There’s More to Concussions than Meets the Eye

Today’s guest blogger is Dr. Robert Fox.  Dr. Fox graduated fromSUNY-State College of Optometry in 1985, after which he completed a residency in Rehabilitative Optometry at the Northport VA Medical Center.  He is in private practice in Schenectady, NY, and also consults on brain injury related vision problems at the Sunnyview Rehabilitation Hospital in Schenectady.  When not busy at his practice Dr. Fox likes to snowboard, play hockey, and golf.

A recent article in USA Today, highlighted the use of a simple eye test in the detection of concussions.  The test, known as the King-Devick test, is a test for eye movement speed and accuracy.  The goal of the test is to read lines of numbers off a page as quickly as you can.  Research conducted at the University of Pennsylvania School of Medicine has shown that poor performance is a confident indicator that a concussion has occurred.

Awareness of concussions has grown rapidly over the past few years.  Professional and scholastic athletes are now being required to sit out much longer than in the past to recover from severe blows to the head.  Blows to the head are not limited to football.  As an optometrist who consults with a local bring injury rehab center, I have seen injuries in activities such as hockey, lacrosse, gymnastics, dance (yes, dance), and soccer.  One of the most important aspects of this new article is the connection between vision function and brain injury.  Even mild concussions can cause major visual function problems.  These can include:

*blurred vision – especially when reading

*headaches associated with reading

*double vision

*eye pain

*poor reading comprehension

*light sensitivity

*frequent loss of place when reading

For the student athlete, these symptoms can have a huge effect on learning and school performance.  These vision problems can also linger months after the initial pain and headaches associated with the concussion have gone away.  The most common causes of these problems are a convergence insufficiency (eyes that don’t work well together at near) and/or accommodative (focusing) insufficiency following the injury.

The good news is that these vision problems respond well to optometric intervention.  The King-Devick test is just one of a larger battery of tests designed to evaluate eye function and the integrity of the vision system.  Treatment usually consists of a combination of glasses for reading and optometric vision therapy.  These treatments allow the student to return to their academic activities much sooner than just waiting for things to clear up on their own.

Further information on vision therapy and brain injury is available from the College of Optometrists in Vision Development and the Neuro-Optometric Rehabilitation Association.

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Tips for a Perfect Season

Pitchers and catchers are reporting to spring training this week.  What better time to think about what you can do to improve this season.  “Keep your eyes on the ball.”  Here is Dr. Lynn Hellerstein explaining what that really means.

Dr. Lynn Hellerstein practices in (metro) Denver, Colorado.  She is a past president of the College of Optometrists in Vision Development (COVD).  She is also the author of the book See It Say It Do It.

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What the Green Bay Packers Can Teach Us About Vision

Today’s guest blogger is Dr. Kellye Knueppel.  Dr. Knueppel practices in Brookfield and Madison, Wisconsin. She is a devoted Green Bay Packers fan, a real “cheesehead.”  This post also appears on her blog for the Vision Therapy Center.

The Lombardi Trophy has returned to Titletown, as the Green Bay Packers captured this year’s Super Bowl.  The road to yet another championship wasn’t easy, however.  The Packers had to overcome a rather formidable obstacle:  Injuries.

People with vision problems also face physical setbacks, and they create their own methods for coping with their problems. However, by taking a page out of the Packers playbook, they can overcome their vision issues and achieve Super Bowl success in school and on the job.

Super Bowl hopes on the ropes

Early in the Packer season, many picked Green Bay to rocket through the regular season and make it to Dallas for another shot at the Super Bowl.  But as is often the case in the NFL, the Packers were hit hard by a rash of injuries to key players.

First, starting running back Ryan Grant hurt his ankle in the season opener at Philadelphia.  Then tight end and budding superstar Jermichael Finley joined him a few weeks later.  Both players were lost for the season.

The rash of injuries continued.  The Packers lost a starting linebacker.  Then a safety.  In all, the Packers placed 15 players on injured reserve, and soon found themselves fighting to stave off a sub-.500 season and missing the playoffs.

That’s when a miraculous thing happened, and it proved to be the key to their Super Bowl victory.

The Packers adapted and learned

Knowing they were short-handed, the Packers had to play their young talent.  Many of these players were extremely green, and lacked technique and experience.  But within the hands of a talented coaching staff, they quickly refined their game.

They learned their assignments.  They improved their technique.  And they began to win.

The Pack finished out the season with five straight wins, including the Super Bowl.  Essentially, the team adapted to the obstacle, then under the guidance of the coaching staff, learned how to get better.

Here is where the parallel can be drawn to people with vision problems.

People with vision problems also “keep playing”

According to the American Optometrists Association, nearly 1 in 4 people have a vision problem that affects their ability to learn.  Like the Packers, people who have vision problems do the natural thing:  When faced with an “injury” or a setback, they keep playing.

Just because you have a vision problem doesn’t mean your life stops.  We humans are remarkably adept at finding ways to compensate.

In her landmark book, Fixing My Gaze, Sue Barry details several accounts of people who get through life by adapting unorthodox techniques, including herself.

“I had trouble reading road signs when driving because I couldn’t keep my eyes on the words,” she writes.  “I would slow the car to a crawl in order to read them, unnerved by the honks from angry drivers behind me.  If I had to go someplace new, I would head out the day before at the least-trafficked time and drive to the new location so I wouldn’t get lost the next day.”

Sue Barry and other people with vision problems share the commonality of overcoming a physical setback.  But what if people don’t even know they have a vision problem?

Take your visual system to Super Bowl levels

Because most people aren’t even aware of the types of vision problems that can affect learning, they find their way to compensate for their issue and march forward.  But they never realize their true potential.

The Packers achieved greatness because of a coaching staff who taught them how to play at a Super Bowl level.   The young players translated that expertise into action, and the Pack beat the Steelers in a classic Super Bowl.

People with vision problems need to do the same.   With the help of a developmental optometrist, they need to pinpoint exactly what their vision problem is, and then take the corrective steps to improve their visual system.

Yes, people can get through life with vision problems.  But it’s only those who find the time to identify their issues and work with a developmental optometrist will reach their own personal Super Bowl.  If they do, they’re guaranteed to be winners for life.

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Spotlight On……The Science of Thrill

Today’s guest blogger is Dr. Kara Heying.  Dr. Heying practices in Cedar Rapids, IA.  She presently serves as a member of COVD’s Board of Directors.

I had the opportunity recently to learn more about visual science through the eyes of Fighter Pilots – specifically though the eyes of the Blue Angels.  How did I get the honor of spending the day filming, interviewing and learning from these decorated Lieutenants?  It all began over 2 years ago when a connection was made in my community between a team of creative producers and some local physicians/scientists.  The production team was working together for science, developing a blended experience between film and physical experiment geared for kids.  The project developed a name called the “Science of Thrill,” and the details and scope of the project continued to expand over time. Today it is projected to end with a multi-episode series teamed with middle school science curriculum and supported by the National Science Foundation.

The Orange County Choppers was the first group of “thrill seekers” to be involved in the project.  Since that time additional Thrill Seeking Sports, Technology and Motor/Aviation participants have also become involved.

I was brought in as the first vision expert because the co-producer had a daughter who was a patient of mine and had recently completed vision therapy for the remediation of her visual motor, visual spatial and binocular vision dysfunctions.  Her daughter had a long standing diagnosis of dyslexia and had been working hard with her school and teachers to utilize multi-sensory instruction to allow her success in learning.  Through these approaches she had become a very good reader and excellent student.  However, despite all her customized learning strategies she continued to lose her place as she read and struggled to copy from across the room.  She was also very tired by the end of the school day, and although she was involved in sports her coordination was questionable.  By adding vision therapy, her compromised visual system was able to be improved and give her even further academic and sports success.  She noted and expressed to her Mom that she felt improvements in tracking (or keeping her place while reading), speed of reading and experienced less fatigue in school.  By the end of vision therapy her Mom had a whole new appreciation for vision and the important role it played in learning, performance and behaviors.

As the need for expert advice behind this Science of Thrill project developed, the production team decided they wanted some interpretation on the visual system.  They needed an eye doctor!  Fortunately, due to this co-producers experience with her daughter’s vision therapy, they realized that my credentialing made me the perfect local fit.  They wanted information about the visual system and its integration with the body and mind.  My job became to help them understand the large variety of ways in which vision is involved in these thrilling experiences.  They didn’t just want to understand the physiology and mechanics of the eye; they wanted to understand how the brain and eyes were connected!

After some time it became clear that the possibilities for this project were endless.  I decided to approach the producers with a request for further support and involvement from my network of vision experts in Developmental Optometry.  I informed them of the association within Optometry called COVD (College of Optometrists in Vision Development) which is dedicated to helping Optometrists gain access to education in this specialty field and which also provides the public knowledge to ensure access to appropriate care.  In addition we wanted COVD to be the voice of the vision expertise involved in the project. Thus, the collaboration between COVD (College of Optometrists in Vision Development) and the Science of Thrill was established.  At this point we have a task force created within COVD to help develop more visual connections for the Science of Thrill episodes.

I have been fortunate to be invited to participate in this exciting project called the Science of Thrill, and I feel we within Developmental Optometry have been given an opportunity to reach the public in yet another way.  Creating numerous avenues to reach people about the importance between vision, learning and function is certainly one of our goals within COVD.  As doctors and specifically as Developmental Optometrists we know our work will never be complete, but we can continue to close the gap of confusion between vision and learning by expanding awareness so children and adults don’t suffer with treatable visual conditions.  We all know that there is a lot of visual science within Thrill – so I along with your COVD Science of Thrill task force will work to represent COVD and inform the pubic of the extensive science of vision within “Thrill”.

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Choose Prevention

Many disabilities, including visual disabilities, cannot be prevented.  They result from genetic disorders, disease processes, or aging processes.  But some disabilities can be prevented.

I am an avid cyclist.  Three weeks ago, I went for a bike ride with a couple of friends.  It was a beautiful morning.  We were riding on familiar roads, with very little vehicular traffic.  I remember the sensation of riding over some rough road and the realization that I was going to fall.  I don’t remember hitting the road.  I spent the next several hours in the emergency room of the nearest hospital.  I had road rash all along the left side of my body, multiple lacerations on my face, black and blue eyelids, a headache and a soreness along the left side of my head.  I was diagnosed with a mild concussion and I was able to walk out of the emergency room.

I WAS WEARING A PROPERLY FITTING HELMET AND PROTECTIVE EYEWEAR WHEN I CRASHED.  When I got home, I took a look at my helmet and my glasses.  The helmet had multiple cracks along the left side.  My helmet cracked but my head did not.  My “sports goggle”/prescription eyewear wasn’t even bent.  But most of the paint was scraped off the front of the frame and the lenses were deeply gouged.  The glasses will be replaced; my eyes, which cannot be replaced, required no treatment.

I don’t like to think about what would have happened if I wasn’t wearing a helmet and protective eyewear.  They may have saved my life.  At the very least, they saved me from far more serious injury and resultant disabilities.

Health care, particularly in the US, is focused on diagnosis and treatment.  Public health organizations do their best to provide education concerning prevention, and in a few instances, prevention is legislated (seatbelts, no smoking laws, etc.).  Most of the time,  it is the individual who must choose.  From my perspective, this is a no-brainer.  Choose prevention.  Wear a helmet and protective eyewear.  Invest in yourself, prevent a life-threatening injury or a lifelong disability.  You are worth it.

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Sports Vision: An Interview with Dr. Arnold Sherman

Part 2 — Hockey

Dr. M: Let’s talk about hockey. I know that is one of your favorite sports and that you actually worked with the 1980 gold medal Olympic Team.

Dr. S: Yes, I had the pleasure of actually evaluating potential members of that team. That evaluation was one additional piece of information used by Herb Brooks in selecting the players for the Olympic Team.

Dr. M: So you should have gotten a gold medal too!

Dr. S: At least I can say I had a small part in winning the gold medal.

Dr. M: Let’s start with the goalie. It seems to me that it is similar to baseball. The puck is traveling at very high speed and the goalie has to make split second decisions about where and when to make his move.

Dr. S: Absolutely, the puck might be traveling at close to 100 mph. Like a pitcher in baseball, the offensive player is going to try to deceive the goalie, to make it more difficult for the goalie to track the puck. But in hockey, the puck can be coming from anywhere on the ice, and the net is much bigger than the strike zone. There are more variables that have to be processed to make the save—velocity, distance, angle. Don’t forget the goalie is also wearing a mask that reduces peripheral vision very significantly.

Dr. M: Not to mention they have to make their move wearing 50 pounds of gear! How do they make ANY saves?

Dr. S: It is amazing. The best goalies are successful 92% of the time. That’s one reason why hockey players fight so hard for the puck. The offense knows they are going to need MANY shots on goal to score.

Dr. M: What is the most important visual skill for hockey goalies?

Dr. S: Visual motor reaction time; this refers to the amount of time that elapses between the initiation of a visual stimulus (such as a light going on) and the completion of the motor response to that stimulus (such as hitting the light with your hand). Athletes with faster response times to very simple visual-motor tasks will be at an advantage when they are asked to react to very complex tasks such as making a save.

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Sports Vision: An Interview with Dr. Arnold Sherman

Dr. Arnold Sherman is a Fellow of COVD and a Diplomate of the American Academy of Optometry. He has served as a consultant to the NY Jets, the NY Rangers, and the US Olympic Committee. He has worked with athletes of all ages, from little leaguers through the professionals. He maintains a private practice in Merrick NY and is a member of the clinical faculty at SUNY Optometry.

Part 1 — Baseball

Dr. M: Thanks for sitting down with me to answer my questions about vision and sports. Sitting here in Bryant Park, I can feel spring! That means baseball, lacrosse, and tennis! And of course your favorite, hockey playoffs are starting. Let’s talk about elite athletes first. How would you describe the visual requirements to succeed in these sports?

Dr. S: All these sports are different and they all require different visual skills. But let’s look at what they have in common first. Baseball, hockey, lacrosse, and tennis all require the athlete to respond to a moving target. Vision is the signal that directs the muscles of the body; the eyes LEAD the body. Vision utilizes the eyes for input, the brain for integrating information from the other senses, and the action system of the body for output.

Dr. M: Can we get specific? How does that apply to these sports?

Dr. S: Let’s start with baseball. Vision provides the batter with information as to “WHERE” and “WHEN.” Where is the ball going to be and when do I swing? A fastball traveling at 90 mph reaches the bat in 400 milliseconds—less than a half second! It takes 150 milliseconds to initiate the swing and make contact with the ball. Therefore, the hitter has at most 250 milliseconds to decide whether or not to swing. Vision has to be razor sharp. Superior size, strength bat speed and agility cannot make up for inefficient processing of “where” and “when” to respond.

Dr. M: Even the most successful major league hitters are only successful about 35% of the time. Can improvements in vision have big impact?

Dr. S: In baseball and other sports, most performances that fail are not due to the wrong physical movement but the movement being performed at the incorrect time or in the incorrect place. In baseball, fine tuning the visual time machine can result in raising a batting average to the next level. Joe Mauer (catcher for the Minnesota Twins) is a perfect example. He never swings at the first pitch. He’s not afraid to stand at the plate with 2 strikes because he has gathered visual information from seeing several pitches and that helps him get to the right place at the right time when the right pitch is delivered.

Dr. M: What is the most important visual skill for baseball players?

Dr. S: One of the most important skills is binocularity. You need both eyes following the ball in order to make accurate judgements about “when” and “where.” You need to turn your head toward the pitcher enough to get both eyes working together. Once you have your head posture figured out, you may need to make adjustments to the rest of your body, because, remember, the EYES LEAD THE BODY.

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Vision is Learned

Have you heard the name Steve Holcomb over the last few days?  Holcomb piloted a 4-man bobsled to Olympic gold, the first American to do so since the 1948 Winter Games.  Like many Olymic athletes, Holcomb’s backstory is one of perseverance.   He suffers from keratoconus, a degenerative eye disease.  This disease causes bulging of the cornea into a cone shape.  As his corneas’ curvature became steeper and steeper, it became more and more difficult to correct his vision with glasses and contact lenses.  Holcomb learned to rely on proprioception to “feel” his way instead of “seeing” his way down the track.  Holcomb’s vision deteriorated to the point where he was forced to consider retiring from the sport.  This is a sport where little mistakes cause you to lose time, but big mistakes could cause you to lose your life.  “Feeling” your way was just becoming too risky.  Then somebody told him about a new surgical procedure that involves implanting a contact lens inside the eye.  Holcomb’s surgery was very successful and his vision was restored beyond expectations.  In fact, he found his vision was “too good.”  All the visual information he was receiving made it difficult for him to use proprioceptive information, and his performance began to decline.  Holcomb finally reduced the amount of visual information his brain was processing by scratching up the visor on his helmet! This helped him find the right balance of “seeing” and “feeling” to pilot his bobsled down the track at 90 miles per hour! I think this is a great example of how vision is learned.  You may have 20/20 vision but unless you have learned how to use all of your visual skills in an integrated way, you may not win a medal, or finish your schoolwork, or score a goal.  I’ll bet that Holcomb will learn how to process more visual information effectively and integrate his visual system with his other senses so that he doesn’t have to scratch up his visor.  Look for his bobsled in 2014!

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