O.D. Scene

THE ENTERTAINING SIDE OF OPTOMETRY

O.D. Scene creator, writer and editor Jack Schaeffer, O.D.

The bodies of elite athletes are the result of years of training, practice and sacrifice, but what of their vision?

This month, I speak with members of optometry’s sports vision community. These individuals and their sports vision colleagues are elevating athletes’ performance through training techniques and, most recently, mild traumatic brain injury identification and treatment. In fact, sports-related concussions have garnered more coverage than Cleveland Browns’ cornerback Joe Haden. (See “The How and Why of mTBI” at www.optometricmanagement.com/articleviewer.aspx?articleID=107458.) One optometrist, in particular, discusses how he’s using a sideline test, initially developed for identifying learning disabilities, to determine whether an athlete has had their bell rung and should, therefore, leave the playing field.

Our role as optometrists in regard to athletic performance and safety has come a long way, thanks to optometric sports vision specialists. No doubt, our future involvement will strengthen as more connections are established between vision and sports.

Key Opinion Leaders Weigh in…

Graham B. Erickson, O.D., David G. Kirschen, O.D., Ph.D., and Donald S. Teig, O.D.

Q: Can you describe your practice?

GE: I teach full time at Pacific University College of Optometry, so most of my clinical practice is conducted with our interns and residents. I supervise in our Forest Grove Vision Therapy and pediatrics clinic, where I also schedule some athletes. In addition, I see athletes in our Beaverton clinic site, and I go on location for certain teams.

DK: I have been a solo private practitioner at the same location in Orange County, Calif. since 1982. I specialize in pediatric eye care, strabismus, amblyopia, diplopia and sports vision.

DT: I just retired from my practice in Ridgefield, Conn. after 40 years to move to Hollywood, Fla., where I am a high-performance vision trainer at a multidisciplinary fitness-training center.

Dr. Kirschen and wife, Alyse, vacationing in Iguazu Falls in Argentina.

Q: How do you define sports vision?

GE: [I define it as] vision care and consultation designed to protect, correct and enhance vision to make sports and athletic competition safe, enjoyable and more successful.

DK: It is a discipline within optometry that caters to the visual needs of athletes of all ages and abilities. It requires the practitioner to approach the exam differently: They must have knowledge of the visual demands of the sport their patient plays and make sure those visual demands are met. We don’t stop at 20/20 vision. We make sure our patients’ monocular and binocular vision is optimized.

The Erickson family on a water taxi in Dubai Harbor.

DT: It is a specialty niche that addresses all the unique visual demands of the athlete patient. Sports vision should be all encompassing, involving specialized testing, training, contact lens fitting, protective eyewear, visualization and positive imagery training, sports eye injury care and first aid. In fact, to truly practice sports vision, in my opinion, you must be able to deal with all and any visual requirements that confront an athlete from soup to nuts.

Q: How did you become interested in sports vision?

GE: My initial “specialty” interest in optometry was working with children and adults who had vision disorders affecting visual performance. Working with athletes provides an opportunity to combine my passion for sports with the challenge of maximizing human visual performance.

DK: In 1992 I asked a team physician, “Do you think there is anything special about the vision of elite athletes?” He replied, “I don’t know. Why don’t we test it and see.” So spring training that year we began testing the visual performance of elite athletes and have continued to this day.

DT: I was always a sports fanatic. When I majored in Psychology at the University of Buffalo, I developed a keen interest in a course called Perception. I learned that we all perceive differently. This fact applies to athletes, as they strive for excellence in sports. In 1980, I developed a friendship with Fran Healy, the back-up catcher to Thurman Munson on the New York Yankees. I was afforded the opportunity to evaluate the vision skills of seven Major League Baseball teams in 1980, and, as the saying goes, the rest is history.

Q: What do you think is the biggest misconception the average O.D. has about sports vision?

GE: That visual acuity and contrast sensitivity cannot be improved beyond what refractive compensation provides.

DK: That sports vision is associated with vision training when, in fact, most aspects of sports vision can be accomplished in the exam room with equipment the O.D. already owns: A careful refraction using a phoropter, a trial frame and a well-calibrated projector is critical to optimum sports performance. Also, a slit lamp to carefully evaluate the orientation of toric lenses is essential for optimum visual acuity.

DT: The average O.D. looks at sports vision as nothing more than a glorified extension of vision therapy (VT). In addition, most feel they can’t make a living from it. The reality is that, although some VT techniques play a role in this specialty, the technology and training procedures that make this niche unique go way beyond the basics of VT. Also, I have proven through my 40-year career that sports vision services are quite lucrative.

Dr. Teig with his band, the Retrotones, during a performance.

Dr. Erickson on top of Mt. Jefferson.

Q: How do you see sports vision evolving?

GE: I see O.D.s partnering with sports training facilities in their communities to provide visual performance training opportunities for athletes. The optometrists would provide primary eyecare services to the athletes in the O.D. practice, and certified trainers would incorporate visual performance training into the overall sports-training program at the sports-training facility.

DK: I see a bright future. I think many O.D.s will gradually understand the field of sports vision and realize how much they can help their patients and how that will help their practice grow. Many O.D.s are looking for profit centers in their offices outside of insurance. Sports vision is one of those areas.

DT: Although it’s unlikely that sports vision will become part of all eyecare practices, I believe the future is bright, as more athletes, coaches and athletic trainers recognize this as a component that can provide a competitive edge.

Q: What sports do you play, and what is the highest level of competitive sports you played?

Dr. Kirschen, wife, Alyse, and son, Matthew, in Antarctica.

GE: In high school and college, I was a distance runner, particularly cross-country, and I’ve competed on tennis teams. Currently, I try to run a marathon every year or so, and I cherish my long forest runs on the weekend.

DK: I was a competitive tennis player in high school and college. I played for UCLA a year when they won the national championship.

DT: Basketball, softball, tennis and golf have dominated my athletic career. Having played basketball in high school, as well as briefly in college, I have stayed with hoops well into my sixties.

Q: What is the best sports event you’ve attended?

GE: This may be a strange response, but I cannot recall being more intensely engaged in an athletic event than when watching my children compete.

DK: I was fortunate to work with Team USA, as they prepared for the Beijing Olympics, and I went with them to Beijing, China.

DT: The seventh game of the 1994 Stanley Cup finals pitting the New York Rangers against the Vancouver Canucks. I watched the New York Rangers defeat Vancouver from the owner’s suite with the team president. I got to celebrate with the team, as they skated around with the cup.

Q: Who are the members of your family, and what do you like to do for fun?

GE: My wife, Dina, is an optometrist and teaches with me at Pacific University. I have a son, Alexander (age 14) and a daughter Maya (age 12), whose activities in sports, music, academics and theater occupy my free time. For fun, I love music, literature, sport and the great outdoors. Other than running, I love mountaineering, skiing and hiking.

DK: My wife Alyse, who is a psychologist, and I love to travel: Adventure trips like the Galapagos Islands, African Safari, Antarctica and any place we can learn about other cultures. My oldest son, Matthew, is an MD, Ph.D. pediatric neurologist at CHOP in Philadelphia (He got his brains from his mom). My daughter, Shayna, is a pharmaceutical rep, and my youngest son Todd, is a biomedical engineer. Also, I have five grandchildren — all under age 5. I like outdoor activities, like hiking and photography.

Dr. Teig and former NY Yankees manager Joe Torre.

DT: My wife, Joyce, is a former elementary school teacher, and school and office administrator. My son, Jason, is a graphic designer in the film industry. My daughter, Lori, is the senior VP for VEVO. For fun, I work out, play golf, sing and practice my guitar. Also, I am writing a soon-to-be published book called High Performance Vision - An Athlete’s Guide To Keeping Your Eyes On The Ball (Square One Publishing), and I’m working on a Broadway musical about how early rock ‘n roll music changed our world, as seen through the eyes of Lloyd Price. It will be called Lawdy Miss Clawdy.

Q: If you could have dinner with anyone living or dead, who would it be and why?

GE: My best companion for a dinner in the wilderness would be environmentalist Edward Abbey. The best dinner/drink companion for me in the city would be The Clash’s Joe Strummer.

The Kirschen crew in Hawaii.

DK: Steve Jobs, to learn more about what drove his entrepreneurial spirit.

DT: Mickey Mantle. He was my boyhood idol. As a kid, I tried to emulate his majestic upper cut swing and his unique running style.

Q: What is your favorite book, band and adult beverage of choice?

GE: Book: The Fool’s Progress: An Honest Novel (Holt Paperbacks, 1998); Band: So many talented musicians give me something to love in almost every genre; Adult beverage of choice: Pacific Northwest Microbrew.

DK: Book: Steve Jobs (Simon & Schuster; 2011); Band: Klezmer and country music; Adult beverage of choice: Coke Zero with lemon.

DT: Book: The Haj (Bantam, 1985); Band: the Eagles; Adult Beverage of Choice: vodka gimlet.

Dr. Teig with Joyce, Lori and Jason.

Special Industry Interview

Steven Devick, O.D., King-Devick Test

Q: Can you describe your background?

SD: I stopped practicing in the early 1990s and have since been involved in taking six companies from start-ups to initial public offerings. Now, I’m principally involved in the business of the King-Devick Test.

Q: Can you explain the King-Devick (K-D) Test?

SD: It’s an objective, physical test that assesses functions, such as saccadic performance, related to rapid number naming. My friend and colleague Al King, O.D., and I developed it in 1976 as a senior research study at the Illinois College of Optometry. Specifically, the K-D test is comprised of a series of cards that contain numbers on them, and spacing between the numbers varies through the progression of the cards. Recording error-free speed in reading the cards determines the subject’s baseline. The test can be given in two minutes or less on a digital tablet or with a physical K-D Test. Following suspected head trauma, the time it takes to perform the test is slower than the baseline, if the subject has a concussion.

Dr. Devick goofing around with “The People’s Champion” Muhammad Ali.

Q: What has the test been used for?

SD: The K-D test has been validated as an effective and accurate sideline screening test for concussions, however, it was initially developed to help identify learning disabilities, such as dyslexia. Peer-reviewed published studies have also shown it is accurate in identifying hypoxia, as a quality-of-life measure in Parkinson’s Disease and MS patients and in measuring functionality in extreme sleep deprivation patients.

Q: How did the K-D test come to be used as a sideline screening for concussions?

SD: After reading about the link between saccadic eye movement and concussion, I surmised that the test would be able to indicate concussions on the sidelines. I took it to leading neurologists, and they determined I was correct. Now, it is widely utilized in schools and league sports with athletes ranging from adolescents to professionals. The amazing thing about the wide spread use of this test is that we have spent very little as a company on marketing it. In the last two years, more than 30 studies in peer-reviewed neurological journals have been published on its effectiveness, and the press has really come to us.

Q: What are your thoughts on the $750 million settlement by the NFL to the NFL Players Association regarding concussions?

SD: I don’t think the settlement will compensate for the long-term damage some players will have. This includes neurological disorders, such as chronic traumatic encephalopathy, Parkinson’s disease and amyotrophic lateral sclerosis.

Q: What’s your opinion on children playing football, considering the concussion risk?

SD: I think that tackle football should not be encouraged before high school. Young brains aren’t completely myelinated yet, and kids have disproportionately large heads relative to their body size along with small, weak necks. This creates a “bobble head” effect, which leads to excessive head movement, especially when wearing a helmet (which adds to the weight of the head).

Q: What is the future of the K-D Test Company?

SD: The test will be a widely used tool. For instance, the U.S. Military currently uses it. I believe that, eventually, many consumers will have it in their homes to screen for head injuries. For instance, if a parent knows their child’s K-D baseline and the child hits their head falling off their bike (the most common cause of concussions), it might save them a trip to the ER and an unnecessary MRI or CT scan.

Q: Why should an O.D. get involved with concussion diagnosis and treatment?

SD: O.D.s are equipped to manage concussions, and they should. If the OD has the subject’s K-D baseline on file, it can be used to monitor concussions. Concussion remediation through ocular motor integration with vestibular training is the latest science for symptoms lasting more than two weeks. Since K-D baselines change every year, having kids, even if they don’t need glasses, come in for annual exams is important.