Visual demands and risks in sport

There is a tendency to assume that a high level of visual skill and performance is needed for sport. This is not necessarily so. What is needed is appropriate application of visual function in order to meet the demands of the particular sport and level of play.
It follows that there will be considerable variation between sports, and that age and functional ability between individuals will mean an individual approach to best performance in order to meet the needs of the particular sport.
The number of people regularly engaged in active sport is not always properly appreciated. Various surveys carried out in the past decade have suggested that about half the population take part in some form of sport or leisure activity. Participants come from a wide range of age groups. Genuine sporting activity may start as early as 10 years of age, while at the other extreme organised activity may be carried out by those in their 70s.

ignorance isa problem
While there are plenty of resources available for the protection of eyes and vision in different sports, much of this is not known or is ignored by players, clubs and sports bodies. 'It can't happen to me' or a 'macho' approach is a common response by players when asked. So much for eye protection!
With regard to function, a very high percentage of players, even of Olympic standard, take their eyes for granted and have never had an eye examination, never mind a visual assessment for their particular sport.
Optometrists must take a large share of the blame for this lack of interest or awareness by sports people, be they amateur, professional, participant, coach, manager or whatever.
Sports vision should not generally be seen as the domain of the expert or specialist but of the profession in general who have, to a large extent, not taken sufficient interest in sport as an area needing their expertise and input. It does need some effort to acquire the additional knowledge required to make a proper contribution to a sports person's visual ability and hence sporting ability, but there is an expanding literature, lecture and workshop sector aimed precisely at them.

sports vision association
The Sports Vision Association (SVA) has been running for some 10 years now. Its membership is around 100. It is not exclusive to optometrists, as membership has included professionals from other disciplines such as medicine, dispensing opticians, and sport and vision scientists, all of whom have brought their own skills, knowledge and experience.
There has also been sustained and positive input and support from the professional bodies and from some sectors of the optical industry in the form of corporate membership which has been very significant to the success of the association. The SVA has also offered courses and examinations leading to a Higher Certificate in Sports Vision in collaboration with UMIST. Each course offered has been fully subscribed, but again this does not run to large numbers due to the practical content of the course and subsequent limit of demand on facilities.
A relatively small number of non-SVA optometrists have also offered sports vision services to good effect but this, too, has involved only a small number of participants.

eye protection
As in other areas of visually based activity some needs can be very basic, such as the correction of a modest myopia, the effect of an astigmatic correction, anisometropia, stereopsis, ocular dominance, presbyopia and contrast and other routine problems of patients, albeit in some instances requiring more specific dispensing needs. Bifocals designed for use with a VDU or other office use will demand a different adaptation for a golfer. Lateral thinking will be needed. Visual task analysis is essential here.
Other aspects of need affect dispensing for a sportsperson Ð protection, weight of the appliance, choice of spectacles or contact lens correction and field of view, especially where dynamic postural factors are a part.
Ocular dominance is an important factor, and yet an elusive one in many sporting activities. Any of the shooting sports and many of the ball sports are influenced by dominance and, while interesting conclusions have been made concerning dominance, there still remain anomalies and contradictions.
Binocular vision is a further example of a visual function or skill which is required. Routine optometric binocular vision assessment and treatment is of value to a significant number of sportspersons.
Convergence/divergence ability, speed of fixation and of pursuit, fixation disparity and stereopsis must all be considered in relation to the demands of the sport.
The dynamic needs of many sports are of critical importance. Many visual demands need to be related to body posture and movement and cannot be fully evaluated with the patient sitting in the consulting room chair. Simulation of the specific activity which individual sports persons may use, may show variation from one individual to another and from one sport to another, but may be the only way forward.
Dynamic visual acuity, in addition to static acuity, is essential to assess in many cases. The same can be said about contrast sensitivity. The type, distribution and level of illumination is a factor always to be borne in mind. The body posture, especially head or neck, can be important in activities, such as cycling and swimming.
The visual needs are not always obvious. Rifle shooters focus on the foresight blade and not on the target and any refractive correction may need to be adapted for this. Sports where the action is fast presents some surprises on analysis. A batsman does not keep his eye on the ball bowled by a fast bowler. There isn't time with the speed of flight of the ball and other visual clues have to be learnt and used. Anticipation is a skill to be acquired.
In many sporting situations, peripheral vision is critical, not only in helping to follow the flight of a ball or other target but in fitting the player's activities into the whole state of play. Awareness of the position of other players is vital.

occupational optics
The sports vision practitioner should have an awareness of the needs of the sport he is dealing with. There are available sets of data relating to different sports but observing a game and/or training and talking to players about their visual problems can be very instructive. This is basic occupational optics after all.
The above is only a brief overview of the needs for sports vision practice. In addition, there are the whole, more specialised, areas of hand/eye, foot/eye reaction and response times.
Many sports are, by their nature, fast moving and speed of response is a most important factor. Although important, this begins to get into more specialised fields including, in some cases, the use of more sophisticated and expensive equipment. It is, however, interesting work and at the leading edge of the science.

Training to win
The concept of vision training in sport has both proponents and opponents. The correction of basic errors and dysfunction is part of everyday optometry, is not controversial and can be applied to the sports person's needs. To go further, enhancement vision training is becoming more acceptable. There is still need for soundly based research within a rigorous academic framework to settle the matter.
While sport has many benefits, all sport to a greater or lesser extent carries risk. This is not an argument against sport but that risk assessment and reduction should control the rate of injury caused compared with the benefits gained. Inherent in this statement is that the risks are analysed, limited as far as is possible and then acknowledged and minimised.
more exposure, more injury
During the last few decades, serious eye injury in sport has steadily risen as a percentage of eye trauma needing hospital admission. Industrial accidents, road traffic accidents and injury in the home have been reduced and become a smaller proportion of the whole. The Factories Act and Protection of Eyes Regulations, Health & Safety at Work Act, seat belt legislation and car design have, for example, reduced eye trauma. It is to be regretted that this reduction in eye injuries has not been reflected in sport. To aggravate the problem, there has also been an increase in the amount of sport played. More exposure, more injury, is a reasonable conclusion.
It is said that 90 per cent of sport-related eye injury is preventable. It is clear that there is plenty of scope for remedial action. Bear in mind that we also have a duty of care to our patients too.
One of the basic steps to take is to create more awareness and give advice. Are all patients asked: 'What are your hobbies and do you play any sport?' Is appropriate advice then given on the risks of the sport played, remedies reviewed and needs carried through into the dispensing function? Are appropriate sample appliances available for the different sports and are they displayed? The cricketer who stands on a sunlit pitch all day may need advice on UV protection.
All the above and much more applies to the average patient and not only to professional sports persons. The information needed is available in ophthalmic literature and on sports vision courses.
Advice on efficient visual function and on necessary protection applies to a large percentage of our patients and lies within our scope of practice, without the need to be a 'specialist' sports vision practitioner, interesting though that may be to some.
Giving systematic advice and information can only raise the level of players' awareness to the point where more take action with the consequent benefit.
The above is only an introduction, the tip of the iceberg of an aspect of optometry which affects very many of our patients, including younger patients who have no refractive problems.
Sports vision practice has the potential for the prevention of unnecessary pain, suffering and visual loss. It is a subject which is challenging, rewarding and increasingly important with the expansion of leisure activities.

Peter Smith is an optometrist practising in West YorkshireThere is a tendency to assume that a high level of visual skill and performance is needed for sport. This is not necessarily so. What is needed is appropriate application of visual function in order to meet the demands of the particular sport and level of play.
It follows that there will be considerable variation between sports, and that age and functional ability between individuals will mean an individual approach to best performance in order to meet the needs of the particular sport.
The number of people regularly engaged in active sport is not always properly appreciated. Various surveys carried out in the past decade have suggested that about half the population take part in some form of sport or leisure activity. Participants come from a wide range of age groups. Genuine sporting activity may start as early as 10 years of age, while at the other extreme organised activity may be carried out by those in their 70s.

ignorance isa problem
While there are plenty of resources available for the protection of eyes and vision in different sports, much of this is not known or is ignored by players, clubs and sports bodies. 'It can't happen to me' or a 'macho' approach is a common response by players when asked. So much for eye protection!
With regard to function, a very high percentage of players, even of Olympic standard, take their eyes for granted and have never had an eye examination, never mind a visual assessment for their particular sport.
Optometrists must take a large share of the blame for this lack of interest or awareness by sports people, be they amateur, professional, participant, coach, manager or whatever.
Sports vision should not generally be seen as the domain of the expert or specialist but of the profession in general who have, to a large extent, not taken sufficient interest in sport as an area needing their expertise and input. It does need some effort to acquire the additional knowledge required to make a proper contribution to a sports person's visual ability and hence sporting ability, but there is an expanding literature, lecture and workshop sector aimed precisely at them.

sports vision association
The Sports Vision Association (SVA) has been running for some 10 years now. Its membership is around 100. It is not exclusive to optometrists, as membership has included professionals from other disciplines such as medicine, dispensing opticians, and sport and vision scientists, all of whom have brought their own skills, knowledge and experience.
There has also been sustained and positive input and support from the professional bodies and from some sectors of the optical industry in the form of corporate membership which has been very significant to the success of the association. The SVA has also offered courses and examinations leading to a Higher Certificate in Sports Vision in collaboration with UMIST. Each course offered has been fully subscribed, but again this does not run to large numbers due to the practical content of the course and subsequent limit of demand on facilities.
A relatively small number of non-SVA optometrists have also offered sports vision services to good effect but this, too, has involved only a small number of participants.

eye protection
As in other areas of visually based activity some needs can be very basic, such as the correction of a modest myopia, the effect of an astigmatic correction, anisometropia, stereopsis, ocular dominance, presbyopia and contrast and other routine problems of patients, albeit in some instances requiring more specific dispensing needs. Bifocals designed for use with a VDU or other office use will demand a different adaptation for a golfer. Lateral thinking will be needed. Visual task analysis is essential here.
Other aspects of need affect dispensing for a sportsperson Ð protection, weight of the appliance, choice of spectacles or contact lens correction and field of view, especially where dynamic postural factors are a part.
Ocular dominance is an important factor, and yet an elusive one in many sporting activities. Any of the shooting sports and many of the ball sports are influenced by dominance and, while interesting conclusions have been made concerning dominance, there still remain anomalies and contradictions.
Binocular vision is a further example of a visual function or skill which is required. Routine optometric binocular vision assessment and treatment is of value to a significant number of sportspersons.
Convergence/divergence ability, speed of fixation and of pursuit, fixation disparity and stereopsis must all be considered in relation to the demands of the sport.
The dynamic needs of many sports are of critical importance. Many visual demands need to be related to body posture and movement and cannot be fully evaluated with the patient sitting in the consulting room chair. Simulation of the specific activity which individual sports persons may use, may show variation from one individual to another and from one sport to another, but may be the only way forward.
Dynamic visual acuity, in addition to static acuity, is essential to assess in many cases. The same can be said about contrast sensitivity. The type, distribution and level of illumination is a factor always to be borne in mind. The body posture, especially head or neck, can be important in activities, such as cycling and swimming.
The visual needs are not always obvious. Rifle shooters focus on the foresight blade and not on the target and any refractive correction may need to be adapted for this. Sports where the action is fast presents some surprises on analysis. A batsman does not keep his eye on the ball bowled by a fast bowler. There isn't time with the speed of flight of the ball and other visual clues have to be learnt and used. Anticipation is a skill to be acquired.
In many sporting situations, peripheral vision is critical, not only in helping to follow the flight of a ball or other target but in fitting the player's activities into the whole state of play. Awareness of the position of other players is vital.

occupational optics
The sports vision practitioner should have an awareness of the needs of the sport he is dealing with. There are available sets of data relating to different sports but observing a game and/or training and talking to players about their visual problems can be very instructive. This is basic occupational optics after all.
The above is only a brief overview of the needs for sports vision practice. In addition, there are the whole, more specialised, areas of hand/eye, foot/eye reaction and response times.
Many sports are, by their nature, fast moving and speed of response is a most important factor. Although important, this begins to get into more specialised fields including, in some cases, the use of more sophisticated and expensive equipment. It is, however, interesting work and at the leading edge of the science.

Training to win
The concept of vision training in sport has both proponents and opponents. The correction of basic errors and dysfunction is part of everyday optometry, is not controversial and can be applied to the sports person's needs. To go further, enhancement vision training is becoming more acceptable. There is still need for soundly based research within a rigorous academic framework to settle the matter.
While sport has many benefits, all sport to a greater or lesser extent carries risk. This is not an argument against sport but that risk assessment and reduction should control the rate of injury caused compared with the benefits gained. Inherent in this statement is that the risks are analysed, limited as far as is possible and then acknowledged and minimised.
more exposure, more injury
During the last few decades, serious eye injury in sport has steadily risen as a percentage of eye trauma needing hospital admission. Industrial accidents, road traffic accidents and injury in the home have been reduced and become a smaller proportion of the whole. The Factories Act and Protection of Eyes Regulations, Health & Safety at Work Act, seat belt legislation and car design have, for example, reduced eye trauma. It is to be regretted that this reduction in eye injuries has not been reflected in sport. To aggravate the problem, there has also been an increase in the amount of sport played. More exposure, more injury, is a reasonable conclusion.
It is said that 90 per cent of sport-related eye injury is preventable. It is clear that there is plenty of scope for remedial action. Bear in mind that we also have a duty of care to our patients too.
One of the basic steps to take is to create more awareness and give advice. Are all patients asked: 'What are your hobbies and do you play any sport?' Is appropriate advice then given on the risks of the sport played, remedies reviewed and needs carried through into the dispensing function? Are appropriate sample appliances available for the different sports and are they displayed? The cricketer who stands on a sunlit pitch all day may need advice on UV protection.
All the above and much more applies to the average patient and not only to professional sports persons. The information needed is available in ophthalmic literature and on sports vision courses.
Advice on efficient visual function and on necessary protection applies to a large percentage of our patients and lies within our scope of practice, without the need to be a 'specialist' sports vision practitioner, interesting though that may be to some.
Giving systematic advice and information can only raise the level of players' awareness to the point where more take action with the consequent benefit.
The above is only an introduction, the tip of the iceberg of an aspect of optometry which affects very many of our patients, including younger patients who have no refractive problems.
Sports vision practice has the potential for the prevention of unnecessary pain, suffering and visual loss. It is a subject which is challenging, rewarding and increasingly important with the expansion of leisure activities.

Peter Smith is an optometrist practising in West Yorkshire