Charles Shidlofsky, OD, FCOVD
I recently worked with two professional hockey players on a team for which I provide sports vision care.
One of the players is still struggling with post-concussion syndrome 2 years after a sport-related concussion, because his oculomotor problems were never treated. The second player was injured in the current season. I was able to work with him immediately after the injury, and he is now back to full visual performance — in fact, he has exceeded his pre-season baseline thanks to vision rehabilitation.
These cases illustrate how important it is for sports vision doctors to be aware of and involved in concussion management for their athletes. Many of those who are active in sports vision came to the specialty through a love of sports. Traditionally, sports vision doctors have focused on optimal vision correction, eye protection and visual skill enhancement to help healthy individuals reach the next level in sport by improving their visual performance.
But as doctors who are already embedded with teams, we should also be leveraging our skills and knowledge to help athletes who have suffered a concussion and are performing below normal. Here are three ways to up your game:
Do pre-season screenings. Depending on the level of sport and the time allotted, this could be as simple as a King-Devick test or as complex as a full hour exam that includes sensory training evaluations. With professional athletes, I typically get about 15 minutes per athlete, which is enough time to take an ocular health and concussion history and perform autorefraction, quick visual acuity and ocular health exam, an automated eye tracking test and a King-Devick test. Not only does this serve as a basis for identifying players who can benefit from a change in vision correction or need to work on improving reaction time, but it also establishes a baseline so that we can evaluate deficits and progress with treatment if the player sustains a concussion.
Use what you know. The same tools and activities that sports vision specialists use to enhance visual performance can also be used to rehabilitate visual performance. For example, visual spatial activities that we would normally “load up” to make them more challenging for an elite athlete can be “unloaded” for an injured athlete until they return to baseline.
Forge interdisciplinary relationships. Many teams default to MD-based neurological care when an elite player has a concussion. There’s nothing wrong with that — as long as they realize that concussion management really demands a team approach. Be sure to educate coaches, athletic trainers and other team doctors about the role of vision and oculomotor dysfunction in post-concussion syndrome and recovery.
This doesn’t mean that every sports vision doctor needs to become a vision rehabilitation specialist. Some may prefer to co-treat or refer to others with a stronger interest in rehabilitation. But using your voice to advocate for and support good post-concussion vision care for injured athletes is essential.
For more information:
Charles Shidlofsky, OD, FCOVD, is clinical director of Neuro-Vision Associates of North Texas, a specialty clinic serving children and adults with neurological vision issues. He is a member of the medical staff at Baylor Scott and White Institute for Rehabilitation-Frisco in Dallas and Ft. Worth, Texas.
Shidlofsky serves as a consultant for several Texas-based rehabilitation centers, including the Centre for Neuro Skills and Pate Rehabilitation, and as residency director for a private practice residency in vision rehabilitation through Southern College of Optometry. He is the team vision consultant for the Dallas Stars (NHL), Allen Americans (ECHL) and FC Dallas (MSL). In addition, he is vice president of both the Neuro-Optometric Rehabilitation Association (NORA) and the International Sports Vision Association (ISVA).
