Beyond 20/20: Why “Perfect” Vision isn’t Enough in Elite Sport

Bruce: Hello and welcome to the latest episode of the Irish Sport and Exercise Science Association podcast. I’m your host, Bruce Wardrop, and I am very excited to be back for twenty twenty six. I hope you all enjoyed your Christmas and New Year and are not suffering too badly from the January Blues. We are back to our normal scheduling here at the ISESA, and we will have loads of great content to keep you entertained and engaged right through to the summer.

We have a full schedule of webinars kicking off on the twenty ninth of January, with a joint webinar between the ISESA and our new strategic partners, the Chartered Association of Sport and Exercise Sciences in the UK. In this webinar, professors Tom Cummins and Graham Close will draw on their lifetimes of experience providing strength and conditioning and sports nutrition support to elite athletes across multiple sports, including Olympians, Paralympians and the British and Irish Lions. This webinar is absolutely not to be missed and a super kick off to our twenty twenty six programme. Full details are available on the website.

Right back to today’s episode. I started my first podcast back during Covid. It wasn’t as similar to this one. I was interviewing Irish people who worked in various sport and exercise science roles. The most challenging thing back then was trying to identify contact and secure guests. Once I had tapped out my own contact list, this became tricky and stressful. Trying to stick to a release schedule whilst scrambling around looking for guests.

One of the great things about the Irish Sport and Exercise Science Association is how much my network has grown, and the willingness of this new extended network to collaborate with each other. This has led to some serendipitous interactions, like just before Christmas when my boss knocked on my office door and said, “Hey, Bruce, this is Fraser Horn. He’s here from the States for a couple of years for work, and I think you guys should do a podcast together.” Never in my wildest dreams did I imagine guests would simply be delivered to my door like that.

I arranged to meet Fraser for a coffee, and I quickly realized the podcast gods were kind and that he was going to be a great guest. Fraser is a professor at the Pacific University of Oregon’s College of Optometry. He is an expert in optometry, teaching and researching extensively in this area. Fraser also has a particular interest and expertise in sports vision, having worked as the team optometrist for the university’s athletics program, and collaborated on major sports vision projects with industry partners such as Nike.

I have to admit, I was a little bit nervous about interviewing Fraser. There are some things that I know a lot about and I’m comfortable discussing. There’s plenty of things that I know a little bit about, and I can wing it. And then there are things like sports vision that I know nothing about, and that makes me anxious. Anxious, especially when I’m chatting to an expert. However, I needn’t have worried because Fraser was a superb guest. He was really engaging, informative and patient with my questions. I thoroughly enjoyed my chat with him and I hope you do too. Fraser, how you doing?

Fraser: Doing well. Yeah.

Bruce: Thank you very much for joining me in the studio this morning. It is a wild and stormy morning out there, but we both made it in safe and sound.

Fraser: Yeah. No. Thank you so much. It’s a pleasure to be here and happy to talk about all sorts of fun stuff.

Bruce: Yeah, so. Well, I figured we’d start out like this. Might sound like some very basic, fundamental undergrad level stuff for you, but, you know, in preparation for this podcast, I was thinking about eyesight. And I know we had mentioned in the run up to this about the quality or how good someone’s eyesight is. Now, I always believed if you pop down to the optician and get your eyes tested, twenty twenty vision, that’s that was the gold standard. That’s what everyone wanted, but I understand. Well, I get the impression from talking to you that that’s not always the case. So let’s start off. What is twenty twenty vision for most of us?

Fraser: Yes. So twenty twenty vision. A lot of people think is perfect vision, but the reality is it’s average vision. So it’s an old construct that was designed where they looked at: How big is the letter? How much does the average person see at basically twenty feet or six meters? So in the research that’s been out there, and I work a lot with athletes, we find that most athletes see twenty over fifteen, if not better. So the lower the second number, the better it is for your vision. So obviously the higher the number, the worse it is.

You know, and people often ask, “So what?” Well, we want you at twenty twenty minimally. And we’d prefer you to be better. And really what it means is for somebody who’s twenty fifteen, who sees better, they can see an object at twenty feet, whereas somebody who’s twenty twenty has to get closer to it, has to get to fifteen feet. So if you want an example of what that is in real life, why that matters is—and this is in sport as well—is when you’re driving, the better you see, the more time you have to react. So think about today when it’s been blustery, cold, wet as you’re driving. If you’re not familiar with the area, you’re looking for a road sign. And if you have twenty fifteen vision, you’ll see it earlier, which gives you more time to tap on the brakes or put on your turn signal compared to if you’re twenty forty, which is much worse vision. Now you have less time because you have to get that much closer in order to make things clear.

Bruce: So from an optometry point of view… So, I’m thinking to myself, I remember when I was younger, I wore glasses when I was in primary school, and I switched over to contact lenses when I was in secondary school, and then I got laser eye surgery when I was in my early twenties. And that’s been fantastic. So it has been a long time since I’ve thought about it like this. But one defining memory I have was playing rugby when I was in secondary school. The first time I had contact lenses, and I remember walking out onto the pitch and I was like, “Whoa, hang on, you guys can see the ball when it’s in the air!” You know, it was mind blowing for me. Transformed my ability to play the game. So when you’re looking to correct someone’s vision, do we correct it to twenty twenty? Or for an athlete, would you look to correct it slightly better? Like if an athlete wears contact lenses, can you correct it slightly better than average?

Fraser: Yeah, that’s the goal. So if the average athlete is about twenty fifteen, that’s where I want them to be. So when they come in and we see them, I want them to see twenty fifteen, if not better. So often that’s done with contact lenses, mainly because it’s really hard to play a lot of sport with glasses on. You know, and even like FIFA, you have to get a medical waiver in order to wear glasses. I think the last person that’s probably done it was like Edgar Davids, who had that. But, so yeah, we try to push them to see how well they can get, that’s often done with soft contact lenses. We do have athletes that they get Lasik like you did and that benefits them as well. So there’s definitely options. And then we also have some standards out there for different sports. For example baseball. The average visual acuity is twenty over twelve point five. That’s the average visual acuity. So if I have a baseball player when I was back in the States, who plays college baseball and they are twenty twenty, I know they’re already behind.

Bruce: And I know baseball is an interesting one. So let’s talk about that. So, you know, obviously they are trying to focus or to hit a fairly small object that is moving very, very fast. So like how do they process how do they do that? What’s involved in that?

Fraser: Yeah. Great question. So it’s physically impossible to track the ball all the way to the glove essentially or where you’re going to hit it. So what they do is they’re actually looking at the release point of the pitcher. So where the pitcher winds up and throws their release point and how their fingers are and how the ball rotates, tells them what type of pitch it is, they’re already starting their swing. So if you watch baseball players at Major League Baseball level, they’re already, you know, getting ready to swing. And then based off the release point, they do what’s called a predictive saccade, and they will move their eyes to about the maybe halfway point to see is the ball where they think it’s going to be, and then that’s an adjustment or that’s them saying, “No, I’m not going to swing.”

Bruce: And how quickly does that happen? That must be incredible because those balls are coming like over one hundred miles an hour.

Fraser: Yeah. I mean and I’m thinking more of, like a ninety mile per hour pitch. That’s coming pretty darn fast. So they’ve got to make a decision in about a second. They’re making decisions in less than a second. So mainly like about a half a second.

Bruce: And then you said that those baseball players they are twenty over twelve point five. How rare is that? Like is that exceptionally good eyesight? Like how often would you see that in someone normally, your average patient let’s say?

Fraser: You’ll see a lot that’ll get to twenty fifteen or six over four and a half. But not everyone gets to twenty over twelve point five. That’s pretty exceptional for your average person. But in baseball you see it pretty consistently and in other sports, too. Quarterbacks for American football. I don’t know how hurling or camogie players are. We’re actually working on that with a PhD student here. I have a feeling we’re going to find that your top players are going to have really good vision.

Bruce: Yeah, it’s probably one of those traits that they have that has allowed them to get good at what they’re doing without realizing that they had it.

Fraser: Yes.

Bruce: Okay. Yeah. So that was going to be my next question. So baseball is a pretty specific example. It’s not something we’re terribly familiar with over here in Ireland. But let’s bring it back to field sports in Ireland. So soccer, rugby, Gaelic football, hurling—maybe hurling is probably the one where the vision is going to be that slight bit more important. So let’s talk about that. What challenges would a hurler face on the pitch that you see or know about from your expertise?

Fraser: So if we look at all of the field sports you mentioned, visual acuity is really critical. So the better you see, the more time it gives you to process and make decisions. Now, that’s quantity of vision. When we talk about visual acuity there’s also quality of vision, which is contrast sensitivity. So somebody who’s playing hurling or camogie, you know, they’ve got to do multiple things at once. It’s one of the most exciting sports that I’ve seen coming here. We’ve been introduced to it. It’s been wonderful and it’s so fast paced. I thought ice hockey was actually one of the most visually taxing sports. I think hurling and camogie is right up there, if not exceeding it at times.

So if I was breaking down the visual skills, visual acuity is really critical. They’ve got to be able to see what’s going on, where people are at, they’ve got to be able to pick out the sliotar. Now, the key with that is actually it starts to go to contrast sensitivity, which is that ability to detect subtle differences between the background and maybe the object of regard. I reference golf a lot with that, but with this I’m thinking about cloudy day balls up in the air, the sliotar is up in the air. You’ve got to be able to pick that out. That’s called figure ground. So it’s picking out the sliotar compared to the background and then being able to track it. So now tracking is eye movements. And then it all comes back to eye-hand and eye-foot coordination. So you notice I don’t say hand-eye coordination. That’s because I think the eyes lead the body, which is what Coach Blanton Collier once said. But it’s true. Eyes lead where the hands are going to go in order to catch the ball or receive the ball. If it’s on the ground, kick the ball somewhere. So it’s very visually demanding.

Bruce: And I’m thinking when you mentioned ice hockey there, of course whether it was designed that way or not, you’ve got a black puck on white generally down on the ice, white ice I presume there’s a nice contrast. It’s easy to pick that out. Whereas like you said, a white sliotar against a dull and gray day, which we have plenty of here in Ireland. That makes processing a lot more challenging. Is that something… Well, okay, I know that we can change the color of the ball, and sometimes we use those luminous yellow balls. But is contrast sensitivity something that can be trained? Is that something we can practice for?

Fraser: Yes. So there’s multiple ways to do it. One is just getting the right glasses or contact lenses that will help you in general. You can also look at supplements. So, carotenoids are a pigment that’s in the back of your eye. And when that pigment is low, your contrast sensitivity isn’t as good. And this is a lot of research that’s being done at the Nutritional Research Center Ireland with John Nolan and his team. And they found that when we actually increase that macular pigment, we improve that contrast sensitivity. And they look at the quality of the product that they have assessed is wonderful. It’s all made by marigold flowers based out of Mexico, but that’s one way we can do it, is by taking a supplement.

Bruce: Okay. And that’s backed by research at the moment. We can take a dietary supplement. It will result in increased carotenoids in your eyes. And then that results in actually multiple things: better contrast sensitivity, better processing. And then with better processing you get better eye-hand reaction time.

Fraser: Okay.

Bruce: So in your opinion—well I’m not putting words in your mouth now—but would that be a bit of a no brainer for athletes to be looking into those kind of supplements if visual acuity is something that’s important to them?

Fraser: Definitely. Yeah, I believe so because I think it’s one of those where we already look at supplements. Athletes are looking at supplements all the time. We talk about this in the States as well. And one of the issues is there’s not enough research about the quality of those supplements. And often, you know, when they’re exposed to light that oxidation reduces the quality. And there’s people with the powders, they have almost a buffet of powders just sitting out in the open and gummies. And, you know, I’ve seen athletes just walk by and put things randomly in their shaker, and then they shake it and go, “Well, that has to be good for me.” Well, they don’t really know what they’re getting. So that’s why it’s really important that you get something that is of good quality and that’s really going to help you.

Bruce: That is fascinating. And that’s research that’s ongoing here. It just happens to be in Waterford as well.

Fraser: Yes. Yeah. So it was a nice environment for you to move into. Definitely. Yeah. It’s one of the reasons that enticed me to come here as well.

Bruce: Very good. Another thing then, so when we were thinking about field sport players and again, I know we’d casually mentioned this, so my train of thought here was I’ve noticed recently—and I’m getting on a little bit—that if I’m spending a lot of time focusing on my phone, and then if I stop looking at my phone and I want to look at something a little bit further away, I’m finding that it’s hard to switch gears.

Fraser: Yes.

Bruce: With my vision there, it’s a little bit slow. The distance vision is a little bit blurry just for a second. And then when it catches up, everything’s perfect. And, you know, I’ve had my eyes tested. I don’t know what my vision was, but I was told it was okay. It was perfect for me. So that got me thinking then about athletes and field sports players in particular, and the need for them to switch from, you know, focusing on something that’s very small, like a ball or a person that’s in front of them, to scanning a field that’s in front of them to take in all that extra information.

Fraser: Yes.

Bruce: So how important is it for athletes to be able to switch back and forth between those, like broad vision and narrow focus vision?

Fraser: Yeah. No, it’s a great question. You know, if I take a step back, part of it, what you’re describing is focusing, which we call accommodation. And so the ability to look up close, you’ve got to really crank in your focusing ability. And that’s the lens in the middle of your eye. We know that when you’re sitting there reading a book or looking at your phone for a while, your focus kind of gets locked in a little bit. Just like, for example, if you hold your hand in a fist and you hold it for five minutes and you say, “Relax completely,” it doesn’t relax completely because it’s kind of gone into that state. So what we do is we actually have a test that’s a near-far rock and that looks at flexibility of focus. It’s also called Haines distance rock. And athletes’ ability to look from the distance to up close back and forth quickly. While they may not recognize that they do it a lot in sport, it’s really critical. So it’s one of those that we can test and we can train.

The other thing we do, you brought up focus and broad. There is this ability to focus on one thing but also be aware of everything else—soft focus. So I played golf and soccer. When I was a defense in soccer, I would always find myself noticing that I wasn’t looking directly at the defender, or sometimes even directly at the forward who’s dribbling up, who has the ball or the wing. And instead I’m kind of in the middle because I’ve got to watch the person I’m defending, but I’ve also got to be aware of where the ball is. And that soft focus, that split attention between two different things, is a really important piece that we can train, and it’s a constant thing we do.

Bruce: Yeah. And thinking again of a clip I saw recently of Sam Prendergast, the Outhalf. I think he was playing for Leinster at the time and he received the ball. And then just quick as lightning, he did this beautiful cross-field kick. So he would have been focusing on that ball coming to his hand. But then at the same time he needed to look at the total other side of the pitch and place a perfectly weighted kick into someone’s hands as they’re running onto it. So that’s kind of what you’re talking about.

Fraser: Yes.

Bruce: Switching the soft focus, taking in everything that’s all around. But the forgive my terminology here. Narrow focus?

Fraser: Yeah, yeah I mean hard focus if you want. But yeah. And that’s often when you see there is that ability to do what we call split attention. So you’ve got to modulate back and forth between, you know, when you’re going for a catch. You’ll see people that miss an easy catch. And it’s because they shifted their focus from keeping their eyes and hands on the ball to what’s next. Who’s going to hit them? And then that’s when they miss an easy catch and you’re going, “What’s going on?” And we just know that that’s part of that modulating attention.

Bruce: Yeah. You see that in rugby quite a lot actually. You know someone who’s throwing a fairly flat simple pass. But you can tell that they have focused on the defender that’s going to come and hit them any second now.

Fraser: Right.

Bruce: And they make a mess of the catch. So is that again that type of switching? Is that a trainable characteristic? Is that something that athletes can work on?

Fraser: Yes. Yeah. Most stuff that I assess and that we do, we know we can train. And it’s a process that we build up to. Doctor Dan Laby and Doctor David Kirschen, they created this sports vision pyramid. And the foundation—because you’re only as good as pyramids are only good as their foundation—is all about visual acuity and contrast sensitivity. And then from there we go up to how the two eyes work together, and then we look at eye-hand coordination and also processing. So that’s all of that is the trainable piece where we make sure that the base is super solid. And then we go ahead and work from there and we start working on those on those skills or what I would term vision driven skills.

Bruce: So I know I don’t want to put you on the spot here, but let’s take the base of that pyramid then. So for anyone who’s listening here, who’s thinking, “Well, okay, well how do I work that into my training?” What type of things could a coach or could an athlete do to build that base to begin with?

Fraser: Yes. So first of all, the base is just get a good eye exam, right. Go down, get an eye exam. And make sure that you’re getting… We always want to get if you need glasses then get glasses. Right. But also for sport contact lenses are often preferred. So talk with your optometrist and discuss with them about what are the options that I have? I like to use single use or daily disposable contact lenses. So that way every time you’re putting them on, you get a fresh pair of contact lenses. And that also helps because some athletes, they only wear them for sport. They don’t want to wear them all the time. Totally fine. So that’s really the key is get a good eye exam, and talk with your optometrist about what the recommendations are.

Bruce: So just going back to what we were talking about at the start, if you were like, what would be normal if you go for an eye test? Would the optometrist be looking to correct most people to twenty twenty or would you have to explain, “Look, I’m an athlete and I’m looking to get a little bit better. I’m looking to really enhance my ability here.” Is that something you’d have to request?

Fraser: Yes. More than likely. Now I’ve gone around, lectured throughout the States and actually a little bit in Europe and Canada and have the discussions with optometrists of “Don’t just stop at twenty twenty. Keep pushing your athlete.” And they’re used to being pushed. So it’s always fine to say, “Hey, can you see how good my vision is? Can I get better than twenty twenty?” And that’s really good insights. And a lot of optometrists, they will check beyond twenty twenty. But every once in a while they’re so busy. So asking that is really, really helpful.

Bruce: And is that something again… I’m just thinking on my feet here, but if the athlete had single use contact lenses that correct it to beyond twenty twenty that they just wore for training and for competing, is that okay? And then if they went back to regular prescription or average prescription outside of that or their normal vision.

Fraser: Yeah. So it’s funny, I talk with my athletes and go, “Do you wear the same shoes walking around that you do on the field?” No, you have specific ones. So there are athletes that I have them everyday glasses and then sports specific contact lenses that maybe have a little more prescription. So I don’t want them wearing all the time because that’s just going to put too much strain on their eyes. But you know I would rather have them compare that way and they get it. And then what I also say is get a little baggy, a little plastic bag, put an extra pair in there. And if you have an athletic trainer or anybody, you know, your management team, depending on what level you’re at, give that to them with your name on it. So that way if a contact lens pops out, you have a spare pair there. If you don’t have an athletic trainer or sports management team, then just put that in your bag. So that way, if you’re playing recreationally and a contact lens comes out, you always have a spare.

Bruce: Yeah, we see that… we do notice that more and more in field sports now with players replacing contact lenses. But I don’t know. This might not be news to everyone else, but I find it fascinating that, you know, we can take it beyond what is considered typical good vision. And is it fair to call it an overcorrection?

Fraser: Well, I would actually say it’s the right, the right correction. Yeah.

Bruce: That’s why I stopped myself by saying that it doesn’t, you know, in our conversation here, it doesn’t feel like you’re overdoing. It feels like you’re doing it appropriately for the situation. Correct?

Fraser: Yeah. And you know, we don’t stop with sports that’s also drivers, you know. So driving at nighttime, all those pieces, making sure that we are maximizing their vision. So my line that I always say is, I don’t care if you’re an elite athlete or you do competitive cross stitching at the nursing home. My job is to maximize your vision.

Bruce: Yeah, yeah, really really interesting. Another thing that I came across when I was just thinking about this and preparing for this is, uh, when I was talking to another practitioner the other day and he was discussing how so many games are won and lost in the final couple of minutes of a game when people are really, really fatigued and tired and they’re under pressure and they’re stressed. And I won’t pretend that I knew this, but I read that what can happen is that in those high stress, high fatigue situations, our field of vision can start to narrow and you get essentially a tunnel vision.

Fraser: Yep.

Bruce: Can you tell me more about that?

Fraser: Yeah, yeah. So just like the rest of the body, towards the end of the game, we get fatigued. And our vision gets the same. So it’s just this natural thing. So, yeah, it’s almost this… It’s not a real what we call scotoma, but we pay less attention to our periphery. Instead, we are focused on what we need to because we’re exhausted. We notice that athletes don’t, you know, maybe don’t turn their head as much to catch a ball if they’re going to catch a ball. And we know that if we have two eyes looking at the ball, I have better depth cues, so I have better timing. When both eyes are looking there, if I turn my head and I don’t turn it all the way and my nose blocks one eye’s vision, now that may throw off my depth perception a little bit, making my catching inconsistent. A lot of vision issues are demonstrated with inconsistency, especially in times of stress.

Bruce: Okay.

Fraser: Yeah. So we can train all this. We do different things and I’ll give a you know… this is work that I do with my colleagues in the United States. We have a side business called Sports Vision Pros where we actually have worked with athletes. And we have all these videos of different training techniques and different training tools. One of the best things we can do is actually there’s—and I don’t have any stake in this company or anything like that—but there’s a pair of strobe glasses. And so these strobe glasses can help with your attention. They’re what one of my friends called resistance training for the brain. What it does, it takes away your view of an object. So let’s say you and I were sitting there and we’re just passing a ball back and forth. I see it one hundred percent of the time. I put on these strobe glasses. They may give me three views because they block off my view for the rest of the time. Now I have to anticipate off those three views. Where is that ball going? What’s the timing of it? And we go through a whole process of training to where I’ve now stressed the brain more. I’ve stressed the eyes more. Then when you take them off, it’s almost like things have slowed down. So this gets back to your point of towards the end of the game, we often physically have worked ourselves up to where we can endure that stress, but we haven’t done it visually. And so we can do that type of training where we stress the system. So that way you’re ready for those stressful times.

Bruce: Okay. And again, when you’re talking about those glasses, I can vaguely remember seeing something like that. They’re not exactly mainstream piece of equipment. Is that fair to say?

Fraser: Yeah. Correct. They were. The history goes back to actually, it started with the United States Air Force and then eventually an alum of Pacific University College of Optometry designed them. And back then they were called strobe specs. And then Nike eventually bought the rights to them. And then Nike was actually really involved with vision for quite a while. I was fortunate enough to my mentor was part of that. And I could be a consultant with Nike, which was wonderful. They eventually dropped their vision line and focused again on shoes and dropped their whole training line. They used to have a training line called SPARQ. Well, that got licensed then through a different company that’s called Senaptec. So they’ve done a really nice job and they have a whole platform of assessments, but then they also have training. And one of those training pieces are is the Senaptec strobe glasses. And so again we go back to baseball something like that, where that’s exactly what those players have to do. They have to be able to anticipate or read the trajectory of the ball really quickly.

Bruce: Does that transfer into lots of other sports as well? Is it beneficial for everyone to, you know, consider at least doing something like that training?

Fraser: Yes. I mean what we find is some people go out and they buy the glasses and then they don’t know how to use them. So it’s really about making sure you use them correctly, just like any training tool. Right? If you went out and bought a kettlebell and all you do is you just pick it up, you would eventually go, “Ah, why do I need this?” Maybe a horrible example, but yeah, but this is similar. You’ve got to learn how to use it and how you integrate it. Most of the training that I like to do with athletes is integrated within their warm ups before their actual training with the team. So I don’t I don’t like to necessarily say we’re going to do this thirty minutes on the side. Instead, I integrate it with what they’re already doing.

Bruce: And okay, so obviously having those correct glasses, the stroboscopic glasses, that’s the right way to do it. You know. Is there any way to kind of maybe mimic that type of training if you don’t have access to those glasses?

Fraser: It would be really challenging to mimic it there. There are some platforms that they’ve tried to do that with virtual reality to some success, actually. It’s just that virtual reality… I don’t think people are using quite as much as what they used to be, although I think, who knows, it could come back. But I think that there are other things you can do. Easy things, if you’re with, let’s say there’s you and I are throwing a ball back and forth. We’ll use that example again. And we have another friend that’s there. They may stand behind you and just show fingers. And I’ve got to count the fingers while you and I are passing the ball. So I’m jumping back and forth between their fingers and watching where the ball is coming, and then they’ll come behind me and then you’ve got to call them out. Those are ways that you can just work. Not necessarily the same skills as what the strobe glasses do, but really work on your vision, how quickly you’re moving your eyes, your awareness, and kind of that split attention.

Bruce: Yeah. Splitting your attention back and forth. Okay. That’s that’s very simple to incorporate into.

Fraser: It’s really easy to do. We do things like ball tosses where they’re shuffling. So you get the team, you line them up directly from across each other and you use tennis balls, and you just shuffle one way while tossing the ball, and then shuffle the other way while tossing the ball. Beanbags actually are a little bit better because they don’t roll away, but there’s just various little things that you can do.

Bruce: Yeah. So you might see footage of a team doing something that looks like just a fun warm up, but there’s something very specific behind it like that.

Fraser: Yes. Yeah. Because really what you’re doing is you’re watching. You have to watch the people next to you, because if they drop the ball and stop, you don’t want to run into them. So now I’m working your peripheral vision, as well as you paying attention when the ball comes to you.

Bruce: Fascinating. Yes. You know, you mentioned Nike there and we’ve been talking a lot about the eyes leading the hands. And essentially that’s our software.

Fraser: Yes.

Bruce: So what what else can we do from an eyewear point of view? What benefits are there? Should we be wearing like sunglasses and blue light filters? You know, if you are a golfer, I’m sure there’s plenty of golfers listening. What benefit might different types of glasses have for them?

Fraser: Sunglasses. You know, eye protection is always important within any sport. And definitely if we focus on golf for a moment, you know, they’re out there often in the sun. Ultraviolet light can come just like how we can burn our skin. It can also actually cause almost a sunburn on the front of your eyes called the cornea. So that’s just a keratitis. So wearing good sunglasses that offer UV protection is really important. And then this has been going on for well over twenty years. I actually did my thesis project on certain tints for golf. They’ve actually designed various types of tints, and the tint is actually embedded within the lens. It’s not the mirror coating on the front. And what they do is they’ve made it so that way certain wavelengths or colors of a sport are enhanced and others are dampened. So within golf, for example, the golf tints that are out there and all the manufacturers have them really are designed to maximize your ability to read the greens. So that way you can see the subtle differences on the grass, and that may give you more information to make a better putt or at least line up better. I mean, even, you know, there’s definitely plenty of times that I think I hit it where I was supposed to, but didn’t. So I knew where I was supposed to go. So those are wonderful opportunities that are there. Blue blocking is important. So we talk about that, especially if you’re going to look up close on your on screens like laptops and phones because those decrease those harmful blue light. And, uh, you know, that’s also important at nighttime. You know, on your phone, you should put that blue blocking on. And then also you have it on your glasses. The other piece of that is also just getting the correct lenses for up close. So we have some athletes we talked about earlier that they overfocus. If they hold that focus up at near, we can just get some readers that actually relax their focusing a little bit and also put the blue blocking on. And now they’ve just got what we call the comfort lenses. So that way they don’t have what you noticed that blur in the distance, even if it’s for a moment, it just relaxes them a little, I think.

Bruce: Do you mentioned an example of that to me previously? Like say uh, athletes? Uh, I think it was basketball players who said, you know, they might be playing a game and hopping on a plane afterwards to, to fly home or fly somewhere else, and they’d be reviewing game footage at night when they’re tired after a game and they’re unknowingly putting themselves under unnecessary stress. Right?

Fraser: Yes, exactly. So these guys and girls, these men and women, are traveling all the time. And so they’ll play a game, and then that night they’ll be on a plane. So that way they’re flying to the game maybe the next day. And they may be looking at game film from that night or prepping for the next day. It happens also in football, American football, soccer as well. You’re good. But they’ll do that. They’ll look at their phones. And so having those what we call their comfort glasses just takes off that little bit of stress. So anything we can do to help them with performance, we’re open to it.

Bruce: Yeah. Really really interesting. So yeah. Comfort readers not something that we should consider just to take that pressure off, make that downtime a little bit easier. Even if it’s not fully downtime. Right?

Fraser: Correct.

Bruce: Very good. So. And bringing some of it… Well, coming back to the start. So if an athlete coming to you or if an athlete out there, we said the base of that pyramid is getting that good eye test. What other screening things should you be building up that might help you to diagnose things in future or help an athlete come back from something in the future?

Fraser: Right. Good question. I mean, there’s all sorts of… one of the areas that we look at is concussion, right. And so when we are doing our our foundational assessment or a complete eye exam, there’s actually tests that we do that are building blocks for baselines for concussions. So looking at pupils, making sure they’re reactive, making sure they’re both the same size actually about twenty percent of the population has a tiny difference in pupil size. So I want to know if you have that difference in pupil size. Because if you get a concussion and it hits your nerves and now you have a blown pupil or a change in that pupil size. I need to know that on baseline. And how much did that change?

Bruce: I’m going to pause here just for a second. So I’ve heard that term before a blown pupil. What, your pupil is dilated or it doesn’t react or if it’s fully dilated what impact does that have? I know it’s not a good sign but what impact does that have?

Fraser: Yeah. So if somebody has a blown pupil that’s normally pretty bad. They’ve got probably some brain damage. But blown pupils don’t happen often. Of all the concussions I’ve seen, I’ve seen some that have a little slight change in pupil size, but no blown pupils per se. We will see it sometimes for someone who has a really bad trauma hit to the eye, that actually can tear the iris because the pupil is actually just a hole. It’s the iris, the colored part of your eye. That’s actually what forms the pupil. So you can get it to where if you have a really bad injury, car accident, punch to the face, where you can actually cause a structural damage to that iris, and then that changes the form of the pupil.

Bruce: So yeah. Not good. Okay. So someone gets a back of the head, they’re at risk of a concussion. That’s one of the signs. Pupils are one of them.

Fraser: Exactly. We also look at eye movements. So we follow their eye movements to see… we want very smooth following. So if I had you look at a pen and I had you look from side to side, you would follow your eyes would be nice and smooth. Those are called pursuits. And then we’ll also look at how quickly can you move your eye. Let’s say I hold up a blue pen and a red pen and I go “Blue, red.” And you jump back and forth. Those are called saccades. There’s actually been studies that are done. UPMC, who is here in Ireland, they’ve done a lot of research in the world of concussion management. And they’ve actually created VOMS, which is a Vestibular Ocular Motor Screen. That’s not actually what it is, but that’s one of the tests within there. But they look at multiple pieces of how your eyes react. So saccades, how quickly your eyes move back and forth and consistently pursuits. Then they also look at visual ocular motion sensitivity. And we know that when those work together or those induce headaches, nausea, dizziness, anything like that, it correlates to a concussion.

Bruce: So this is interesting because I know an athlete that I’ve spoken to previously who suffered a bad concussion and was struggling to recover from that concussion for a fairly prolonged period of time. They were under a little bit of pressure with a fairly major competition coming up. And I know that they went and got some specialized treatment, which I’ve since found out was called visual or ocular training therapy done.

Fraser: Yes.

Bruce: So I think that’s… is that what you’re talking about? So if you had these baseline tests done then this type of training can be built upon that to see where you should be. Is that right?

Fraser: Yes. And the studies are anywhere between fifty percent to ninety percent of people who sustain a concussion have visual symptoms and visual symptoms can be sensitivity to light, blur, all sorts of various things. Sometimes it’s headaches. I had an athlete that he was getting horrible headaches over his brow, and that was actually because of his eyes. And that’s a very common thing. So we can do things now. Luckily, with sports related concussions, they’re often transient and they’ll recover. But I work with a lot of student athletes. When I was back in the States, my key was to not hold them back and to try to help them while they’re doing their studies, if they’re cleared to return to school. So I would give them readers, for example, just to make it so that way they didn’t have to work as hard, help them with their return to school, and also return to play.

Bruce: And I think the training that this athlete got is involved. Like it’s again, it seemed like some fairly simple things. I think they were walking on a treadmill and just trying to, you know, can you walk on a treadmill and look ahead? Okay. Now can you walk on the treadmill and turn your head slowly from side to side? And it kind of progressively built up and up and up from there until the point where they couldn’t do something right. So is that this type of training? Is that the right type of thing?

Fraser: Yeah. So yeah. Then there’s all sorts of training. There’s people that do… I’ve done, I do the basic pieces of it, and then I refer to my colleagues who are actually vision therapists. And actually I think in here in Ireland and the UK and others orthoptists help dramatically with this. They are wonderful at this type of training. So they also work with not just post-concussion but also post acquired brain injury. Similar things will happen or any type of traumatic brain injury in all honesty. And yeah, it’s a slow movement. There’s University of Buffalo Doctor Leddy, he has the Buffalo Protocol. And this is in general not for eyes, but they have a protocol that they put them on a treadmill, and it’s almost like a stress test. They push you to a point to where, okay, does that induce symptoms? All right. Let’s go back and then let’s keep your rehab at that level. And then they keep checking and they keep ramping up rehab until you’re back to ready to play. And we do the same thing with the vision. If your eye movements are not quite as strong or actually a really common one… is what’s called vision motion sensitivity. We’ll ask athletes “When you walk into the grocery store, is it overwhelming?” And it’s really that when you walk down the aisle, having all the products to the side overwhelms your vision. Typically pre-concussion, our brain is so good at dampening down all of those distractions. But post-concussion our brain is raw. One of our colleagues, Doctor Keith Smithson, likes to say that our brain is raw. And so we’re trying to just get it back to where it was. So you can do a type of training that actually allows your brain to get used to that motion over time.

Bruce: Yeah. And that’s obviously so important for any athlete that has any sort of linear speed runners, cyclists maybe in particular where the, you know, things are going past that must be incredibly difficult and overwhelming if there are those symptoms present.

Fraser: Right. Yeah.

Bruce: Fascinating. It’s like, you know me when you’re talking about the athletes on the treadmill. They make me think of like maybe an owl who, you know, they need to. They’re very good at keeping their head steady and focusing on things while their body is moving or while they’re in the air. Is that kind of a similar concept?

Fraser: Yeah. Why not? Yeah. Why not?

Bruce: Okay. No, I think it is.

Fraser: I think ultimately we often start skill isolation and then we bring in more skills. And I think that’s exactly what you described. Walking straight ahead, looking straight ahead. That’s your isolation. Can you maintain that without any symptoms? Now can I turn and you know, am I creating symptoms? Nope. That’s good because I’ve now brought in a different type of movement, a side to side movement. So exactly what you’re talking about, you just keep integrating until we figure out where’s that point where we need to work.

Bruce: Yeah. And I know obviously in lots of different sports, rugby again in particular, there’s loads of research and work being done in here and abroad. Um, looking at rules, looking at things like tackle height to make the game safer and try to limit those high risk collisions that put the athletes at risk of concussion. So coming at it from the other point of view, like, again, I think this is a fairly straightforward question. We should be doing all these baseline tests in order to maximize well, to fully understand the the extent perhaps of an athlete’s injury, if they do get one and then to manage their recovery afterwards.

Fraser: Yes. No, definitely. Doing that is critical. Actually, Doctor Clark, who works with the University of Cincinnati’s football team, he does this baseline. And then he’s also instituted vision training with all their football players. And what they noticed, I think it was a couple of years ago, a reduction in concussions and also a quicker return to play compared to the rest of the collegiate football players, American football players. So I think you’re one hundred percent right. Minimally, we should be assessing the foundational pieces just like we do other areas of performance, but we should be assessing those before they go out. So that way we can always compare it. If unfortunately someone gets a concussion.

Bruce: Yeah. Is it possible that if say, someone had at baseline that their pupils were slightly different from each other. Could they possibly be diagnosed with a less severe or more severe concussion? But if that wasn’t available, even if there wasn’t info…

Fraser: Actually the way we would do it is ask them for, “Can you show me some photos before the concussion that are kind of of your face?” and see if I can zoom in on their on their phone first to see if I can see a difference between the two? So and then I would, I would explore other things as well. There’s ways that we can assess the pupillary response with bright lights. Do they constrict through the bright lights? Does each eye constrict at the same amount? And often if there was ever a question, we would talk with neuro-ophthalmology, neurologist and ophthalmologist to see what what they want. It could be an MRI. It could be, you know, just we especially with any brain injuries, we can’t be too careful.

Bruce: Yeah. Okay. Really, really interesting stuff. Um, okay. Well, I think we’ve covered a lot of ground there. We’ve got a good, decent bit of time. Done. So, Fraser, thank you so much for coming in to speak to me today. And hopefully there’s a lot of people listening who are now when they hit stop on this podcast, they’re going to be making a call to get their eyes tested and make sure they are properly prescribed.

Fraser: Yes. Yes, definitely. Thank you so much for this opportunity to talk about something that’s a lot of fun. Not always, uh, focused on pun intended, but definitely something that we can do to help athletes at all ages.

Bruce: Yeah. It is, it’s very, very interesting. And I’d be curious to find out if it’s similar for other service providers or other listeners, that this was not something that was part of my sports science or exercise physiology training. It’s very, very interesting to talk about, but it’s something that I’ve not studied before. So hopefully that might change going forward. Or at least listening to this today, some people would be definitely more aware and might start to seek out those extra edges. Yeah. Help. So thank you so much for the opportunity.

Fraser: My pleasure.