Improving peripheral vision could help prevent sports injuries

A summary of the blog by Alex Andrich, OD, FCOVD called Improving peripheral vision could help prevent sports injuries.


The UC researchers found that female high school soccer players close their eyes when heading the ball 91% of the time, versus 79% of the time for males. The good news is that training soccer players to suppress the startle reflex and improve awareness of peripheral vision can reduce their chance of concussion. With good awareness of the periphery, for example, the player can drive the ball towards the goal, but at the same time avoid or brace himself or herself for a collision. Concussion avoidance is getting a lot of attention in youth and professional sports.

We know now that concussions can have long-lasting effects, especially if a player sustains a second hit while concussed. In addition to preventing injury, training athletes on peripheral vision can also improve performance. Think of the ability of NFL quarterbacks, for example, to find an open receiver anywhere on the field. And just watch this video for a great example of how John Wall, a top-level NBA basketball player, can channel his attention to the periphery with great accuracy, even while looking straight ahead.

The implications of training to overcome perceptual narrowing go well beyond sports. Military and police officers also routinely experience tunnel vision during stressful situations, which can blind them to important information and put their lives in danger. The relatively minor stress of being in a hurry has likely reduced your peripheral awareness. Neuro-optometric and sports vision specialists use specific tools to improve central-peripheral integration, the skill needed to keep the brain from blocking out peripheral visual inputs.


Collaborative care neglected in new CDC concussion guidelines

A summary of the article Collaborative care neglected in new CDC concussion guidelines.


While the new CDC guidelines for managing mild traumatic brain injury in children cite vestibulo-oculomotor dysfunction as a part of concussion syndrome, the CDC failed to mention optometry’s role and those of many other integral health care providers that must be included in the comprehensive care of these vulnerable patients.

The CDC published the recommendations, “Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children,” for providers who treat children with mTBI in JAMA Pediatrics in September 2018. In 2013, the American Academy of Neurology published guidelines related to the management of sports-related concussion in children and adults, and a year later, the Ontario Neurotrauma Foundation also published a guideline for diagnosing and managing pediatric concussion. The CDC’s guideline was based on a literature search from January 1990 to July 2015.

What’s new in the guidelines

The previous guidelines recommended that a student athlete could return to play if cleared by a doctor or a certified athletic trainer, Charles Shidlofsky, OD, FCOVD, who practices at Neuro-Vision Associates of North Texas and is the secretary and treasurer of NORA, told PCON. The new guidelines suggest, and Shidlofsky agrees, that an athlete should never return to the playing field the same day. “It is now understood that 80% to 90% of adult concussions resolve in 7 to 10 days, but the recovery time for children and adolescents tends to be longer. Previously, all concussions were considered relatively equal,” Shidlofsky said. Symptoms of concussion in young people can last from weeks to months, he continued. In addition, they may need a longer period of physical rest than adults and then a gradual return to normal activities.

Where the guidelines can improve

Aside from optometry, the guidelines left out the role of the neuropsychologist, occupational therapist, and speech and language therapists, Edmonds and Shidlofsky agreed.”I was unhappy they did not mention optometry, convergence insufficiency and accommodative facility. We weren’t singled out as a resource or as knowledgeable practitioners to diagnose and treat mTBI,“ Edmonds said. He is hopeful that will come with later iterations of the guidelines.

When those with mTBI are referred to a neuro-optometrist they will check for binocular function and accommodative amplitude and will find abnormalities, Edmonds said. The most common is convergence insufficiency.

In young people, typically, their focusing and convergence do not line up, Edmonds said. “Interestingly, the CDC’s report has listed this as a problem in mTBI, but they lump it together with vestibulo-ocular symptoms.”

Collaborative efforts, moving forward

Edmonds hopes optometrists will read the guidelines and be aware to look for oculomotor problems and triage properly. “I hope more optometrists take an interest in how to treat these patients”.

He would like to see more collaborative efforts with neurology, physiatry, sports medicine, psychology, physical therapy, occupational therapy, athletic trainers, and speech and language pathologists.

In Philadelphia he works within several different groups specializing in comprehensive concussion management. Magee Rehabilitation, Jefferson Comprehensive Concussion Center and the Rothman Concussion Network all integrate optometrists, physiologists and physicians who can diagnose, treat, recommend and write prescriptions for therapy.

“It’s never just the eye; it’s often cognitive, speech and vestibular. You need a comprehensive team to manage concussion properly,” Edmonds added. Furthermore, he wants young optometrists to learn how to look for, refer and manage mTBI and join teams where they are able to provide this level of care.