS VISION SPORTS VISION

Presented by Presented by

NORMAN PHIL EINHORN NORMAN PHIL EINHORN O.D., M.S., F.A.A.O. O.D., M.S., F.A.A.O.

Performing a Performing a Comprehensive Comprehensive Sports Vision Examination Sports Vision Examination

WHO ARE YOUR ATHLETES? WHO ARE YOUR 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.

Understanding the Role of Understanding the Role of Vision in Athletics Vision in Athletics

Sight Sight: The clarity of the image on : The clarity of the image on the retina and an intact retina the retina and an intact retina Motor Motor: pursuit & saccadic eye : pursuit & saccadic eye movements, accommodation, movements, accommodation, vergence and fusion. vergence and fusion. Information Processing Information Processing: quick : quick interpretation and visual perceptual interpretation and visual perceptual processing processing

Your eyes are holding you back Your eyes are holding you back if: if:

You show little improvement in sports, You show little improvement in sports, even with practice even with practice You make the same mistake time and You make the same mistake time and again in competition again in competition You have difficulty judging ball rotation You have difficulty judging ball rotation

• r knowing where the ball or other
• r knowing where the ball or other

players are players are

Your eyes are holding you back Your eyes are holding you back if: if:

Do you experience loss of concentration Do you experience loss of concentration during sports performance? during sports performance? Do you ever notice decreased peripheral Do you ever notice decreased peripheral vision during sports performance? vision during sports performance? Do you ever notice sensitivity to lights, or Do you ever notice sensitivity to lights, or difficulty recovering vision after looking difficulty recovering vision after looking into bright lights? into bright lights?

INCONSISTENCY IN INCONSISTENCY IN PERFORMANCE PERFORMANCE

Areas of Sports Vision Areas of Sports Vision

Refractive compensation Refractive compensation

– – Spectacles Spectacles vs vs Contact Lenses (CRT?) Contact Lenses (CRT?) vs vs Refractive surgery Refractive surgery

Assessment/remediation of functional Assessment/remediation of functional visual inefficiencies visual inefficiencies Assessment of sport Assessment of sport-

• specific visual

specific visual abilities abilities Enhancement Vision Training Enhancement Vision Training Consultation Consultation

THREE PARTS THREE PARTS

Visual Task Analysis Visual Task Analysis Visual Skills To Evaluate Visual Skills To Evaluate Visual Skills that are Visual Skills that are “ “Improvable Improvable” ”

Knowledge of Sport/Activity Knowledge of Sport/Activity

Personal Participation Personal Participation Patient Observation / Interaction Patient Observation / Interaction Expert Interaction Expert Interaction Personal Observation Personal Observation AOA Sports Vision Section (SVS) AOA Sports Vision Section (SVS) Guidebooks Guidebooks *Available online FREE to SVS members,

*Available online FREE to SVS members, as a benefit of membership, at as a benefit of membership, at www.aoa.org www.aoa.org

Environmental Analysis in Environmental Analysis in Sports Sports

Ocular Hazards Ocular Hazards Ocular Protection Ocular Protection Facial Protection Facial Protection Head protective wear (visibility & Head protective wear (visibility & mechanical forces) mechanical forces) Lighting & glare Lighting & glare Temperature Temperature

Environmental Analysis in Environmental Analysis in Sports Sports

Humidity Humidity Altitude Altitude Dust & Foreign Body Potential Dust & Foreign Body Potential Sweat Sweat Fogging Fogging Precipitation Precipitation Environmental Variability Environmental Variability

Sports Vision Evaluation Sports Vision Evaluation

Visual Acuity Visual Acuity

– – Snellen Acuity Snellen Acuity – – Landolt Landolt c c’ ’s s

Literature Support Literature Support

Most studies since 1942 have found Most studies since 1942 have found better static VA in athletes compared better static VA in athletes compared to nonathletes. to nonathletes. However, it is not uncommon to find However, it is not uncommon to find some athletes performing at a high some athletes performing at a high level despite having reduced VA level despite having reduced VA’ ’s. s.

– – Consider the task demands Consider the task demands

Sports Vision Evaluation Sports Vision Evaluation

Visual Acuity Visual Acuity

– – Contrast Sensitivity Contrast Sensitivity

Literature Support Literature Support

The general results suggest elevated The general results suggest elevated CSF across all spatial frequencies for CSF across all spatial frequencies for athletes. athletes. It has been demonstrated that It has been demonstrated that contact lenses can degrade CSF if contact lenses can degrade CSF if the lenses are not optimal. the lenses are not optimal. CSF should also be assessed with CSF should also be assessed with any performance tints used for any performance tints used for titi titi

Sports Vision Evaluation Sports Vision Evaluation

Dynamic Visual Acuity Dynamic Visual Acuity (Method?) (Method?)

– – Rotators, horizontal Rotators, horizontal sweeps? sweeps?

Literature Support Literature Support

Variability in measurement parameters Variability in measurement parameters has created significant difficulty in has created significant difficulty in determining performance determining performance characteristics. characteristics. Most studies found better DVA in Most studies found better DVA in athletes compared to nonathletes. athletes compared to nonathletes. Standardized methodology is needed. Standardized methodology is needed.

Sports Vision Evaluation Sports Vision Evaluation

Refraction Refraction

– – Retinoscopy Retinoscopy – – Auto Refractor Auto Refractor

AAU JUNIOR OLYMPICS AAU JUNIOR OLYMPICS

31% wore eyewear 31% wore eyewear routinely routinely 13.2% wore contact 13.2% wore contact lenses to school lenses to school <1% wore protective <1% wore protective eyewear eyewear

Sports Vision Evaluation Sports Vision Evaluation

Fixation Fixation Disparity Disparity

– – Method? Method?

Sports Vision Evaluation Sports Vision Evaluation

Ocular Alignment Ocular Alignment

– – Distance Cover Test Distance Cover Test – – Near Cover Test Near Cover Test – – Maddox Rod Test Maddox Rod Test – – Thorington Thorington Card Card – – Fixation Disparity Fixation Disparity

Literature Support Literature Support

Early studies found lower amounts of Early studies found lower amounts of heterophoria in athletes (especially at heterophoria in athletes (especially at far), but more recent studies have not far), but more recent studies have not confirmed these findings. confirmed these findings. Some suggest that measurement of Some suggest that measurement of fixation disparity may be a better fixation disparity may be a better assessment of the accuracy and assessment of the accuracy and stability of eye alignment. stability of eye alignment.

Sports Vision Sports Vision Evaluation Evaluation

Dominant Hand / Dominant Eye Dominant Hand / Dominant Eye

– – Implication of Crossed Dominance Implication of Crossed Dominance

41% Crossed in General 41% Crossed in General Population Population 40% Crossed in Athletic 40% Crossed in Athletic Population Population 4% No Eye Preferred 4% No Eye Preferred Left Handed Left Handed -

• Higher Incidence

Higher Incidence Crossed Crossed

Literature Support Literature Support

There have been many theories concerning the There have been many theories concerning the advantages/disadvantages of crossed eye and advantages/disadvantages of crossed eye and hand dominance in sports performance. hand dominance in sports performance. Coren Coren & & Porac Porac found that the dominant eye found that the dominant eye processed visual information ~14msec faster processed visual information ~14msec faster than the than the nondominant

nondominant eye, fueling eye, fueling speculations. speculations.

Eye/Hand Dominance in Sports Eye/Hand Dominance in Sports

The preponderance of evidence suggests The preponderance of evidence suggests that there is no relationship between eye that there is no relationship between eye dominance patterns and batting dominance patterns and batting performance. performance. The only sports where The only sports where ipsilateral ipsilateral dominance offers an advantage is in dominance offers an advantage is in “ “sighting sighting” ” sports such as target shooting sports such as target shooting (quicker skill acquisition). (quicker skill acquisition).

Sports Vision Evaluation Sports Vision Evaluation

Eye Teaming & Spatial Eye Teaming & Spatial Localization Localization

– – Lateral Disparity vs. Random Dot Lateral Disparity vs. Random Dot

AO AO Vectographic Vectographic Slide Slide Mentor BVAT Mentor BVAT Random Dot Random Dot

Sports Vision Evaluation Sports Vision Evaluation

Eye Teaming & Spatial Localization Eye Teaming & Spatial Localization

– – Speed of Stereopsis Speed of Stereopsis

Timed Random Dot Timed Random Dot Mentor BVAT Mentor BVAT

Sports Vision Evaluation Sports Vision Evaluation

Eye Teaming & Spatial Localization Eye Teaming & Spatial Localization

– – Howard Dolman Apparatus Howard Dolman Apparatus

Literature Support Literature Support

Studies have demonstrated that binocular Studies have demonstrated that binocular vision can improve performance on vision can improve performance on certain tasks compared to one certain tasks compared to one-

• eyed

eyed performance. performance. Research comparing static stereopsis Research comparing static stereopsis performance has had mixed results with performance has had mixed results with athletes, some differences due to athletes, some differences due to differences in testing procedures used. differences in testing procedures used.

Dynamic Dynamic Stereoacuity Stereoacuity

It has been suggested that the lack of It has been suggested that the lack of correlation between depth perception and correlation between depth perception and athletic performance is due to the static athletic performance is due to the static nature of the testing. nature of the testing. Dynamic stereopsis assessment Dynamic stereopsis assessment procedures have been suggested to procedures have been suggested to discriminate differential performance discriminate differential performance relating to sports. relating to sports.

Sports Vision Sports Vision Evaluation Evaluation

Vergence Function Vergence Function

– – Vergence Ranges Vergence Ranges – – Vergence Facility Vergence Facility

Accommodative Function Accommodative Function

– – Near Near-

• Far Facility (Haynes)

Far Facility (Haynes)

Literature Support Literature Support -

• Vergence Ranges

Vergence Ranges

Only 2 published studies have compared Only 2 published studies have compared vergence ranges in athletes to vergence ranges in athletes to nonathletes. nonathletes. One study found no statistical difference One study found no statistical difference in performance, and one found narrower in performance, and one found narrower ranges in athletes (speculated to ranges in athletes (speculated to correspond to more accurate spatial correspond to more accurate spatial judgments via EOM action). judgments via EOM action).

Literature Support Literature Support -

• Near point of Convergence

Near point of Convergence

There have been mixed results on studies There have been mixed results on studies

• f NPC ability and sports performance.
• f NPC ability and sports performance.

It is theorized that the more dynamic It is theorized that the more dynamic nature of the testing assess vergence nature of the testing assess vergence function more function more “ “globally globally” ” than static than static procedures. procedures.

Literature Support Literature Support -

• Vergence Facility

Vergence Facility

There have been mixed results on There have been mixed results on studies of vergence facility using studies of vergence facility using prisms and sports performance. prisms and sports performance. It has been suggested that a near It has been suggested that a near-

• far

far method of assessment more closely method of assessment more closely simulates simulates “ “real world real world” ” accommodative accommodative-

• vergence facility demands.

vergence facility demands.

Literature Support Literature Support -

• Accommodative Facility

Accommodative Facility

Studies using lenses to assess Studies using lenses to assess accommodative facility in athletes found accommodative facility in athletes found no difference in performance compared to no difference in performance compared to nonathletes. nonathletes. Similar to vergence facility, it has been Similar to vergence facility, it has been suggested that a near suggested that a near-

• far method of

far method of assessment more closely simulates assessment more closely simulates “ “real real world world” ” accommodative accommodative-

• vergence facility

vergence facility demands. demands.

Sports Vision Evaluation Sports Vision Evaluation

Oculomotor Function Oculomotor Function

– – Subjective Qualitative Assessment Subjective Qualitative Assessment – – Projected tests (DEM, King Projected tests (DEM, King-

• Devick)

Devick) – – Objective Eye Movement Recording Objective Eye Movement Recording ( (Ober Ober Visagraph Visagraph) )

Literature Support Literature Support -

• Shorter Latencies/Trainable?

Shorter Latencies/Trainable?

Studies have found that athletes do NOT Studies have found that athletes do NOT have shorter latencies for initiating pursuit have shorter latencies for initiating pursuit

• r saccadic eye movements.
• r saccadic eye movements.

However, if the target trajectory is However, if the target trajectory is predictable, the latency period be reduced predictable, the latency period be reduced through a learning effect (e.g., initiating through a learning effect (e.g., initiating the correct pursuit eye movement to track the correct pursuit eye movement to track a baseball pitch). a baseball pitch).

Sports Vision Evaluation Sports Vision Evaluation

Speed of Recognition Speed of Recognition

– – Tachistoscope Tachistoscope Presentation Presentation

Limitation of Eye Movements Limitation of Eye Movements

Literature Support Literature Support

There have been mixed results when There have been mixed results when comparing speed and span of recognition comparing speed and span of recognition in athletes to nonathletes (speed is usually in athletes to nonathletes (speed is usually better than span). better than span). The use of number sequences for recall The use of number sequences for recall may be the confounding factor, and this may be the confounding factor, and this may be overcome by the use of more may be overcome by the use of more ergonomically appropriate targets (sport ergonomically appropriate targets (sport-

• specific).

specific).

Inspection Time Inspection Time

It is the psychophysical measurement of It is the psychophysical measurement of visual processing time, with shorter visual processing time, with shorter inspection times allowing accurate inspection times allowing accurate decision to be made from shorter stimulus decision to be made from shorter stimulus durations. durations. Most studies have found that experienced Most studies have found that experienced athletes can evaluate relevant visual athletes can evaluate relevant visual information more rapidly than information more rapidly than inexperienced observers. inexperienced observers.

VISUAL SKILLS TO EVALUATE VISUAL SKILLS TO EVALUATE

Motor Response Time Motor Response Time Visual Visual-

• Motor Reaction

Motor Reaction Time Time

Literature Support Literature Support – – Motor Response Time Motor Response Time

Simple motor response times have Simple motor response times have been demonstrated to be faster in been demonstrated to be faster in athletes than nonathletes. athletes than nonathletes.

Literature Support Literature Support -

• Visual Motor Reaction Time

Visual Motor Reaction Time

Simple visual Simple visual-

• motor reaction time

motor reaction time studies have had mixed results. studies have had mixed results.

– – Several studies found faster Several studies found faster RT RT’ ’s s in in athletes in various sports, and it was a athletes in various sports, and it was a good discriminator of expertise level. good discriminator of expertise level. – – Other studies have not found this Other studies have not found this correlation. correlation.

Sports Vision Evaluation Sports Vision Evaluation

Eye Foot Speed Eye Foot Speed

Literature Support Literature Support

Simple eye Simple eye-

• foot visual

foot visual-

• motor reaction

motor reaction time studies have found faster time studies have found faster RT RT’ ’s s in in athletes in various sports, and it was a athletes in various sports, and it was a good discriminator of expertise level. good discriminator of expertise level.

VISUAL SKILLS TO VISUAL SKILLS TO EVALUATE EVALUATE

Eye Eye-

• Hand

Hand Coordination Coordination

Literature Support Literature Support

Using different evaluation methods Using different evaluation methods and equipment, the results of eye and equipment, the results of eye-

• hand coordination in athletes has been

hand coordination in athletes has been demonstrated to be better than demonstrated to be better than nonathletes in most studies. nonathletes in most studies.

Lighting Levels Lighting Levels

The level of ambient room lighting The level of ambient room lighting has been shown to effect has been shown to effect performance on the Wayne Saccadic performance on the Wayne Saccadic Fixator and the Fixator and the Acuvision Acuvision. .

– – Lower ambient illumination improves Lower ambient illumination improves performance performance

VISUAL SKILLS TO VISUAL SKILLS TO EVALUATE EVALUATE

Visual Coincidence Visual Coincidence-

• Anticipation Skills

Anticipation Skills

Literature Support Literature Support

Performance on the Performance on the Bassin Bassin Anticipation Timer did not correlate Anticipation Timer did not correlate with batting performance in baseball or with batting performance in baseball or softball. softball. Timing accuracy was found to improve Timing accuracy was found to improve with increasing target velocity, with increasing target velocity, decreasing range of movement, and decreasing range of movement, and length of the runway. length of the runway.

VISUAL SKILLS TO VISUAL SKILLS TO EVALUATE EVALUATE

Peripheral Vision Peripheral Vision

– – Threshold Visual Field Threshold Visual Field

Literature Support Literature Support -

• Extent of Visual Field

Extent of Visual Field

Study results indicate that athletes Study results indicate that athletes have a larger extent of horizontal and have a larger extent of horizontal and vertical visual fields than nonathletes. vertical visual fields than nonathletes. However, it was NOT found to be a However, it was NOT found to be a sensitive discriminator of skill level sensitive discriminator of skill level within a sports population (Varsity vs. within a sports population (Varsity vs. JV collegiate football). JV collegiate football).

Literature Support Literature Support – – Form Recognition in Periphery Form Recognition in Periphery

Study results indicate that athletes Study results indicate that athletes have better form recognition at more have better form recognition at more peripheral locations than nonathletes. peripheral locations than nonathletes.

Literature Support Literature Support -

• Peripheral Awareness/Reaction

Peripheral Awareness/Reaction

Only normative data have been Only normative data have been published for measurements of published for measurements of peripheral awareness/reaction using peripheral awareness/reaction using the Wayne P.A.T.T. in athletes. the Wayne P.A.T.T. in athletes.

VISUAL SKILLS VISUAL SKILLS TO EVALUATE TO EVALUATE

Eye Eye-

• Body Coordination

Body Coordination Vision & Balance Vision & Balance Field Dependence Field Dependence-

• Independence

Independence Visualization Visualization

VISUAL SKILLS TO VISUAL SKILLS TO EVALUATE EVALUATE

Ocular Health Ocular Health Procedures Procedures

Other considerations for the Rx Other considerations for the Rx

Timing of first prescription Timing of first prescription Value of overminusing Value of overminusing Prescribing for twilight Prescribing for twilight Prescribing for specific Prescribing for specific distances distances Prescribing modalities: Prescribing modalities: – – Spectacles Spectacles – – Contact lenses Contact lenses – – Refractive surgery Refractive surgery

Spectacle Considerations Spectacle Considerations

ANSI standards and the sport ANSI standards and the sport Wrap designs Wrap designs Contact sports Contact sports Weather and atmospheric Weather and atmospheric conditions conditions Prescribing tints Prescribing tints Considerations for Considerations for presbyopes presbyopes

VISUAL TASK VISUAL TASK

VISUAL TASK VISUAL TASK

Filters & Visual Information Processing Filters & Visual Information Processing Driven by information provided from Driven by information provided from visual input (VA, CSF, Stereopsis, etc.) visual input (VA, CSF, Stereopsis, etc.) Specific skills affected by filters: Specific skills affected by filters:

– – Visual Discrimination Visual Discrimination – – Visual Figure Visual Figure-

• Ground

Ground

Filters and Lighting Variations Filters and Lighting Variations

Incandescent lighting Incandescent lighting Fluorescent lighting Fluorescent lighting Sodium lighting Sodium lighting Daylight (clear vs. Daylight (clear vs. cloudy) cloudy) Outdoor night lighting Outdoor night lighting

Filters and Performance Factors Filters and Performance Factors

VISUAL SKILLS VISUAL SKILLS THROUGH FILTERS THROUGH FILTERS

Visual Acuities Visual Acuities Refractive Status Refractive Status Contrast Contrast Sensitivity Sensitivity Dynamic VA Dynamic VA

VISUAL SKILLS VISUAL SKILLS THROUGH FILTERS THROUGH FILTERS

Phorias Phorias & & Vergences Vergences (stance & facility) (stance & facility) Fixation Disparity Fixation Disparity Speed & Accuracy Speed & Accuracy

• f Depth Perception
• f Depth Perception

VISUAL SKILLS VISUAL SKILLS THROUGH FILTERS THROUGH FILTERS

Visual Visual-

• Motor

Motor Reaction Time Reaction Time Eye Eye-

• Hand

Hand Coordination Coordination

VISUAL SKILLS VISUAL SKILLS THROUGH FILTERS THROUGH FILTERS

Vision Anticipation Vision Anticipation Skills Skills Speed of Speed of Recognition Recognition

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Polarizing filters Polarizing filters

– – Suppresses reflected light (horizontal) Suppresses reflected light (horizontal) – – Best with reflected glare (water, road surfaces) Best with reflected glare (water, road surfaces) – – Transmit a maximum of 50% (usually ~40%) Transmit a maximum of 50% (usually ~40%) – – Act as neutral filters for unwanted reflections Act as neutral filters for unwanted reflections – – Sports applications Sports applications

* Fishing, water sports, driving/cycling (wet surfaces) * Fishing, water sports, driving/cycling (wet surfaces) * May remove important details in skiing, golf, etc. * May remove important details in skiing, golf, etc.

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

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

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Neutral grey filters Neutral grey filters

– – Filters wavelengths equally Filters wavelengths equally – – Keeps colors more Keeps colors more “ “natural natural” ” – – Sports applications Sports applications

* When subtle color differences matter * When subtle color differences matter … … * Golf, mountaineering, skiing * Golf, mountaineering, skiing * Mountaineering: blocks yellow light in * Mountaineering: blocks yellow light in whiteout whiteout

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Neutral grey filters Neutral grey filters

– – Filters wavelengths equally Filters wavelengths equally – – Keeps colors more Keeps colors more “ “natural natural” ” – – Sports applications Sports applications

* When subtle color differences matter * When subtle color differences matter … … * Golf, mountaineering, skiing * Golf, mountaineering, skiing * Mountaineering: blocks yellow light in * Mountaineering: blocks yellow light in whiteout whiteout

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Red range filters Red range filters

– – Enhances objects in the red spectrum Enhances objects in the red spectrum – – Sports applications Sports applications

* Orange clay shooting * Orange clay shooting * Skiing (contrast changes of * Skiing (contrast changes of reflected light) reflected light)

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Yellow range filters Yellow range filters – – Transmits only longer wavelengths Transmits only longer wavelengths – – Ocular media scatters short wavelength light more Ocular media scatters short wavelength light more -

• improves contrast by eliminating some of this

improves contrast by eliminating some of this “ “internal glare internal glare” ” – – May enhance contrast differences (contours) May enhance contrast differences (contours) – – Sports applications Sports applications * Shooting sports, Snow sports, Driving, Flying * Shooting sports, Snow sports, Driving, Flying * Blue backgrounds (tennis, baseball, golf, etc.) * Blue backgrounds (tennis, baseball, golf, etc.)

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Specialty filters Specialty filters -

• Mirror Coatings

Mirror Coatings

– – Limits glare and increases Limits glare and increases absorption absorption – – Reduces Infra Reduces Infra-

• Red

Red -

• reducing heat

reducing heat build build-

• up

up – – Sports applications Sports applications

* Snow Sports * Snow Sports * Water Sports * Water Sports * Cycling/Running * Cycling/Running

FILTER TYPES & SPORTS FILTER TYPES & SPORTS

Specialty filters Specialty filters -

• Anti

Anti-

• reflective coating

reflective coating

– – Minimizes reflections Minimizes reflections -

• especially back

especially back surface surface – – Sports applications Sports applications

* Racquet sports * Racquet sports * Fishing * Fishing * Shooters/Archery * Shooters/Archery

LENS DESIGN FACTORS LENS DESIGN FACTORS

Goggle designs Goggle designs – – Ski goggles Ski goggles – – Swimming Swimming goggles goggles – – Diving masks Diving masks

Performance Contact Lenses Performance Contact Lenses

Factors to consider: Factors to consider: – – Gaze positions (ex: Gaze positions (ex: upgaze upgaze for cyclists) for cyclists) – – Speed of eye movements (re Speed of eye movements (re-

• orientation)
• rientation)

– – Length of competition Length of competition – – Environment (humidity, temperature, altitude, Environment (humidity, temperature, altitude, debris, wind, UV exposure) debris, wind, UV exposure) – – Replacement possibilities Replacement possibilities – – Tint possibilities Tint possibilities

CONTACT LENS CONTACT LENS CONSIDERATIONS CONSIDERATIONS

Material: water content Material: water content Diameter Diameter Handling Characteristics Handling Characteristics Stability Stability Replacement : ease and Replacement : ease and frequency frequency – – spare lenses on sidelines spare lenses on sidelines – – solutions on hand solutions on hand – – 1 1-

• day lenses

day lenses

Importance to Wearers Importance to Wearers-

• MAX EYES

MAX EYES

Ocular Health in Ocular Health in Performance Vision: Performance Vision:

– – Reduce UVA, UVB Reduce UVA, UVB – – Reduce visual Reduce visual fatigue fatigue – – Eliminate potential Eliminate potential – – “ “Device Device” ” hazard hazard – – Minimizes blue Minimizes blue – – Light hazard Light hazard

COMPLIANCE ISSUES COMPLIANCE ISSUES

100% non 100% non-

• compliant with at least

compliant with at least

• ne step
• ne step

95% either don 95% either don’ ’t disinfect or clean t disinfect or clean regularly regularly 94% don 94% don’ ’t keep case clean t keep case clean 53% fail to wash hands 53% fail to wash hands

EMERGENCY KIT FOR THE EMERGENCY KIT FOR THE ATHLETIC TRAINER ATHLETIC TRAINER

Non Non-

• preserved saline

preserved saline Lubricating drops Lubricating drops Several clean contact lens Several clean contact lens cases cases DMV lens removers DMV lens removers Fluo strips Fluo strips Sterile swabs Sterile swabs Anesthetic? Anesthetic?

Sports Eye Injury Prevention Sports Eye Injury Prevention

Educate the general Educate the general public public Proper coaching for safe Proper coaching for safe play play Modify regulations Modify regulations Promote proper eyewear Promote proper eyewear

Sports Eye Injury Prevention Sports Eye Injury Prevention

Comprehensive patient care Comprehensive patient care Regular visits Regular visits Thorough case history Thorough case history Legal/ethical responsibility to identify & Legal/ethical responsibility to identify & warn warn Verify habitual sports/recreational Verify habitual sports/recreational eyewear: eyewear:

– – Appropriate for risk(s) Appropriate for risk(s) – – Meets relevant standards Meets relevant standards – – Inadequate condition Inadequate condition

Prevalence (all trauma) Prevalence (all trauma)

2.5 million cases per year in U.S. 2.5 million cases per year in U.S. 40,000 40,000-

• 45,000 cases of permanent visual

45,000 cases of permanent visual impairment impairment Accounts for 20% of unilateral blindness; Accounts for 20% of unilateral blindness; 7% of bilateral 7% of bilateral 70% male 70% male Sports related ocular trauma=100,000+ per Sports related ocular trauma=100,000+ per year year

Sports Eye Injury Prevention Sports Eye Injury Prevention

Pre Pre-

• existing conditions that increase risk:

existing conditions that increase risk: – – Post Post-

• refractive surgery

refractive surgery – – High myopia High myopia – – Visual field defects Visual field defects – – IOL implants IOL implants – – Other surgical procedures to eye Other surgical procedures to eye tissues tissues – – Amblyopia and Strabismus? Amblyopia and Strabismus?

Eye Injuries Associated With Eye Injuries Associated With Sports Sports

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%.

Determination of Risk Determination of Risk – – Classification of Various Sports Classification of Various Sports

By Physical By Physical Contact: Contact: – – Contact/Collision Contact/Collision – – Limited Contact Limited Contact – – No Contact No Contact

High Contact/Collision High Contact/Collision Sports Sports

Basketball Basketball Hockey (Field and Hockey (Field and Ice) Ice) American Football American Football Soccer Soccer Rugby Rugby Water Polo Water Polo Wrestling Wrestling Boxing Boxing

Limited Contact Limited Contact

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

Noncontact Noncontact

Archery & Riflery Archery & Riflery Crew/Rowing Crew/Rowing Track & Field Track & Field Golf Golf Running Running Sailing Sailing Swimming & Scuba Diving Swimming & Scuba Diving Tennis, Badminton & Table Tennis, Badminton & Table Tennis Tennis Weight lifting Weight lifting

Sports Eye Injury Sports Eye Injury Demographics Demographics

True incidence is unknown True incidence is unknown No reliable, fast & complete data No reliable, fast & complete data collection systems in place collection systems in place Must rely on incomplete data from Must rely on incomplete data from various data gathering systems various data gathering systems Data does show a major public health Data does show a major public health problem problem

Sports Eye Injury Demographics Sports Eye Injury Demographics

Eyes = 0.25% of body surface Eyes = 0.25% of body surface Eyes account for ~2% of sports injuries Eyes account for ~2% of sports injuries ~10% of patients have had an eye injury ~10% of patients have had an eye injury 10% of all ER 10% of all ER-

• treated eye injuries are

treated eye injuries are sports sports ~27% chance of hospital admission in ~27% chance of hospital admission in ER ER-

• treated eye injury (compared to 2%

treated eye injury (compared to 2% rate) rate)

Injuries in Sports by Age Injuries in Sports by Age

5 5-

• 14 year olds

14 year olds 15 15-

• 24 year olds

24 year olds Basketball Basketball 16.5% 16.5% Basketball Basketball 34.0% 34.0% Baseball Baseball 15.5% 15.5% Baseball Baseball 7.2% 7.2% Swimming & pool sports Swimming & pool sports 12.5% 12.5% Racquetball & Ct. sports Racquetball & Ct. sports 8.1% 8.1% 25 25-

• 64 year olds

64 year olds Basketball Basketball 19.6% 19.6% Swimming & pool sports Swimming & pool sports 14.9% 14.9% Racquetball & Ct. sports Racquetball & Ct. sports 6.7% 6.7% Total injuries all ages 39,297 Total injuries all ages 39,297

One Eyed Athlete

• Risk of Blindness for the One Eyed

Athlete 1.75 ± .30 / 1000

• Risk of Blindness for the General

Population .11 / 1000

One Eyed Athlete

• More than 150x more likely to go blind
• Trauma causes more than 50% of this

blindness

Pre Pre-

• Participation Physical Exam

Participation Physical Exam

Clearance can be divided into 3 categories: Clearance can be divided into 3 categories:

– – Unrestricted Unrestricted – – Clearance after further Clearance after further evaluation/rehabilitation evaluation/rehabilitation – – Not cleared for all or certain sports Not cleared for all or certain sports

Does condition(s) limit participation due to: Does condition(s) limit participation due to:

– – Increased risk of injury Increased risk of injury – – Puts others at risk of injury Puts others at risk of injury – – Can it be treated to allow safe Can it be treated to allow safe participation participation

VT Techniques Related to VT Techniques Related to Sports Performance Sports Performance

Relate technique to sports tasks Relate technique to sports tasks Stress awareness of response & strategy Stress awareness of response & strategy Achieve quality of response initially Achieve quality of response initially Push speed of response when ready Push speed of response when ready Build automaticity of response Build automaticity of response Discuss strategies to assist transfer of skills to Discuss strategies to assist transfer of skills to the playing field the playing field

THANK YOU FOR YOUR THANK YOU FOR YOUR TIME AND TIME AND INTEREST INTEREST

NORMAN PHIL EINHORN NORMAN PHIL EINHORN O.D.,M.S.,F.A.A.O. O.D.,M.S.,F.A.A.O.