Part 1 of this
series focuses on the aspects of vision important for sports performance, as well
as the testing necessary to make sports vision a specialty in your practice.
have often wondered how to both attract new patients to our office, and offer new
and innovative services to our existing patients. For the past decade and a half,
we have been fortunate to work in the field of sports vision with professional athletes
who display exceptional visual performance. You can use the lessons we've learned
to successfully add sports vision to your practice.
have visual acuity levels far superior to the general population
Why so different?
Why is it important to test to the level of function of a professional
athlete? Although the vast majority of our patients are not professional athletes,
we do see many children and adults who enjoy recreational and competitive athletics.
Research has clearly shown that the better an athlete's vision, the better he or
she performs. This is especially true at the professional level, but carries down
into the college, high school and little league levels as well. Parents want the
best for their children and will make every effort to provide them with the necessary
tools (e.g. vision and visual efficiency) to perform at their maximum potential
in any given sport. In addition, we are all familiar with adults who are true "weekend
warriors," giving up their day-job to don sports uniforms on weekends. The market
for weekend sports activities is huge, and many of these athletes are keenly interested
in doing all that they can to be more successful in their athletic competition.
our vision screening system, we use the M&S Smart System, which runs the Professional
Sport Vision Tester (PSVT). We have used this system for the last several years
because it tests all the performance-based measures used in our vision profile.
It is efficient, easy to calibrate and can be operated by a technician. The results
of the screening are formatted for direct comparison with our professional baseball
player database. The printout provides the performance level on each test along
with a color graph of how the test results compare with the major league database.
These printouts are very informative for doctor and patient alike.
Testing athletic vision
Since 1992, we have evaluated close to 2,500 professional athletes.
Professional teams such as the LA Dodgers, NY Mets, Boston Red Sox and Los Angeles
Kings have participated in screening the four critical areas of vision: visual acuity,
contrast sensitivity, distance stereo and dominant eye. We learned a great deal
about what differentiates the visual function of an elite professional athlete from
the general population. We have developed a professional athlete profile that makes
it possible to compare any athlete, professional or not.
can test sports vision easily and efficiently.
We use 4-position Landolt rings to record acuities for professional
athletes and have gathered measurements ranging from 20/200 to 20/8. This method
of testing vision is language and literacy independent and takes all examiner bias
and interpretation out of the doctor's hands. The computer runs a predetermined
algorithm that increases the test/retest reliability of the measured acuity. The
Smart System Pro-Sports screening system records all patient responses and then
compares the results with normative baseline data.
The acuities closely follow a normal distribution with 20/8.9
being the best vision recorded to date. There is no significant statistical difference
in the vision between the right and left eyes.
The most sensitive test for binocularity is stereopsis. Our unique
approach measures distance stereo utilizing both contour stereo and random dot targets.
Liquid crystal shutter goggles generate the stereo targets. The disparate target
is located in one of four positions on the screen. The subject indicates the correct
location of the stereo target by pushing a button on the response pad and the computer
records the input for future analysis. As with visual acuity, the computer runs
a predetermined algorithm that increases the test/retest reliability of the measured
Contrast sensitivity testing with and without glare yields important
information when assessing the professional athletes' visual capabilities. We use
black and white sin wave gratings placed on one of three positions to test contrast.
We test low, middle and high spatial frequencies binocularly and again, the computer
captures the answers in real time to eliminate any erroneous data. A predetermined
algorithm increases the accuracy and efficiency of the test. Professional athletes
are statistically significantly more sensitive to contrast at all spatial frequencies
than the general population.
From these data, we have been able to derive a vision profile
for professional athletes. Our goal now is share this information so vision screening
can be done at the college and high school levels. By identifying those athletes
who need vision correction early in their career, we can correct it so that poor
eyesight will not limit their performance.
Correct all refractive
errors and abnormalities, regardless of how small they are.
Add a sports vision specialty
Now that we have reviewed the visual capabilities of professional
athletes and their differences from the general population, we'll discuss specific
steps you can take to add sports vision to your practice. What equipment do you
need? What are the necessary components of the examination? What is the difference
between a vision screening and an examination? What components should be done in
the office and what can or should be done "on the field?"
Adding a sports vision specialty is a win-win-win proposition.
First and foremost the patient wins (all puns intended). By offering the examinations,
implements and therapies that get your patient to perform at their visual best in
their sport of choice, you deliver what your patients expect from their eye doctor.
If you can provide those services the patient benefits.
Secondly, the doctor wins. We are in a service profession. We
are in a unique position as optometrists because we are able to provide both the
professional services our patients need and the products that will make their lives
better. When a patient comes to the office, they generally have a vision problem.
We provide the services and products to solve their problem and in so doing, meet
The office also wins. When we provide beneficial services for
our patients, our reputation grows and with it, so do referrals. A reputation as
a sports vision provider (dare we say "expert?") will increase your referral base
not only with patients who need sports vision services, but with the rest of their
family as well. Sports vision is an excellent practice builder and rejuvenator.
It will pump new life into a stagnant practice. It will get you back out into the
community dealing with active and young if not young-at-heart people.
You can increase
revenues in your practice by offering vision screening to athletes at the high
school and collegiate levels.
Vision screening can determine whether a patient is performing
above, at, or below a fixed criterion. For example, schools conduct vision screenings
to see if children have vision worse than 20/40. If they do, the school recommends
a complete examination to determine the exact nature of the problem. A vision screening
can be done in the office or "on the field." To conduct sports vision screenings
outside the office, you need equipment that is portable and easy to set up and use.
We use the Professional Sports Vision Tester (PSVT) to screen all of our athletes
both in and out of the office. It clearly delineates in the patient's mind the difference
between a screening and a comprehensive examination. The tester has all the components
necessary to do a through sports vision screening (see chart below). It is actually
the exact same equipment we us to screen the professional baseball players during
spring training each year.
testing is fully computerized and takes about 10-12 minutes per player. The players'
answers flow to the computer via a button pad. You can test yourself, or delegate
to a technician with ten minutes of training. We are always on site during the screenings.
We begin the testing and gradually turn it over to the technician so we can focus
on educating the players and coaches. It is vitally important that the coaches and
trainer understand the information that is being gathered and the importance of
vision in optimum sports performance. Take advantage of this education process and
marketing. Use parent volunteers to help organize the players and get them off the
field and to the vision screening site in an efficient manner. These parent volunteers
play a vital role in spreading the word to the players about the benefits of the
The PSVT results are electronically transferred to a scoring facility
where the data are analyzed and an individual report is sent back for each player.
It contains the performance level on each test and a bar graph that rates the players
against the major league profile. We then distribute the results to each player
or their parents and explain each component. If deficiencies are found, we recommend
a comprehensive evaluation from a doctor who understands the needs of athletes.
That examination will hopefully determine the nature of the problem and offer the
athlete options to fix the problem(s).
acuity – right and left eye separately without an occluder
at distance – contour and random dot
dominance – independent of handedness
sensitivity – at spatial frequencies known to be related
to sport performance
sensitivity with glare
time with varying targets
Further refining correction
The PSVT results determine the necessity of a comprehensive examination.
In addition to the normal components of a comprehensive exam, pay particular attention
to the deficiencies found during the screening. Let's focus particular attention
on refraction. The guiding principle for refracting athletes is, "Very small refractive
errors, especially astigmatism, make big differences in the athletes' vision." When
refracting an athlete, do not arbitrarily stop at 20/20; keep refining the refraction
to challenge the patient's visual system to perform to 20/12.5 or 20/10. Remember
the average professional baseball player has 20/12.5. Even if the refractive error
is small, trial frame that Rx. You will be surprised at the number of times that
small correction will result in one-half or one line of acuity improvement. Additionally,
athletes may comment on how much clearer their vision is with the small amount of
correction. Prescribe it!
amounts of central suppression often reduce stereopsis at distance. Correcting small
refractive errors and small anisometropias can often break down small amounts of
central suppression. Orthoptic eye exercises may also result in improved stereopsis.
Optimal correction can improve below-expected contrast sensitivity.
This is especially true if contrast sensitivity is low in the high spatial frequencies.
Colored filters can also enhance contrast sensitivity depending on lighting conditions.
focus on Sports Vision will continue next month, with details on how to further
refine athletic correction and how to market your new specialty.
received his O.D. and Ph.D. degrees from the University of California at Berkeley.
He is currently the Chief of Binocular Vision and Orthoptic Services at the Jules
Stein Eye Institute at the David Geffen School of Medicine, UCLA. He also serves
as Full Professor of Basic and Visual Science and Optometry at SCCO.
Dr. Laby received his medical degree from
the George Washington University School of Medicine. He serves as Assistant Clinical
Professor of Ophthalmology at Harvard Medical School and has served as staff ophthalmologist
for several professional sports teams including the LA Dodgers, Boston Red Sox,
NY Mets and LA Kings, among others. He is the co-author of Dictionary of Ophthalmology.