Feature, Report

League of their own: The science of sports vision

How can optometrists pull an elite batsman out of a form slump? What’s the best type of laser vision correction for a boxer? And how are prescription lenses integrated into ski goggles? RHIANNON BOWMAN explores sports vision from three perspectives.

Whether it be height, muscle mass or agility, sports studies have alluded to an ever-increasing emphasis on physiological attributes that enhance athletic performance.

Vision, the primary sense used in almost every sporting arena, fits neatly into that category, but is arguably an understated determinant of sporting success – or failure.

Countless studies have sought to identify differences in the visual performances of athletes and non-athletes. Some have shown that dynamic visual acuity and stereoacuity – essential in sports such as cricket, AFL and soccer – were more developed in athletes, while others believe depth perception and dominant eye awareness play an equally important role.

Australian history consists of a rich vein of sporting culture, with current statistics indicating that approximately 82% of Australian adults and 58% of children participate in sport at least once a week. Yet, 13% have been sidelined due to eyesight issues, according to Optometry Australia’s The 2020 Vision Index.

For three Australian eyecare professionals who specialise in this field, poor eyesight should be no reason to miss out. This month, an optometrist, ophthalmologist and dispenser discuss their work to help sportspeople remain ahead of the pack.

The Eye Man

With more than 30 years’ sports vision experience, independent optometrist Mr Patrick Gerry, from Eyeman Optometrists in Brisbane, says the simple act of discussing sport with every patient has shaped his career. “That’s the gospel truth of how all this started,” he says.

“My big break came with the Australian Football League (AFL) in 1998. I was locuming when the president of the Brisbane Lions came in; he just needed glasses, but I provided a full consultation and detected health issues with his eyes. We talked about sport and I said, ‘If you’ve got $2.5 million worth of cattle running around the field, shouldn’t you be sure they don’t have any problems?’.”

Since then, Gerry’s career has taken him Australia-wide as a consultant, conducting vision screenings for sporting organisations, including the Australian Institute of Sport, Cricket Australia, Cricket Umpires Australia, Queensland Cricket, the National Rugby League, the AFL and Fox Sports.

Gerry, who has a degree in optometry and completed a Masters in Sports Vision, works with junior through to elite athletes and, as recent as last November, screened 44 Brisbane Lions players.

Following his consultancy work he has returned to his bricks-and-mortar practice, Eyeman Optometrists. It features onsite sports vision facilities where athletes can perform drills specific to their sport and the optometrists can observe where their vision needs help.

He has collaborated with leading scientists to establish that sports players perform dramatically better when they have strong depth perception, an awareness of their dominant eye, and clear peripheral and central vision.

Athletes experiencing handling issues may be inadvertently using their peripheral vision.

“We can combine different therapies to provide athletes with tangibly improved vision. It’s not always just about prescriptions and contact lenses – in our experience, sports players get the best results when they spend time with our dedicated sports optometrists learning how to use their eyes and how to never lose sight of the ball,” Gerry explains.

“We know from our work over the last decade with elite athletes that sportspeople are far more likely to experience difficulties with their depth perception than with their visual acuity. Three times more likely, in fact. This means that the most common problem a player will face with their vision is not being able to judge where the ball is exactly, despite being able to see it clearly.”

Gerry’s team has found that those experiencing handling difficulties or form slumps are trying to watch the ball. But in trying hard to do so, their eyes get stuck where the ball ‘was’ and don’t move to where the ball is going. This leads to them trying to catch or hit the ball using their peripheral vision, increasing the chance of error.

This principle, he says, can be applied to any sport, and it is this process of knowing where to look that enables experienced and skilled individuals to perform at an elite level. In his experience, about 30% of athletes will fail a vision screening and require a follow-up.

“You need to talk the talk, you need to demonstrate your expertise, for example that over-convergence affects play, you need to demonstrate how it impacts their ability on the field, court, pitch, shooting range, et cetera.

“For example, when talking faster ball sports such as tennis I talk about aspects of their game where they are most likely to make an error – which elite players don’t want to hear – so it is always prefaced with comments like: ‘you have got this far because you can play. My job is to minimise the errors in the team; to decrease dropped balls or turnovers, or unforced errors’.

“I will then chat about errors specific to that game, but not the player. If I have already worked with that sport, I’ll use examples of other players, or comments from coaches. Players are then more relaxed. I then ensure I take it away from the sport and talk about other aspects of their life – night driving; reading; vision problems other family members might have.

With faster ball sports it’s important to discuss aspects of their game where they are most likely to make an error.

This is so essential as they are very protective of their sporting performance and fear failure and being dropped from the team. Where possible, I also get the coach to speak to the players about me first – if you have the coach’s endorsement it is easier to have the player’s trust.”

Gerry’s practice focuses on sportspeople at the amateur level too. When children under the age of 14 first arrive at his practice he sits them in the chair and throws a ball to them.

He says it helps them relax and demonstrates to parents what their child is doing with their hands, such as if they catch on the body or away from the body, turn their head or close their eyes when they catch the ball.

For Gerry, it illustrates to him their level of hand-eye co-ordination, depth perception, peripheral and central vision.

For eyecare professionals considering incorporating sports-related care into their practice, Gerry also recommends asking specific questions about the sport they play and talking to coaches and clubs to offer services for vision screening, even if it’s after hours.

“For a junior athlete, you need to relate their sports vision back to their school performance, their performance outside of sport, to get buy-in from their parents.”

Separately, but through his specialisation is sports vision, Gerry has collaborated with world-renowned scientists to create MiSite technology, a micro-camera that’s built into glasses and helmets to produce first-person, high definition video. He has used MiSite technology as a training tool with athletes and umpires in elite sports and says it has been proven to drastically improve their performance on the field.

“In one case, we could see that when the referee was running backwards, with his head down, he missed the actions of the player standing directly in front of him,” he says.

“When athletes are anxious or fatigued, their vision is affected. Using MiSite technology on AFL players doing a 5km run, we can track their head movement when they’re fatigued. This helps players
and coaches understand how physical activity and fatigue can impact vision, without a visual problem being the cause.”

He says the technology can be used beyond sport too.

“I had a young female patient who had suffered a stroke. She couldn’t see on, or use, her left side. But when she put on MiSite glasses, it was apparent that she was looking straight down at the ground, not to her left to compensate for her vision loss, which you might assume would be the case. Her visual problems weren’t so much from her hemianopia, but rather her poor stability, meaning she had to concentrate on the ground, not what was ahead of her.”

Matching the procedure with the endeavour

“I wish I did this earlier.” ophthalmologist Dr Chameen Samarawickrama has heard this statement countless times from patients that elect for laser eye surgery to improve their vision for sport.

As a corneal surgeon and associate professor at the Sydney Medical School, at the University of Sydney, Samarawickrama has performed hundreds of laser procedures during the past five years in Sydney. “Patients who want to correct their vision for sporting pursuits but don’t want to wear glasses have three treatment options; external to the eye, as in contact lenses; the surface of the eye, as in laser correction; or inside the eye, as in an implantable collamer lens, or ICL.”

Samarawickrama says, by far, contact lenses are the most common
form of vision correction among sportspeople due to their affordability, ease of use and relatively low risk profile.

This assertion is reinforced by OA’s The 2020 Vision Index which states 24% of Australians always wear prescription contact lenses while exercising or playing sport, and that 41% would prefer to wear contact lenses while playing sport over spectacles.

Flap dislocation following laser surgery can be a risk for people who play contact sports.

However, Samarawickrama notes contact lenses aren’t suitable for everyone.

“Some patients are keen for laser surgery because they’ve had several infections from wearing contact lenses. Some patients complain that they are ‘sick to death’ of contact lenses, they’ve been doing it for so many years. They might say it’s starting to get expensive, with the cumulative cost of purchasing contact lenses over the years.”

The average price per eye for laser surgery in Australia, according to consumer comparison site Finder.com, is $2,200-$3,400 for LASIK, $2,400-$3,400 for photorefractive keratectomy (PRK), $3,300-$3,700 for SMILE, and $4,700-$6,200 for ICL.

By comparison, hypothetically, a patient who wears soft contact lenses typically buys a box of six disposable lenses for $30 ($258 per year), and changes lenses at least every two weeks. The patient also buys at least $150 worth of contact lens solution and cleaning products per year, as well as consultation fees, valued at $100 per year, for a total annual cost of $508.

Multiplied over a decade, a patient could spend $5,080 on contact lenses or have PRK surgery for an average cost of $5,800.

Samarawickrama says that, taking into consideration the cost and risk of infection associated with contact lenses, laser surgery is preferable for some athletes.

From a surgical perspective, it’s also becoming incrementally faster to perform and increasingly accurate.

“It’s a quick procedure. It used to take 90 seconds; now it takes 30-40 seconds, and it’s only going to get faster. Tracking software has also improved. The laser automatically cuts off if it detects movement,” he says.

He explains that treating the surface of the eye can be done via three types of laser eye surgery.

LASIK (laser assisted in situ keratomileusis), the most common type performed worldwide, involves creating a thin flap in the front
of the cornea with a femtosecond laser. The flap is lifted and an excimer laser is then used to reshape the underlying cornea to treat the refractive error. The flap is then repositioned and a bandage contact is placed over the eye to protect the flap.

PRK (photorefractive keratectomy) is a surface laser eye surgery technique where the excimer laser is applied directly on to the surface of the eye without initially creating a flap (as in LASIK). A bandage contact lens is placed on the eye afterwards.

Swimmers face increased infection risk from contact lens wear.

SMILE (small incision lenticule extraction) uses the femtosecond laser to cut a disc within the cornea that the surgeon removes through a small incision on the surface.

In terms of determining the most suitable laser surgery, Samarawickrama says the sporting endeavour often determines the best approach.

For example, he had a male patient who was a high-level Muay Thai boxer. He wore contact lenses, but a punch to the face during a bout dislodged the contact lens in his left eye. The fight continued, but he couldn’t see clearly on his left side as the blows continued. He lost the bout, so he sought a permanent vision correction solution.

“In this instance PRK was the best solution for him, and his eyes had healed completely a few weeks after surgery and he could get back in the ring,” he explains.

“It’s the same if you play rugby, soccer or martial arts. Contact sports carry a risk of trauma to the head, so PRK is usually the preferred treatment option because there is no risk of flap dislocation in the event   of trauma.”

He continues: “For swimmers, the risk of infection from wearing contact lenses is high, so decreasing that risk through laser eye surgery is ideal. It doesn’t matter which type of laser surgery they choose, and most opt for LASIK as it heals the fastest.

“A third less common option is an implantable collamer lens. I had a 20-year-old male patient who was a -15 D myope. I couldn’t perform LASIK or PRK to correct that degree of myopia, but I could implant an ICL.”

For the average patient who has a desk-job in an office and works out in a gym, LASIK is typically the preferred treatment option for vision correction.

“The evidence shows that the quality of vision at the one-year mark after surgery is the same for all laser surgeries (LASIK, PRK and SMILE),” Samarawickrama says. “But LASIK is less painful and boasts a faster recovery, whereas PRK is more painful and recovery is slower but doesn’t have the risks from the LASIK flap.”

The Go-To Guy

Mr David Aulert is an optical mechanic with more than 30 years at the coalface of making, grinding, cutting, coating, and tinting lenses.

That experience has helped carve a new career as a specialist in prescription sports eyewear, supplying ‘hard to find’ products for a wide range of sporting and recreational activities not readily available in traditional optical stores.

Aulert operates the company Goggleman, which has provided prescription eyewear since 2002, including prescription swimming goggles, ski masks, SCUBA diving masks and motocross goggles.

“Optometrists don’t have in-depth knowledge of what’s available, what’s possible, in this niche market. That’s where my business fits in – retailing prescription eyewear solutions for people in sport and recreation,” he says.

Ski masks are just one example of sports eyewear that can incorporate a prescription.

Aulert’s career began as an optical mechanic with Solar Optics. When the dispensing profession was deregulated, he took a break from the local industry and travelled overseas. When he returned, he accepted a position as technical co-ordinator for Carl Zeiss, which had acquired Solar Optics.

“From the mid-1990s to 2010, optical mechanics and dispensers were underpaid and under-valued. When the profession was deregulated, the tradesmanship of optical mechanics and dispensers were lost. In the space of six or seven years, all the good people had left the industry. The optical dispensing industry is all about knowledge, but that education was lost with the deregulation.”

While working for Zeiss, Aulert often had to turn down requests to fit prescription lenses into sports eyewear, even though he knew it could be done technically, because of Zeiss company protocols.

Those lost opportunities planted a seed in his mind to capitalise on a niche market for a dispensary dedicated to sports and recreation, including skiing, swimming, SCUBA diving, triathlon, cycling, and motocross.

He left Zeiss and established Goggleman in the Adelaide suburb of Brighton. It also has an online presence, which accounts for 70% of his overall business income.

“It’s a specialised field and requires a lot of technical understanding. I have that optical mechanics knowledge, and that knowledge in this industry is like gold,” he says.

Aulert distributes his products directly to consumers from under one roof. Through all his years of problem-solving in optical dispensing, he has built a reputation as the go-to guy for sports and recreation prescription eyewear.

With an emphasis on quality, not speed, Aulert utilises his connections in the industry to produce bespoke products, with some orders sent to several labs.

“I source the lens from this lab, I get a specialised tint from another lab, I go to another lab for fitting. I can go through three or four labs for one pair of specialised prescription eyewear,” he says.

“Based on my years in the industry, I know what labs are good at what, and I can put the pieces of the puzzle together for the best outcome for my customer.

“I’m a specialist in what I do, with 30 years’ experience.” 

Protection and comfort top sports eyewear wish list

Lisa Wymond, national brands manager at Sunglass Collective, says demand for prescription sunglasses is increasing rapidly, particularly among active and outdoors-orientated consumers.

“As Australians, we have a very healthy appetite for the outdoors with a strong and increasing focus on fitness,” she says. “In terms of sporting eyewear trends which meet this active lifestyle, lenses with a large field of view are important for precision optics and they also provide the much-needed protection from all the elements.”

Sunglass Collective is a new venture from the Wymond family (Eyes Right Optical). It promises to bring a new level of style and service to the Australian and New Zealand eyewear market, including the Bollé Performance range.

The Bollé Performance sunglass range, including Bollé Shifter (pictured), provides optimised sports vision with its wide lens and frame offering.

Mr Paul Harrison, head of sales at Sunglass Collective, says the range is an ideal choice in the sports prescription sunglass category with its industry-leading wide lens and frame offering, designed to suit a vast power range of (+6.00 to -8.00, cylinder to -4.00) combined power.

“The products in this category are made to meet the needs of elite athlete performance, using precision optics and ultimate comfort as its highest design priorities,” he says.

“Bollé understands the important needs of elite athletes and through that knowledge, they are industry-leading in the design of customisable frames which can adjust to the wearers shape for the ultimate in comfortability.”

The Bollé Performance sunglass range is designed specifically for cycling – road and mountain biking – triathlon, and golf.

“In these sports, the needs of the athletes can be varied, depending on the environment and potentially changing conditions,” Harrison says. “However, eye protection and comfort are still two of the most important factors.”

“In terms of lenses, Bollé Sunglasses are strongly focussed on delivering the ultimate in precision optics, with a wide field of view and importantly, they are superior in delivering ultra-lightweight, durable and customisable frames.”

He says for sportspeople who are continually striving to improve their performance, their eyewear must also provide superior vision, ultimate protection and comfort.

“Whether the climatic conditions be static or changing, eyewear technology must be able to adapt to these changing light conditions if it’s required. This is extremely important to the athlete who needs to perform at their best, no matter what the conditions provide.”

Harrison says nearly all Bollé lens options are available on Bollé’s B-Thin Active Design prescription program, “including the highly regarded photochromic Phantom lens range and importantly in each of the Shield offerings”.