Article Date: 12/1/2008

Carving a Niche in Performance Vision Optometry

Carving a Niche in Performance Vision Optometry

Sports fans, channel your enthusiasm for eye care into a practice devoted to athletes and active patients.

By Donald S. Teig, OD, FAAO, Ridgefield, Conn.

IN 1979, I met with some players from the New York Yankees, and we discussed the absence of vision care tailored specifically for athletes. That discussion sparked my interest in fulfilling such a need. The result is a nearly 30-year dedication to developing new testing methods, therapies and equipment for sports optometry.

In my career, I've worked with 11 Major League Baseball clubs, men's and women's professional golf and tennis tours, several professional football, basketball and hockey teams, the Olympic worldwide performance vision team, and the Joffrey Ballet. But performance-enhancing vision care isn't just for pro athletes. We see everyone from pilots and law enforcement officers, to 7-year-old little leaguers to seniors who play the occasional game of tennis.

Within our primary care practice of four doctors, we've built a strong reputation for enhancing the performance vision of any patient who wants to raise his level of vision performance above average. If this area of optometry interests you, I recommend learning more about the field and making a start.

The Basics

Since we collect 80% of our information through our visual system, improving the way athletes see during sports activities is likely to impact their performance. The whole field of enhancing vision and athletic performance is about taking the skills of the athlete and connecting them with his eyes.

To do this, we have to understand the sport. So I ask these questions and others about my patients' sports and activities:

■ What does a player do? Does he run, swim, shoot, row backward or jump through the air? How is the sport or activity performed, from beginning to end?

■ What does the player try to avoid? Does she want to avoid missing the ball, getting tackled or hitting a pothole?

■ In your sport or activity, what visual challenges confront you? Does the sport require you to alternate between near and far, detect a light-colored ball against a bright sky or see through dusty conditions?

■ Does the sport pose any physical obstacles to eyeglasses or contact lenses? Do you wear goggles or a face mask or perform in the water?

Once we know the demands and challenges of an activity, you can evaluate the skills necessary to succeed and work to enhance the patient's visual skills.

10 Test Areas

All of our patients undergo a standard eye exam to determine their ocular health and refraction. Patients who want to enhance their performance vision receive a 2-hour evaluation that includes essential performance measurements, some of which we perform with equipment specifically designed for these purposes. These tests include:

1. Static and dynamic visual acuity. We evaluate visual acuity on two levels: clarity of vision (a.k.a. static visual acuity), a familiar and important aspect of everyone's visual health, and dynamic visual acuity, which tells us how well an athlete sees objects in motion. For the latter measurement, we use a diagnostic device called the Kirshner dynamic acuity rotator. Good scores in both areas are essential for performance vision.

2. Contrast sensitivity. This element is very important for sports and other performance-vision needs, such as seeing detail in different light levels and weather conditions or seeing a ball against the sky.

3. Saccades and pursuit. We check the speed and accuracy of two different types of eye movements: the jumping movements between objects, known as saccades, which a player might use to watch her opponents, and smooth action-tracking movements called pursuit, which she might use to watch the ball in motion. A device called the Wayne Saccadic Fixator (Wayne Engineering, Skokie, Ill.) measures both types of movements.

4. Accommodation and convergence. How well can the eye aim and refocus when it switches between objects located at different distances? Athletes must do well in these areas to make quick judgments about where to kick a ball to make the goal or throw an out. We use the Wayne Saccadic Fixator for these measurements as well as computer orthoptics, or computerized vision therapy.

5. Depth perception. Using a device called the Howard Dolman Apparatus (Lafayette Instrument Company, Lafayette, Ind.), we evaluate depth perception at different distances and gaze positions to determine how well an athlete gauges distance, speed and whether an object is moving toward him. These abilities help tennis players who may have to hit a ball coming at them fast from a low or high position.

6. Peripheral vision. I helped develop a device, called the Wayne Peripheral Awareness Trainer (P.A.T.) (Wayne Engineering, Skokie, Ill.), that measures and enhances peripheral vision. We compare how quickly and precisely an athlete can see in her central vision to how fast and accurately she can see in her peripheral vision. Strength in this area is important in most sports. A golfer might keep her eye on the ball as she swings the club, but a soccer player often has to run and maneuver the ball without looking straight at it.

7. Eye-hand coordination. Everyone needs good eye-hand coordination, but it's especially important to test athletes who play fast-moving sports, whether they're connecting the bat with the ball or reacting to terrain on a bicycle. We test this skill with the Sports Vision Trainer (Sports Vision Property, Ltd., Burwood, Australia).

8. Visual balance. Athletes need to maintain balance, so we test their ability to complete a sequence of tasks that simulate the performance conditions they experience while playing their sport. This requires patients to stand on a specialized device called the Wayne Saccadic Fixator Balance Board & Quick Feet Apparatus (Wayne Engineering, Skokie, Ill.).

9. Visual concentration. Using a tachistoscope, we test how well patients can block out distractions to focus on their athletic activities. For example, we may test a gymnast doing a vault in a gymnasium filled with bystanders and other gymnasts performing on other pieces of equipment.

10. Visualization. This practice is a combination of vision care and psychology. Using a visualization training sequence, we ask athletes to do a task in front of sports vision experts while they picture themselves performing their next strategic moves to win. By doing this, athletes prepare their muscles and minds to complete them.

Skill Enhancement

When test results show that my patients are weak in some of these areas, we develop a performance-vision training program to boost their skills. Over the years, I've worked with manufacturers to design equipment that enhances visual and motor performance. My training sequence for most athletes is divided into three stages:

Stage 1: Visual calisthenics. In this stage, we work on enhancing basic visual skills, such as improving the ability of vision to converge, diverge, track or focus.

Stage 2: Visual/motor enhancement. Next, we work on the connection between vision and the body, such as how the body registers or reacts to what the person sees. These skills include visual agility, eye-hand coordination and peripheral vision response. Over 20 years, I helped develop a device called an anticipation timer that evaluates how fast an athlete's hands move in reaction to visual stimuli. The device also helps develop spatial judgment skills, so athletes can better anticipate the rate at which objects are moving toward or away from them.

Stage 3: Visual/mental preparedness. Finally, we improve the athlete's ability to visualize and reach total success by teaching relaxation techniques, such as deep breathing and progressive body relaxation, to achieve an alpha brainwave pattern, making the athlete more receptive to positive imaging.

Want to Add a Sports Specialty?
I don't have a performance-vision practice. I'm part of a general practice with a performance-vision niche.
Maybe you're thinking of doing the same thing, or perhaps as a new practitioner, you're thinking of asking a senior clinician to invest in the technology so you can develop this patient base. Either way, the starting point is the same: Learn all you can.
Read everything about performance vision you can get your hands on. Attend lectures and seminars and take advantage of other learning opportunities. Visit practices that offer these services.
At our practice, we offer a 4-day consultancy for new optometrists, and you're welcome to contact us about it. Next, start getting your feet wet. Have the courage to purchase or lease some equipment as a starting point. An investment of as little as $20,000 will identify your practice as one that's interested in helping young athletes.
Finally, aside from adding performance or sports vision enhancement to your advertising, you can start converting some of your general patients into performance-vision patients. Add sports, activities and occupations to your patient questionnaire. Talk to kids about sports. Some of these patients will be excited about performance-vision enhancement, and they'll direct friends and teammates to you as well.

Sports Vision Correction

All of these treatment avenues increase patients' visual skills, but we also need to address their vision correction needs. An optometric practice with a performance-vision specialty must offer patients the latest vision correction and protection technology. We need to be on top of the latest and greatest in ultimate vision. This requires an active interest because small manufacturers offer many excellent options for individual sports. We want our practice to be the one central place that patients depend on for the newest technologies.

For example, a company called Scuba Spec Inc., Aiken, S.C., inscribes the prescriptions of patients into their scuba masks, and we fill these orders. Ophthonix Inc., San Diego, offers iZon high-resolution spectacle lenses (see article 'Help Patients View the World in High Definition' of this issue) to eliminate higher-order aberrations. Synergize hybrid contact lenses, which are rigid in the middle and soft in the periphery, are available for patients with astigmatism so they can get consistent, sharp vision throughout their athletic performance without weighting or shifting.

We offer polarized spectacle lenses to patients who engage in water sports. And we provide distance-only spectacles as an alternative to progressive lenses, since athletes have to move their eyes around and focus on objects at different heights and in different directions.

Sunglasses and tinted lenses are great options for some athletes. For example, cyclists who need good daytime street vision benefit from sunglasses. My patients who participate in clay and trap shooting are fanatical about their specially designed eyeglasses, which have interchangeable lenses and tilting frames. They need glare treatment, rather than tinting, for cloudy days. Vermillion lenses are good for bright sunny days. Blue-blockers are good for areas with treeless skies, and yellow lenses help in hazy conditions.

No matter what our patients need, we offer it to them. We're even remodeling part of our center to provide them with a new training room. We want patients to be at the top of their game, so we must be on top of ours. nOD

Dr. Teig is founder and codirector of Ridgefield Family Eyecare and the Institute for Sports Vision in Ridgefield, Conn. Dr. Teig received his doctorate from the Pennsylvania College of Optometry in 1970. He's a past president of the International Academy of Sports Vision and past chairman of the American Optometric Association's Sports Vision Section.

Optometric Management, Issue: December 2008