Jan 29, 2015
The Better To See

From having Lasik surgery to catching bean bags over their shoulders, athletes are opening their eyes to enhancing their vision.

By R.J. Anderson

R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected]

Eight years ago, golfer Tiger Woods was legally blind and frustrated by the contact lenses he wore to correct his severe nearsightedness. So, taking the advice of several other players on the PGA Tour, he underwent Laser Assisted in Situ Keratomileusis (Lasik) surgery.

Before the surgery, Mark Whitten, MD, an ophthalmologist and Regional Medical Director for TLC Laser Eye Centers in greater metropolitan Washington, D.C., says Woods had “counting fingers vision,” meaning he could count the number of fingers someone held up only if they were within a foot of his face. After the 20-minute procedure, performed by Whitten, Woods walked away with 20/15 eyesight–slightly better than what ophthalmologists consider perfect. And coincidence or not, Woods won the next five tournaments he entered. Since the surgery, he has 56 PGA Tour victories.

Though his post-Lasik eyesight was no better than when he wore contacts before the surgery, Woods told Golf Digest that it has definitely improved his game. Besides not having to deal with dirty, wind-dried contact lenses, Woods said both the golf ball and the cup look bigger now that he is lens-free. He also said it’s easier for him to read his putts.

Because the correction was so significant in Woods’s prescription lenses, Whitten says the cup may have been minified or distorted a bit when he focused on it with contacts. “After his laser correction, his brain perceived the cup as looking bigger,” says Whitten, who has performed the procedure on many PGA players as well as professional football, basketball, and baseball players. “Most golfers tell me that when they putt after having the surgery, they can actually see which way the blades of grass are growing–and they couldn’t see that before.”

As today’s athletes search for any advantage they can get, they are looking more and more to how their vision affects their performance. From correcting how their eyes judge distances to strengthening their ability to focus, vision enhancement is helping many athletes gain an edge. In this article, we’ll look at the most recent developments in this field.

LASER CRAZE Since Woods’s success with Lasik, a long list of professional athletes have opened their eyes to an ophthalmologist’s laser. Among them are Major League Baseball pitcher Greg Maddux, the NBA’s Amare Stoudemire and Richard Hamilton, and NFL players Ray Buchanan and Tiki Barber. So what exactly is Lasik surgery? And what makes an ideal candidate for the procedure?

A form of refractive surgery, Lasik is relatively painless and known for its quick recovery times. Traditionally used to correct far-sightedness (myopia and hyperopia), Lasik can also improve some forms of near-sightedness and astigmatism. To qualify for Lasik surgery, patients need to be over 18 years old and have demonstrated consistent eyesight for at least a year. If a patient’s prescription changes after having Lasik surgery, he or she will need either a follow-up enhancement surgery or to wear corrective lenses.

To begin the procedure, a surgeon slices a thin, circular flap in the cornea using either a tiny oscillating metal blade called a microkeratome or a laser called a femtosecond microkeratome (a femtosecond is one billionth of one millionth of a second). That flap is folded back out of the way and the surgeon uses an excimer laser, which emits an ultraviolet light beam, to remove microscopic bits of corneal tissue, basically reshaping the cornea and removing its flaws.

Reshaping the cornea allows for a more even, more focused dispersal of light into the eye and onto the retina. When the re-shaping is completed, the flap is laid back in place, covering the area of correction. It heals in a matter of hours.

Lasik surgery was first performed in the U.S. in 1991, and in 2006, more than 1.4 million Americans had the procedure, according to Market Scope, a St. Louis-based market research company. Over the last eight years the field of refractive surgery has seen many technological innovations, which have led to different approaches to laser eye surgery and have made the procedure more effective.

The most significant advance, says Whitten, is Wavefront-guided software, which guides the excimer based on measurements from a wavefront sensor. This has made the procedure more accurate than it was 10 years ago, cutting down on flaws caused by irregularities between the lasered and the untouched part of the cornea. As a result, the night vision problems that used to plague some patients after Lasik surgery are largely a thing of the past.

“There’s a misconception that you’re going to end up with night-vision problems, like glare and halos,” says Whitten. “But an FDA study found that with the Wavefront software, many patients actually had improved night vision following the procedure. The software has been out for a few years, and now it’s very unusual for patients to complain of glare and halos.”

Whitten says the Wavefront technology has also dramatically cut down on the number of patients who have to return for follow-up enhancements–once a common drawback of the procedure. “I used to have between 15 and 20 percent of people come back for enhancements,” says Whitten. “The last few years it’s down to three percent.”

EYEING OPTIONS Before your athletes jump on the Lasik bandwagon, however, they should understand all their options. Other areas of optometry have advanced along with laser surgery, says William Harrison, OD, an optometrist who works with many college and professional athletes and teams.

“An athlete should not decide on lenses or surgery by only looking at that option,” says Harrison. “There are multiple choices that can be tailored to one’s needs depending on age, eye structure, and sport and position needs.

“A lot of people went to Lasik because they couldn’t stand contacts, but as Lasik has gotten better, so have contact lenses,” continues Harrison. “For instance, there is a new lens called a hybrid lens. It’s a firm lens with a soft edge so it gives the comfort of soft outer lens but the vision quality of an aberration-free firm lens–there’s no diminished vision under the lights or at dusk.”

Another alternative is surgically implanted lenses, called phakic intraocular lenses, which are often a good option if a patient’s corneas are too thin for Lasik surgery. The implants, which resemble contact lenses, are placed between the cornea and the iris or just behind the iris. Like Lasik surgery, the implants alter the way light rays enter the eye to achieve sharper focus.

Whitten says Lasik surgery is also not the best choice for athletes who risk being hit in the eye, such as boxers and martial artists, due to the destructive nature of the corneal-flap creation process. “In general, we try not to do Lasik on patients who might do something to cause the flap to move or be dislodged,” he says. “Although it’s highly unusual for that to happen, it is a minute risk that should be considered.”

For these athletes, Whitten says a better option may be Photorefractive Keratectomy (PRK) surgery, which provides basically the same results as Lasik, but does not involve cutting a permanent flap in the cornea. Instead, with PRK the outer layer of the cornea is removed and discarded before applying the laser to the retina. The drawback is PRK can be more painful, and visual recovery takes longer than with Lasik–patients often need three to four weeks before they are 90 percent healed.

For athletes considering Lasik or any other correction, both Whitten and Harrison recommend scheduling a consultation with an experienced physician. “They shouldn’t go to a doctor who does just one thing,” says Harrison. “If a doctor specializes only in contact lenses, they might be biased. The same can be true for a Lasik surgeon who does nothing else. Athletes need to find someone who can clearly give them all the options and explain the costs of each.”

If an athlete does choose surgery, Whitten strongly discourages basing decisions solely on the price tag. “Even though a lot of these procedures are technology driven, it’s still the surgeons themselves who make the most difference in a procedure’s success,” says Whitten. “You’ve got to think that somebody who charges $299 for a Lasik procedure is probably not as experienced as those who charge more.”

How much experience is enough? “If a surgeon says they have done 500 to 1,000 eyes, that’s actually not a lot,” says Whitten, who has performed surgery on over 80,000 eyes since 1993. “Probably 75 to 80 percent of people who have the procedure will turn out well, no matter who does the surgery. However, you don’t want to be among the 20 to 25 percent who have a problem. If you can lower your problem likelihood down to one percent, which is probably the lowest you can go in even the most experienced of hands, it’s worth spending a little more money.”

FIELD VISION Along with correcting eyesight problems, enhancing an athlete’s ability “to see” also means working on their optical interpretation, also called “sports vision.” This is what allows a baseball hitter to pick up the spin of the ball more quickly and accurately when it leaves a pitcher’s hand, a volleyball player to judge where a serve will land, or a football wide receiver to snatch a pass amid several defenders. While Lasik and corrective lenses improve visual acuity–what or how far one can see–sports vision training addresses how a person sees. It is important to note that visual acuity must be addressed before any sports vision training begins.

The premise behind sports vision training is similar to many strength-training principles–if an athlete trains and strengthens the tiny muscles in and around the eyes, his or her performance on the field or court will improve. Most vision training devices and programs address the following components:

Ocular alignment: the ability to properly fixate the eyes on a target, also known as aiming of the eyes. When a coach says, “keep your eye on the ball,” he or she really means, “work on your ocular alignment.”

Depth perception: the ability of eyes to see objects in three-dimensional space and judge the distance between oneself and the object. It’s how a quarterback judges how far away his receivers are from him.

Ocular flexibility: the ability to move one’s eyes inward (convergence) or outward (divergence) when following a target. For instance, when a batter watches a pitcher’s release, his or her eyes are diverging from the target. Then, as the ball approaches, the eyes converge on it as it gets nearer. The quicker a player can change his or her focus back and forth between far and near, the better their ocular flexibility will be.

Visual recognition: the ability of eyes to process information regarding the shape and direction of an object and then make correct motor movements to adjust to it. For instance, a defensive back’s ability to turn and look for the ball when covering a downfield receiver.

Visual tracking: the ability of eyes to move properly to track objects as they move, and then react accordingly. One example is a wide receiver tracking a ball that’s thrown to him. It’s also known as “see, think, react.”

At the University of Tennessee, Brian Gearity, MS, CSCS, ATC, an Assistant Strength and Conditioning Coach for the football and baseball teams, uses a wide assortment of vision training methods–both manual and computer-based–when working with his athletes. Gearity’s favorite is a software-based system that his Volunteer athletes have been using for the last couple of years.

The program addresses each of these visual components within a 12- to 18-minute training session. It’s loaded onto four desktop computers housed in the strength coaches’ offices, and players from Tennessee’s softball, baseball, and football teams typically use it for 20 minutes a day, twice a week, as part of their off-season strength and conditioning programs.

To start, the program tests each athlete on the different skills. From there, Gearity and the computer program’s administrators develop an individualized vision-training program based on the athlete’s weaknesses. The program also assesses each athlete’s progress after every training session.

Staring at a computer, the players wear 3-D glasses while operating a joystick control pad. The on-screen exercises involve identifying and focusing on a series of rapidly moving shapes and arrows. In one exercise to test ocular flexibility, players are directed to hit a control button when they see a diamond appear over a fuzzy background on the screen, then told to follow it and respond to successive commands.

Because the joystick mirrors those used on popular mainstream gaming systems, athletes are comfortable with the program and look forward to training with it. “After I show them how to use it, it usually only takes two sessions before they know how to manipulate all the variables and make it harder as they improve,” says Gearity. “After a while, they’re basically administering the program on their own.”

Carlo Alvarez, CSCS, Strength and Conditioning Coordinator at St. Xavier High School in Cincinnati, is also using a computer-based system as a training pilot program with his school’s ice hockey, lacrosse, and baseball teams. He first became familiar with it while serving as a strength coach with the Cleveland Indians and Cincinnati Reds. He says the computer program allows him to customize each athlete’s visual workout based on their individual weaknesses and the sport they play.

“We go 15 to 20 minutes, twice a week, in the preseason,” says Alvarez. “We use the data from each session to assess and get them to improve at every workout. Then every week or two weeks we bump up the intensity of the session.”

Alvarez says it doesn’t take much prodding to get his athletes to complete their vision training exercises. “We tell them why they’re using it and the program’s video game-like qualities keep the kids excited about it,” he says. “They love putting the goggles on, picking up the joystick, and competing against each other.”

EYE TOOLS While computer-facilitated vision programs may be the wave of the future, there are lower-priced alternatives. Thomas Wilson, OD, an optometrist who has served as a sports vision consultant with the U.S. Air Force Academy, USA Shooting, and the University of Colorado ski team, uses a combination of inexpensive hands-on devices constructed of very basic materials.

Co-author of Sportsvision: Training for Better Performance, Wilson says some of his favorite exercises incorporate a balance beam or a two-by-four piece of lumber and bean bags. Balancing on the beam or board, athletes are tossed beanbags from different angles and told to catch them. An advanced step involves having the athlete catch beanbags that are thrown from behind their shoulders. Wilson says these drills are especially beneficial for football receivers and defensive backs.

A similar drill involves tossing an athlete beanbags in a dark room illuminated by a strobe light. The strobe light trains the athlete’s object tracking ability and eye-hand coordination. To make the exercise more difficult, the strobe’s frequency can be decreased, which increases the amount of time the room is dark while a beanbag is in the air.

Perhaps the most widely used vision training device is called a Brock String. A three to five foot long piece of string that holds three small, multi-colored beads set equal distances apart, the Brock String addresses spatial localization and teaches the athlete how to aim his or her eyes together correctly. It also illustrates the difference between convergent and divergent eye aims and indicates to the athlete if they are shutting off or suppressing an eye.

To use the Brock String, an athlete holds one end of the device against the tip of their nose while the other end is tied to a fixed point. When starting out, the athlete is asked to focus on one bead at a time and name the color. The drill can be made more difficult with gradual adjustments, such as moving the beads closer to the nose.

Along with computer-based training, Tennessee athletes also use manual exercises as part of their off-season vision-training program. “We’ve picked up some things along the way that are easy to use and implement,” says Gearity. “For instance, our football wide receivers catch tennis balls that are shot out of a machine at different speeds. We also have colored bouncy balls that we throw at the players. We’ll ask them to grab a certain colored ball and identify the color or catch one color and drop the other.”

When implementing a program, Alvarez recommends starting with only a few teams or athletes. “And it should be sports where the athletes have to focus on and recognize an object coming at them–hockey, lacrosse, baseball, tennis–sports where you’ll find out quickly if they are making progress or not,” he says. “Once you do it with one or two teams, and you can show off their improved test scores, the athletes will talk about how they enjoy the system, and eventually the other coaches will buy in.

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