Boost your practice by incorporating services for vision performance

Vision performance, sports vision specifically, is a branch of vision care that remains unexplored by many optometrists, leaving it available to other occupations. But there are a myriad of opportunities for primary care optometrists to get involved to various degrees and find a profitable addition to their practice.

“In the world of vision in sports, other fields have embraced what we should be doing because we haven’t picked up the ball to run with it,” Donald S. Teig, OD, FAAO, founder of the Institute For Sports Vision in Ridgefield, Conn., said in an interview with Primary Care Optometry News. “You have occupational therapists and athletic trainers trying to use vision performance equipment – because we haven’t – and not really knowing the science of it.

“If you are truly passionate about sports and believe it fits your practice, you should do it,” Teig continued. “Develop a unique specialty or niche. If you’re going to do it, don’t dabble in it. Learn how to do it from soup to nuts.”

“We get calls almost every week from optometrists who are interested in the field,” Barry L. Seiller, MD, MBA, one of the creators of the Vizual Edge Performance Trainer system, told PCON. “It’s really something that some people aspire to.

Optometrists, however, should note a few things before getting started, Seiller said.

“First, the field is really in its infancy,” he said. “The public doesn’t know much about it. It’s a fairly esoteric type of explanation about what encompasses vision performance, so doctors often get very little response because people just don’t understand it, and they may feel like they’ve wasted too much of their time explaining the idea.”

Seiller said that skeptics are critical because of the lack of controlled studies proving a correlation between training and on-field, on-ice or on-court performance. However, his Vizual Edge Performance Trainer system collects reliable and reproducible metrics and, using the metrics, researchers have been able to prove efficacy.

Second, income in this field can sometimes be difficult to generate, according to Seiller. Vision performance takes significantly more chair time than a typical office visit.

Third, vision performance care also requires equipment, staff training, extensive knowledge and a lot of physical space, he added, which many practices lack.

“We don’t see sports vision patients in our office,” Seiller said. “Our Vizual Edge system is web-based. We bring the patients in for evaluation, then we have them train at home, in a separate facility or their dorm room and oversee their progress. It’s much more time- and cost-effective for us to do it that way.”

Three levels of involvement

According to Kellye Knueppel, OD, founder of The Vision Therapy Center in Brookfield, Wis., and a developmental optometrist specializing in vision-related learning problems, sports vision and rehabilitative optometry, there are three different levels of involvement: vision and eye health, vision enhancement training and vision rehabilitation.

The first and most basic level — vision and eye health — involves making sure patients have the best contact lenses, glasses and sports goggles for their sport, she said in an interview.

“In particular, ‘sports vision’ optometrists may provide specialty contact lens fittings and advise athletes on sports goggles and lens tints specific to the sport or specific to various conditions an athlete may face in a particular sport,” she said.

The second level — vision enhancement training — involves the evaluation of functional aspects of vision, then training for improvement. The training could include eye teaming, depth perception, accommodation, foot- and hand-eye coordination, visual reaction time, peripheral awareness, tracking, fixation and space perception as each sport or situation requires, Knueppel said.

The third level — vision rehabilitation — covers care for athletes with traumatic brain injury or concussion.

“Athletes with concussions can suffer from significant visual problems including double vision, light sensitivity and visual confusion,” she said. “In addition, headaches, dizziness, fatigue, nausea, memory problems and other symptoms could have a visual component. Optometrists trained in vision rehabilitation can diagnose and treat visual problems related to concussions and help resolve symptoms more quickly.”

Knueppel noted that providing the services for the second and third levels “requires space, equipment, staff training and, most importantly, a high level of knowledge for the doctor.”

Such barriers may be resolved by comanaging with another practice, she said.

“For example, the optometrist might want to examine the athlete, fit the contact lenses, provide sports goggles and/or other tinted lenses, and then send the patient to a vision therapy practice to do the vision enhancement training,” she said.

Also, although sports vision is the primary focus of many optometrists involved in vision performance due to its unique nature, vision performance is not just for athletes, nor is it only for people with good vision.

“We work primarily with kids with strabismus or amblyopia who have vision-related learning problems,” Knueppel said. “We also work a lot with traumatic brain injuries.”

Knueppel’s practice is strictly a vision therapy and enhancement practice, not a primary care practice. She will perform comprehensive eye exams, but will send patients out for contact lens fittings and if they have other basic ocular health issues, she said.

“Comanagement is a fantastic opportunity to set your practice apart by providing services that other practices don’t,” she said. “And you can do different levels of sports vision depending on your passion for it, how much you know and what equipment you’ve got.

“Also, most people we see are private-pay patients,” Knueppel noted. “Wherever you can find that in a practice, it would be a good thing to think about adding.”

Specific tips for athletes

Other than comanagement, the simplest way to get involved in sports vision is to coach local players who come in to see you, help them identify problem spots in their vision and give them tips accordingly, Lawrence D. Lampert, OD, FCOVD, told PCON.

“The most effective tip you can give to athletes is to tell them about their dominant eye,” he said. “If a patient needs help with his putting, one of the quickest and best tips is to put the dominant eye over the back tip of the ball.”

Another tip would be to tell a baseball player that, once he is in his stance, he should close the eye closest to the pitcher, and if the eye farther away cannot see where the pitcher is letting go of the ball, he needs to open up his stance a little bit, Lampert said.

“The dominant eye processes information 14 to 21 milliseconds faster than the nondominant eye,” he said. That results in quicker recognition of the ball’s spin upon leaving the pitcher’s hand, which, in turn, allows for quicker recognition of what pitch to expect.

“You can also make a minimalistic investment in equipment,” Lampert said. “Vectograms only cost about $120. You can sell computer-based vision training programs. You can sell sun wear and protective eye wear. My office has a full-time vision therapist; it’s another profit center that can do just as well as the optical. You can do a coaching session with a local high school team. I’ve talked to the booster clubs of area high school baseball teams. The parents are very interested in it. They bring their kids in for exams and may come back for their own routine eye care.”

Professional athletes, pilots, law enforcement

“Everyone wants to be the trainer for the big boys,” Taylor W. Bladh, OD, a vision performance specialist, told PCON. “But there is usually only one vision doctor per team, and they all already have their guy. Most of your athletes will be pre-high school, high school and college teams, and there may be an occasional pro athlete.”

Teig added that “high performance vision,” his term for the field, is not strictly reserved for athletes.

“I work with law enforcement people, secret service, FBI, airline pilots,” Teig said. “It’s really for anybody who’s in a career, a sport or a recreational activity that requires excellence in the way they use their eyes.”

According to Lampert, just as a baseball player needs to be able to track and hit a 95 mph fastball to do his job, police officers also need exceptional vision to do their jobs.

“When you’re under stress, you tend to lose the periphery and tunnel your vision,” he said, so peripheral vision is vital to law enforcement officers. “You run into a room and you tunnel your vision and may miss the guy right over there,” he said.

Necessary equipment

In Knueppel’s sports vision programs, she uses contact lenses, prisms, vectograms, tranaglyphs, Wayne’s Saccadic Fixator, space fixators, Brock strings, Hart charts, trampolines and balance boards, among other equipment, she said.

Dr. Lampert’s system uses software he developed, “which trains what we call ‘dynamic visual acuity,’ speed and span of recognition, saccades and other skills; I’ve used ± 2 flippers, vectograms, Brock strings.

“I don’t have very expensive or elaborate equipment,” he continued. “I look at myself as being a boxing gym — very minimalistic, but very effective.”

“Several devices are good at reinforcing neuromuscular learning,” Teig said. “There’s the Sports Vision Trainer (SVT), which was developed in Australia, the new SPARQ [speed, power, agility, reaction and quickness] System from Nike and the Sanet Visual Analyzer, all for better hand-eye coordination.

“One thing I use a lot is called the Bassin Anticipation Timer,” Teig continued. “It’s a device that simulates the movement of a ball, or any kind of moving object, moving either towards you or away from you, and you time its arrival or departure.”

Nike has taken vision performance training from the analog to the digital world with the Nike Sensory Station, Bladh said, and helped standardize the assessment of reaction time, depth perception, near/far focus, contrast sensitivity, visual acuity and hand-eye coordination.

“Nike SST or Nike SPARQ is an interactive kiosk that runs through a standardized battery of 10 different areas of vision that would relate to sports,” Bladh said. “After assessment, it sends all the data to Nike and generates an immediate report comparing the patient to anyone in his or her age, gender, sport and level of competition.”

There is also a suggested training protocol for each area, he said.

Nike Vapor Strobe glasses are a pair of goggles that can be set to strobe at eight speed settings, Bladh continued. “Each setting takes away visual information a little at a time,” he said, “limiting the sensory information the athlete receives and, in essence, making them work harder with less information.”

Bladh was involved in the prototype testing, and the goggles have been available to the general public for about a year, he said.

Bladh has also been using RevitalVision’s vision training system (RevitalVision LLC, Lawrence, Kan.), a series of computer-based visual cortex training programs that can be used at home, with his patients and athletes. He tried the program himself and ended up seeing 20/8 OU, he said.

“In addition to this, however, I mostly noticed improved night vision under low contrast level and a greater shape and movement detection through a rewired magnocellular visual pathway,” he said.

“We aren’t just throwing Brock strings and pencil push-ups at athletes anymore,” Bladh said.

Neuro-training re-engineers how the brain processes information and gives athletes an edge over the competition, he said.

“Most elite athletes just see better than the average mere mortal,” Bladh said. “The average major league baseball player is seeing 20/12, not 20/20. If there are ways of training your neuro-processes, we are interested in doing that.” – by Daniel R. Morgan

Disclosures:

Bladh, Knueppel and Tieg report no relevant financial interests. Lampert has a financial interest in his own software. Seiller is the developer and owner of the Vizual Edge Performance Trainer.