I wanted to use December's blog to thank those of you that have joined See To Play's mission of educating athletes about their vision. One of the best ways to reach their genetic potential is by taking care of their vision and honing their visual skills.
I'm also very excited at how many of you are implementing the See To Play Gaze Stabilization Exercises and our See To Play Vision Concussion protocol. I continue to be contacted by colleagues, coaches and athletes throughout the year...and this year the number was even larger.
It's also overwhelming for me to see all the different countries involved! We're global!!
Please feel free to contact me so that I can help you with any of your questions on helping athletes See The Best to Be The Best!
Happy New Year!
Unfortunately, injuries are a part of sports. Training staffs are prepared for most injuries. The question is: "Are you prepared for game time eye injuries and eye issues?"
Recently, on a Monday Night Football game, we got to see such an incident occur. This picture shows a trainer attending to an athlete who has having a game time right eye issue.
You can be prepared for the majority of game time eye issues by following these rules:
1. Have a bottle of eye wash available to wash debris out of eyes.
2. Have extra contacts available for players who lose contact lenses in play.
3. Learn this simple method: For athletes who feel something is stuck in the upper lid, simply have them close there eyes, grab the eye lashes of the upper lid and then drag the upper lid over the eyelashes of the bottom lid. Many times, the lashes of the lower lid will knock out trash and dirt stuck under the upper lid.
4. Carry a bottle of artificial tears for athletes to use after the above instances occur.
5. Have cold compresses availabel for any time the eyes sustain blunt trauma.
These are just five quick steps to be ready for the majority of game time eye issues. Athetes should be rushed to the eye doctor's office when there are penetrating wounds or issues where athletes lose vision out of an eye.
We are going to be updating our website page before the new year.
Feel free to stop by frequently as we try to streamline information and also bring you new information on ways to improve athlete's vision.
In June 2013, I had the honor of being interviewed for Fox Sports Ohio Broadcaster Chris Welsh's Tech Talk (a segment found on most of Cincinnati Reds pregame shows). We recorded three segments and one of the segments talked about the importance of athletes eating the right foods so that they will have peak vision for their athletic performance. I even held up some fresh kale, broccoli and spinach during the interview to provide visual aides.
This topic was actually not new news to the players. Many of them had already incorporated greens into their diets. Their favorite was to eat kale chips (kale leaves that had been baked). Some even were taking a supplement to improve vision, Eyepromise.
Fast forward three years to the June 2016 Investigative Ophthalmology and Visual Science Journal and you can now read a study which documents that not only do the ingredients found in green leafy vegetable help protect your eyes from the harmful affects that blue light and aging have on your eyes, but they also help you see better as well as improve your depth perception. (Click here to read the study).
Visual acuity is formed by receptors known as cones in your retina. The larger the number of cones and the more dense they are packed in together allows athletes to have better than 20/20 vision. A larger area of these cones covering the retina give athletes larger areas of central vision (the detailed vision zone) allowing them to see more of the playing field in one gaze.
Let's look how vision works.
The image, say a baseball, enters the eye and hits cones. The cones fire off an impulse of the image to the brain. The brain sees the image....a fastball....swing!
Lutein is an antioxidant which allows the cone to fire quickly, allows the nerve impulse to move faster and digests the waste products of this chemical reaction to be removed by the blood stream preparing the cone for the next image. This topic is also referred to as macular pigment.
Lutein is found in green leafy vegetables which maximize vision. Lutein cannot be absorbed into the body without the help of Zeaxanthin. The daily recommendation of Lutein is 10 mg to 2 mg of zeaxanthin.
Chapter 11 of my book, See To Play, is dedicated completely to the topic of nutrition and the eyes. I break down exactly what nutrients are needed and how they help vision and ocular health.
Now, we have more proof that if athletes eat the best....they can see the best!
This month, we had a patient graduate from our concussion protocol. We call it "graduation" because their visual system has return to normal functioning after being negatively affected by a concussion. Graduation means the patient does not have to return to our office for continued follow up but should continue care with their neurologist as well as continuing their vision exercises.
This particular patient was a 39 year old patient who had hit her head on a concrete wall and had visual symptoms for 4 months or so before being referred to me. She graduated after about 4 weeks of vision therapy.
She was very excited that she was feeling more normal in her world. She also wanted me to know that it was very hard to describe what she was seeing while she was hurt. Mainly, because her brain was hurt and she just couldn't pinpoint the words or thought.
She had a friend show her a youtube clip which really seem to represent how the world appeared to her since she was hurt. She asked that I share this with people. So, I've put it in this blog for you to see. (She stated that it was how the world moved and the heightened sense of color and light sensitivity.) She also said to ignore all the animals! (She didn't see them).
Not all concussions are the same, so this does not represent all visual concussions. But, it is a neat tool for understanding what the injured may experience.
The eyes have muscles that make them move. And to play well, athletes need these muscles to move quickly and smoothly when looking from distant object to a near object. A great example of this is that a hitter in baseball as to look at the ball in a pitcher's hand, figure out the rotation and trajectory of the ball and then watch it moving at 90 miles per hour as it reaches the bat.
Both eyes of an athlete need to point straight towards a ball in order to see it clearly. Both eyes need to turn inward to continually see the ball clearly as it travels towards the athlete. Convergence insufficiency (CI) occurs when one or both eyes stop their proper turn inward causing the appearance of the ball to become blurred and doubled.
Athletes with CI usually depend on one eye more than the other to perform the work of seeing. This causes their depth perception to be decreased and they tend to misjudge to position of the ball or other objects in free space.
Eye doctors can prescribe exercises (vision therapy) to help the eye muscles of both eyes work better as a team. This improvement helps athletes reach their genetic potential.
This is a common visual problem with many athletes. Routine vision screenings at pediatricians' offices or in schools do not test for this problem. A comprehensive eye examination at an eye doctor’s office is recommended to detect this condition.
I've included a great video I found on Youtube regarding an eye exercise know as pencil pushups. This is one of the fist line of defenses to help exercise this problem away.
It's been stated that 80% of the sensory information sent to the brain is vision related and that 75% of the area of the brain is touched by some type of vision related function.
That's why it's easy to understand that most concussions have a visual aspect to them. Many of these show up on sideline tests and many of these issues resolve quickly.
I developed the See To Play Concussion Vision Protocol to be a great tool for optometrists to implement testing and therapy to help in rehabilitation. I've also developed a quick ABC's chart to be a reference guide as well.
ABC’s of Vision Concussions
A. Accommodation: Reduced reserves and facility. Quick test with +/- 1.50 flipper while reading a near
point card for 1 minute. Push plus in refraction for post-concussion prescription.
B. Binocularity: Decreased depth perception, intermittent suppression, suppression and diplopia. Quick
test with Worth 4 dot for moving or missing objects. Decreased stereopsis. Therapy: Red/green
tranaglyph reader with +/-1.50 flipper
C. Convergence: Convergence insufficiency. Quick test with pencil push-ups at straight ahead gaze,
inferior gaze and superior gaze. Therapy: brock string, See To Play Gaze Stabilization “Eye Baller”
Exercise available at Bernell.com
D. Divergence: Sluggish ability to move eyes out. Combine divergence testing with vestibular by fixating
gaze on Snellen 20/40 near point letter on tongue depressor held at 12 inches from face. Patient turns
head right and left (as in shaking head “no”) for 15 seconds then shifts gaze to Snellen 20/200 distance
letter for 5 seconds. Repeat for 1 minute. Visual edge is a good test as well.
E. Erratic Eye Movements: Decreased ability to follow near point target while tracking. Jerky movement
and drop out noticed. Therapy: See To Play Eye Baller
F. Focus/Fog: Problems staying on task and general feeling of being in a haze or fog. Quick test is the
King-Devick and Visual Edge. Therapy: Visual edge and STP Eye Baller
G. Gaze: Diminished capacity to scan surroundings causing decreased perception. Quick pursuits and
saccades: Therapy: STP Eye Baller.
H. Headache: This includes a general headache with stabbing pains through one eye (possibly waking
patient from sleep). This is usually due to an intermittent suppression with one eye. Therapy:
Red/green tranaglyph reader.
I. Irked: Patients are generally annoyed, frustrated and emotional that they have problems comprehending
injury and slower recovery.
My hope is that this this quick reference guide will help more doctors get involved with concussion care. Further vision concussion testing can be performed by using the See To Play (Peters/Price) Vision Concussion Protocol (available for free at www.seetoplay.com) or referral to a traumatic brain injury vision specialist.
Now that we’re down to the Final Four, most of us who filled out brackets to predict the winners in the NCAA tournament have had them badly broken.
Actually, I’m in third to last with the group of family and friends who put their picks in a poll to compete with each other.
Here is something you may not know: vision is the big breaker of basketball players' dreams who desire to make it to the NBA.
In a 2014 poll of NBA teams that I conducted, only 19% of players (1 out of 5) had the need to wear glasses, contacts or had refractive surgery. That compares to 60% of people in that same age group who needed vision correction to see their best in the USA (3 out of 5).
These staggering statistics tell a tale that 2 out of 5 athletes who play basketball and dream of becoming an NBA player will not make it do to their vision alone. They may have the physical skills, the size, the shoes but they didn’t develop the precision eye, hand and body reaction time and coordination because they chose not to push their body to its highest level which is only achieved with excellent vision.
Countless times in my professional career, I’ve had boys through the ages of 8 to 18 chose not to wear contact lenses or sports glasses to help them fine tune their shot and reaction time. I don’t know if they feel that they are too cool or that they are too good, but the truth is they will hit the vision ceiling and get weeded out from being the best.
You really have to see the best to be the best. Vision is the ultimate bracket breaker for an athlete wanting to be the best.
Please help us get the word out and help these young athletes realize they should do all they can do to reach their genetic potential.
And good luck with the rest of your bracket in the Final Four!
There are many apps for smart phone and tablets designed to help detect if athletes have sustained concussions. These can be used by parents or as sideline tools to determine if athletes require further evaluation for a possible traumatic brain injury.
One part of the brain that can be concussed is the area that determines vision, moves our eyes and helps us act on what we see.
When I began my work on examining athletes who have sustained concussions in that part of their brain, I included computer based testing as well. Computer programs designed for vision therapy and testing the visual system have existed for quite some time and are constantly evolving.
Last year, my work culminated in the publishing of the See To Play Vision Concussion Protocol which includes some use of computer testing and exercises.
I like to use this illustration:
Have you ever been in a parked car in a parking lot and the car beside you slowly backs out while you are not paying attention? All of the sudden, you get this huge sensation that the car you are in is moving forward and you, for an instant, see and feel that event happening. Your brain has just been faked out by the information sent to it from the dorsal vision stream.
It is the breakdown of the dorsal vision stream from a traumatic brain injury that causes a concussion in the vision part of the brain.
The ultimate vision concussion app would have to diagnose this area (which would probably even be providing some degree of treatment as well).
Let’s break down what we need test! This part of the brain is comprised of three senses:
1. Input from vision (object recognition and motion)
2. Input from the vestibular canals of the inner ear (body rotation, gravitation and movement)
3. Input from the proprioceptors (information from body’s muscles/bones/joints regarding the spatial relationship of body parts and movement)
Let’s build the ultimate vision concussion app!
First, we use an app for testing vision.
Next, start shaking your head left and right (or turn in circles and reverse often) while performing that app. You’ve just engaged your vestibular senses.
Finally, keep doing the above motions and app testing while standing on a balance board and move the hand that is holding your smart phone in and out and up and down. You’ve just engaged your proprioceptive senses.
Yay! We did it, right?
Now you may be beginning to understand how difficult it is use a stationery computer or a hand held device while trying to test body senses whose core basis are motion and movement in space and time.
Some advocate the use of dynamic vision acuity testing. This achieves adding movement to testing by having athletes stand and determine objects on a rotating eye chart. Unfortunately, this type of movement doesn't seem to fully engage the dorsal vision stream.
Companies are working on virtual reality helmets for athletes to wear which simulate objects, space and movement. Other companies are developing machines that use projector to place objects out in space and time, like a virtual reality room, for the purpose of this testing. The goal is to incorporate all three of the senses areas in this discussion.
I have also worked with developers to help design testing tools that could be on a handheld device, a computer or even on a television screen or smartboard.
In my book, See To Play: The Eyes of Elite Athletes, I discuss the virtue of fixed space vision exercises (such as the use of computers) versus free space vision exercises (which use objects out in real space). Free space exercising seems to win the battle when the goal is to involve the vestibular and proprioceptive senses.
We’ve been able to test and train the vision, vestibular and proprioceptive senses in the See To Play Vision Concussion Protocol by having athletes simply pitch and catch a ball with a clinician standing 10 to 15 feet away. We use prism glasses to cause the world to shift to the left, to the right, up and down. The athlete gets a “real world feel” for what is happening to him or her and has to respond to movement and tasks in real space and time. The use of a balance board and picking up objects on the floor bring in the proprioceptive and vestibular senses.
See To Play is excited to be on the forefront of this type of testing and will continue to help find or develop The Ultimate Vision Concussion App.
Welcome to my blog! I hope this helps you learn a little more about me and also keeps you up to date on my fun world of sports vision.