Article

INVEST IN SPORTS VISION

UTILIZE TECHNOLOGIES TO CREATE OR GROW THIS SPECIALTY IN
YOUR PRACTICE

IN 2014, I excitedly added a Howard-Dolman device to the mix of sports vision equipment at our practice. The piece satisfied my goal of adding a new gadget annually, was budget friendly and tested distance depth perception. The device consists of a rectangular box with two strings — manipulated by the patient from about 10 feet away — attached to two rods, one of which moves and the other is stationary. I enthusiastically ushered in a fairly outspoken pro-bowl defensive end to sit for the new test. The Miami Dolphin player’s reaction: “Doc, what is this? Mouse Trap?”

Several factors go in to building the equipment offered at a sports vision practice, including the “wow” factor from patients. Although this specialty can be added to a practice with minimal equipment purchases, it’s worth considering buying advanced equipment to provide care above the norm.

This article provides background on some sophisticated, high-tech instruments that one could build a practice around. This information, and real-life examples, may aid in considering these investments.

SACCADIC FIXATORS

A saccadic fixator can be used for drills, such as eye/hand coordination and reaction, go-no-go drills and peripheral awareness training, and it has become a staple in acquiring baseline data and creating rehab for concussion patients. Just like base in prisms, that are often used for post-concussion syndrome, this equipment can help a patient to regain the anticipatory peripheral system that has often collapsed in patients who have a concussion. Two such devices:

VISION COACH Interactive Light Board: This saccadic fixator is made up of a large horizontal display measuring 50 inches by 34 inches (about 37 pounds) and a non-glare, shatter-proof membrane. The display can slide up and down its stand at a touch without a motor. Software is housed internally. About 120 embedded LEDs measure precise timing of speed and recognition to one hundredth of a second. There is a corresponding auditory “beep” with target depression. The Board provides no visual cues. Instead, the whole screen is blank and flat until a target is presented, so the user has no idea where the next target will appear. Letters and numbers can be projected as a target for extra cognitive load over a basic light. Finally, the device enables the practitioner to create patient-specific activities with multiple program options.

Dr. Nanasy tests depth perception on the Howard Dolman device at the LPGA tournament.
Courtesy of Jayson Teig/High Performance Vision Associates

LPGA golfer whose reaction time is being assessed on VISION Coach Interactive Light Board.
Courtesy of Jayson Teig/High Performance Vision Associates

In practice: For baseball, the Board can be used to gather baseline information at the start of training camp and then continuously used as part of workout routines of the individual players. Specific drills can be designated for each player, for example a go-no-go drill for batters. The goal in this drill is to hit as many of the lights presented during the testing period — unless the center light is on. This has clear correlation to the visual and cognitive reaction of hitting a ball in, but not out, of the strike zone.

Information: Learn more at visioncoachtrainer.com .

DynaVision D2. This saccadic fixator stands at 4 foot by 4 foot and weighs about 127 pounds. Raised buttons offer tactile input, while an audible beep indicates a successful hit. (The company says that training with both tactile and auditory cues accelerates learning of compensatory visual scanning strategies for those who have visual impairment.) The device’s light board has a non-glare surface.

Raised targets on DynaVision D2 give athletes tactile feedback when they depress each target.
Courtesy of Active Evolution Studios

The software offers basic and advanced programmable options. For example, a basic one-minute drill in which the patient reacts to lights across the board compared with a drill that specifically focuses on a quarterback’s blindside. Other drills make the subject hold down a light before advancing to the next light as it presents. The software adapts to individual skill levels by introducing new tasks of greater complexity.

In practice: DynaVision was used in a four-year University of Cincinnati study, which found that vision training can help reduce the rate of concussions significantly in football players. Specifically, the players completed light board training and reaction time assessments daily during the team’s training camp, and then used it on a weekly basis during the season. Players with enhanced peripheral awareness and reaction time can likely take a hit more safely by giving themselves time to appropriately prepare for the hit with the appropriate muscle control. (I am hoping to mirror this study with a college soccer team during the next few years.)

Information: Learn more at dynavisioninternational.com

SENAPTEC SENSORY STATION

A “multitasker” machine, this device assesses VA, dynamic vision, contrast sensitivity, depth perception, near/far quickness, perception span, multiple-object tracking, reaction time, eye/hand coordination and offers go-no-go drills.

A demonstration prepares an athlete for multiple object tracking on Senaptec Sensory Station.
Courtesy of Jayson Teig/High Performance Vision Associates

Physically, it entails a 55 inches high-definition touch screen. A 13.3 inch screen tablet and smartphone are also used for interactive tests. The device weighs about 300 pounds and can be disassembled into three parts for transport. The height of the stand, or wall mount, is adjusted accordingly to outfit the training exercise.

The system is designed for remote monitoring with cloud-based analytics. An administrator can login to observe real-time results of all persons connected to the practice using any remote computer, tablet or mobile device. Further, the administrator can adjust the training protocols and settings and send these updates to individual/team users at their remote locations.

Senaptec also provides a cloud-based database of individuals performing each assessment. The database is categorized by activity (for example, professional baseball pitcher) and allows the practitioner to tell the patient where he or she has strengths and weaknesses in sensory performance, as compared to others in similar activities and/or positions.

In practice: Using its remote capabilities, this equipment could be used for training college-level football players. For example, after watching the team’s game on Saturday, the O.D. could develop a training program and send it to the remote location. An email could be sent to team trainers saying, “After watching X drop two passes this weekend, I uploaded a new training program for him to begin this week. It’s focused on vision over his left shoulder, as well as focusing to avoid distractions. I’ll keep you posted on how he is progressing.”

An athlete is instructed on contrast sensitivity on RightEye Performance Vision Tests.
Courtesy of Jayson Teig/High Performance Vision Associates

Information: Learn more visit Senaptec.com .

RIGHTEYE PERFORMANCE VISION TESTS

Another multitasker, RightEye Performance Vision Tests assesses VA, vergence ranges, color vision, contrast sensation, discriminate reaction time, dynamic acuity, visual speed and tracking with go-no-go.

The hardware includes a pair of glasses, which enable eye tracking, and a large desktop flat screen, accompanied by a built-in eye-tracking unit that is along the bottom of the monitor and works with the glasses worn by the user. The whole system can fit in a backpack.

During the training programs, the device can measure the time it takes for the eyes, not the hands, to move from start location to stimuli, providing a measurement for processing time. By being able to separate eye reaction time from eye-hand reaction time, practitioners can focus on bettering this specific measurement. Results of the assessments are cloud based and can be accessed by providers monitoring teams offsite. RightEye also has a database that allows the practitioner to compare an athlete’s results with others in his or her same sport/position.

An athlete tracks three of eight objects on NeuroTracker.
Courtesy of Jayson Teig/High Performance Vision Associates

In practice: So much of a skeet shooter’s performance relies on eyes alone. These athletes can benefit from biweekly training protocols focusing on saccades and pursuits. For example, one drill has the athlete soft focusing on the center of the screen while targets that look like aliens present. Looking at the alien will cause it to explode, and RightEye will calculate, in milliseconds, and with what accuracy (over or under shooting) the eyes traveled to the target.

Information: Learn more at righteye.com .

NEUROTRACKER

This software uses various forms of multiple-object tracking, alongside go-no-go and other stacking drills — or drills that require the participant to perform more than one task at a time — to help users strengthen their mental capability for awareness.

No hardware is included with this purchase. The drills can be done on any screen size.

You have two options for financial investment in the software: You can pay per-user access (an opportunity to “try it out”), or pay a one set fee for the full software system that comes with active 3D capability and multiple session types.

In practice: In my experience, projection of an image on a large screen helps athletes to train in the most “real life” scenario. While I don’t have NeuroTracker (yet), I would use it to project the software on a wall for a tennis player. A drill may consist of six tennis balls spread randomly across the screen. Three balls will briefly be identified as the ones to keep track of (think the old which-of-these-cups-has-the-ball-under-it game) before all six balls go bouncing wildly all over the projection area. Thirty seconds later, the balls stop and those the athlete was asked to keep track of must be identified. A skilled athlete may be able to track four balls accurately after training.

Information: Learn more at Neurotracker.net .

BUILDING BLOCKS

Investments in this equipment will be the foundation on which you build your practice. Choose one “big ticket” item that will outfit the needs of your patients, and therefore, work best for your practice. Surround it with the many staples of sports vision that are often inexpensive and easy to store, as needed.

Some factors to consider when deciding which item to purchase:

1. Do you have space limitations?

2. How much work do you want your patient to do on one piece of equipment? (Many doctors will love that they can get one showpiece that performs a majority of the tests needed by their patients. Other doctors may want to be able to keep patients guessing about what exactly they may be doing at the next visit.)

3. Cost. If you love the equipment but have some sticker shock, contact the company anyway. You may be able to lease equipment, do a “per-user” program or even break it apart. For example, Senaptec has a tablet-only option.

If you’re on the fence, ask a vendor where you may be able to see their equipment in person. The good news is that these are all great options that are backed by data and research! OM

Calculate Fees

In making an investment in sports vision, you will want to know how many patients you will need to see to pay for your purchase. To calculate, you need to decide what you will be charging for your sessions and how often you will utilize the equipment in those sessions. (Unless you are working with concussion patients, most sports vision evaluations and training are not covered by insurance payments.)

Begin by setting a price for a complete sports vision evaluation (a one-time group of tests concluding with a report that explains what you tested, how the patient compares, [for example, average] and how the results relate to the specific sport). Pricing can vary depending on the practice and the practitioner’s expertise. For example, an O.D. who has been training athletes for five years may charge more for sessions compared with an O.D. who is starting out in sports vision and building his or her patient base. (I would recommend a price range of $100 to $300, depending on services provided.) This evaluation will give you all the ammunition you need to tell an athlete if and how he or she will benefit from training.

Next, I recommend utilizing packages of sessions, coupled with at-home exercises, rather than having patients pay per session. In my experience, this creates patient buy in and ensures continuity of care, patient compliance and maximum results. Sell a 10 to 20 session package, and offer discounts for prompt payment. As with any service, explain the value to the patient. Consider this script with a female tennis player, following her comprehensive exam (always performed first) and sports vision evaluation.

“Overall you did well on the skills that we analyzed, scoring at or slightly above the average for most tests. At the level you are playing, I am surprised you didn’t do even better on many of the tests that directly correlate to tennis, such as multiple object tracking, peripheral awareness and eye-hand reaction speed. You mentioned you have trouble judging if a ball is tracking out of bounds, and this may be why. If we can improve your performance in those areas, you are likely to see court results. I recommend two sessions per week. It will require dedication and training. Also, I am prescribing drills for your tennis workouts with the Senaptec Strobe glasses. If you want to improve your tennis game, we are ready to help you do it!”