INVITED REVIEW

Review: Visual Performance Assessments for Sport

Graham B. Erickson, OD, FAAO1*
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SIGNIFICANCE: Eye care professionals seek to provide effective vision care for a variety of patient needs, including
performance in sports and recreational pursuits. This review provides an analysis of common visual performance
assessments, including summaries of recent clinical research from a diverse array of professional literature.
Vision is recognized as an important element of sports performance. Elite athletes frequently demonstrate excep-
tional abilities to see and respond effectively in sports competition. Which visual factors are important and how to
most effectively assess visual performance are the sources of much debate. This topical review presents an
evidence-based review of the common visual performance factors assessed in athletes, beginning with guidance
for conducting a visual task analysis for the variety of sports that athlete patients may compete in. An information
processing model is used to provide a framework for understanding the contributions of the many visual perfor-
mance factors used during sports.

Author Affiliations:
Optom Vis Sci 2021;98:672–680. doi:10.1097/OPX.0000000000001731 1
Pacific University College of Optometry,
Copyright © 2021 American Academy of Optometry Forest Grove, Oregon
*[email protected]

Success in sports often requires the athlete to optimize the uti- peripheral visual attention demands.1 These subcategories can be
lization of many physical and sensory abilities. The competitive used to develop a profile of the salient features involved in a sport
sports community exhaustively explores methods to evaluate and and can provide direction for developing an effective visual perfor-
enhance important skills that can potentially improve performance. mance evaluation for individual athletes and specific sports.
To unravel the perceptually demanding aspects of sports, it is ben- Eye care professionals develop a depth of knowledge for a sport
eficial to analyze the visual and visual-motor factors that are impor- activity in a variety of ways, which can provide a foundation for de-
tant to each sport (and position within some sports). Once the livering effective vision care for the athlete. Personal participation
practitioner has identified the vision factors considered essential in the sport activity may provide intimate insights into the visual
to performance of the visual tasks critical for success in a sport, task demands experienced by the athlete. Many vital insights into
an evaluation should be created to measure the quality of those the visual task demands of a sport activity can also be attained
skills in the most appropriate, accurate, and repeatable manner. through interaction with the athlete or other experts (e.g., coach
The visual skills that correlate with successful sports performance and sports trainer) in the sport. In addition, the American Optomet-
have not been definitively identified yet, so the practitioner must ric Association Sports and Performance Vision Web site offers a col-
rely on the available literature and professional judgment to deter- lection of detailed insights into the important visual factors across a
mine the most appropriate evaluation for each athlete. This review variety of sports in the form of webinars, downloadable documents,
provides an evidence-based description of common vision-based and guidebooks.2 The sport-specific guidebooks were compiled
assessments and the potential sport applications. with input from experienced optometric practitioners and are avail-
able with membership in the American Optometric Association.
Additional information regarding the myriad of sports and recrea-
tional activities is readily available on the Internet or through the
VISUAL TASK ANALYSIS many existing sports periodicals and books.
A framework for conducting a visual task analysis for the wide
variety of sports and recreational pursuits can be provided by task
subcategories. Examples of task subcategories include static or INFORMATION PROCESSING MODEL FOR
moving target discrimination, stationary or dynamic movement by SPORTS PERFORMANCE
the athlete, target size, distance of targets, importance of contrast
judgments, demands on figure/ground judgments, length of time Sports performance typically requires the athlete to process visual
required for visual task performance, depth discrimination and spa- information and accomplish an appropriate motor response. Informa-
tial localization, important gaze angles, relevance of competition tion processing models have been proposed to understand the nature
boundaries, eye-hand/eye-foot reaction speed, body position and of the processes occurring in skilled motor performance. A traditional
balance, cognitive versus cardiovascular stress, and central versus information processing model of skilled motor performance first

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 Visual Performance Assessments for Sport — Erickson

proposed by Welford3 and later modified by others4–9 is presented provide additional processing of the signals: a dorsal pathway that
in Fig. 1 as a practical approach for understanding the relevant as- provides information about spatial properties (called the where
pects of sports performance. pathway) and a ventral pathway through the inferior temporal cor-
The model first proposed by Welford suggests that skilled motor tex that provides further information about object details and iden-
performance is the result of three central processing mechanisms: tification. These two neural streams converge in areas of the
the perceptual mechanism, the decision mechanism, and the ef- prefrontal cortex and posterior parietal cortex providing significant
fector mechanism. Although these three mechanisms seem to op- information to assist with decision making. This traditional,
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erate sequentially, further elaboration considers the modifying bottom-up sequential processing model has been modified to sug-
effects of both intrinsic and extrinsic feedback as well as the con- gest a more dynamic model that also demonstrates top-down pro-
tributions of experiential memory. This process is also referred to cessing. In these models of neural processing, prior experience
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as the perception-action cycle, with visuomotor integration guiding and attentional focus direct a process of “perceptual binding” that
the process in this discussion.10–12 selectively processes critically relevant visual information.15–18
The perceptual mechanism receives a tremendous amount of Perceptual binding guides visual processing of important details
sensory information from an extensive variety of receptors (e.g., vi- to overcome the neural limitations of processing all the incoming
sion, vestibular, tactile, and auditory). Sensory channel mecha- visual information and thereby improves efficiency and shortens re-
nisms have a limited capacity to thoroughly process the vast action time to visual signals. The prefrontal cortex and posterior pa-
amount of information simultaneously, thus requiring that the most rietal cortex seem to direct this process by development of
relevant information be selected for processing to execute the es- predictive models and stimulus-response mapping to rapidly iden-
sential task. Irrelevant sensory information must also be filtered tify critical visual information. For disruptive visual information
out by similar neurologic mechanisms. The athlete's experience (e.g., the appearance of an immediate threat), the process is pri-
and ability to control attention are suggested to guide this selection marily bottom-up, whereas goal-directed attention (e.g., looking
and filtering process.3,13 For example, attentional focus and dis- for specific details such as the release of a pitch in batting) is
traction can produce different size estimates, accuracy, and put- top-down and directed by the prefrontal cortex and posterior parie-
ting errors in golf.14 The perceptual mechanism seems to be tal cortex. A study comparing team handball athletes with athletes
responsible for organizing and interpreting the relevant sensory in- in nonteam sports and nonathletes found that sports expertise did
formation in a manner that facilitates optimal performance. not produce differences in basic attention tasks (attentional
Traditionally, the perceptual mechanism for visual information breadth, tracking performance, and inattentional blindness), sug-
is conceptualized as a bottom-up process with a neural chain of vi- gesting that any differences in attention skills may be task spe-
sual signals from the retina traveling through the lateral geniculate cific.19 Studies of gaze behaviors and visual search patterns
nucleus to the primary visual cortex. From these basic responses, during skilled sports performance by elite athletes compared with
the neural signal is then fed forward through increasing complex vi- near-elite athletes show that fixations are typically clustered on fea-
sual processing regions that are tuned to respond to specific prop- tures that provide a significant amount of information about the
erties. The visual signals then diverge into two neural streams that task being viewed.20 More thorough reviews of the role of visual

FIGURE 1. Information processing model for motor performance. A modified information processing model of skilled motor performance first proposed
by Welford.3

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 Visual Performance Assessments for Sport — Erickson

attention in the perception-action cycle and its application in Many of the visual demands in sports require discrimination of
sports are available.21,22 information that is moving, such as judging the speed and trajec-
The sensory information that has been processed is communi- tory of a lacrosse ball. Dynamic visual acuity refers to the ability
cated to the decision mechanism to determine the appropriate mo- to resolve detail when relative movement exists between the ob-
tor response strategies. The decision mechanism may also repress server and the test object. Many variables in the stimulus parame-
a motor response in some sport situations, because there are times ters can affect dynamic visual acuity, including target luminance,
in sport when not reacting is the better response. The athlete's angular velocity, and the time exposure of the target. Human attri-
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sport knowledge and experience exert substantial influence on butes that can affect dynamic visual acuity include the resolving
the effectiveness of decision processing. power of the eye, peripheral awareness, oculomotor abilities,
The preferred motor response is transmitted by the decision vestibulo-ocular performance, and psychological functions that af-
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mechanism to the effector mechanism. The effector mechanism fect the interpretation of visual information. Studies have found
organizes, initiates, and controls the neural commands generated that football (soccer) goalkeepers have significantly better dynamic
by the appropriate brain centers for performance of the chosen re- visual acuity than do forwards35 and that dynamic visual acuity (Tar-
sponse at the ideal time. Internal and external sensory information get Capture on the Nike and Senaptec Sensory Stations [Beaverton,
is continually processed by the perceptual and decision mecha- OR]) is associated with lower strikeout rates in professional base-
nisms to allow for control and adjustment of the motor response ball.36 A study with professional baseball players in Japan did not
when sufficient time exists to modify the response. find differences in dynamic visual acuity by competitive level but
This model provides a useful framework for understanding the did find a significant difference when measuring kinetic visual acuity
visually guided processes occurring when an athlete must react (measurement using an object moving from a distant point toward
and respond in a sport situation. The model also provides a method the subject).39 The use of kinetic visual acuity has shown that ath-
to categorize common assessment areas (Table 1), and using a task letes in interceptive sports have better dynamic visual acuity in the
analysis approach, the relative value of each assessment area in an dominant eye compared with nonathletes.30
evaluation can be appraised. Contrast sensitivity includes many aspects of visual perfor-
mance and can involve measures of the visual system's ability to
process spatial or temporal information about objects and their
PERCEPTUAL MECHANISM ASSESSMENTS backgrounds under varying lighting conditions. These measures
typically require resolution of the light-dark transition of a stimulus
Static visual acuity is commonly measured at far (6 m) or simu- border or edge. Measurement of contrast sensitivity function has
lated distance viewing and is a universal part of the vision evalua- been recommended in athletes because many sports involve visual
tion of athletes. The measurement of static visual acuity is an discrimination tasks in suboptimal lighting owing to environmental
essential element of any vision evaluation because degraded visual variability, and athletes must make judgments about objects that
acuity can have a detrimental effect on many other aspects of vi- are in motion. The general results from studies comparing athlete
sual performance. Reduced visual acuity has been shown to affect populations demonstrate elevated contrast sensitivity function
dynamic visual acuity,23 depth perception,24,25 and accommoda- across all spatial frequencies for athletes, and a study of Olympic
tive accuracy.26 Some recent studies have found better static vi- athletes in a variety of sports demonstrated some differences by
sual acuity in athletes than in nonathletes,27–34 and some have sport.31 Specifically, softball athletes performed significantly better
found no difference.35–37 The expected level of visual acuity most than did track-and-field athletes on both Landolt ring and grating
likely depends on the visual task demands of each sport situation, acuity at 18 cycles per degree.31 Interestingly, reducing contrast
as studies of different athlete populations have found differing vi- sensitivity seemed to affect rifle shooting performance more than re-
sual acuity results. For example, the average visual acuity of profes- ducing visual acuity in a study to determine the minimum impair-
sional baseball players has been found to be significantly better ment criteria for vision-impaired shooting.40 Contrast sensitivity
than the general population average,27,38 whereas this has not con- also may be degraded in contact lens wearers if the lenses are not op-
sistently been found in soccer.28,34,35 timal, even when visual acuity seems acceptable.41–44 Therefore,

TABLE 1. Examples of common visual performance assessments sorted by potential application to the three main mechanisms described in the Welford
information processing model for skilled motor performance
Perceptual mechanism Decision mechanism Effector mechanism
Static visual acuity Information processing speed Visual-motor reaction time
Dynamic visual acuity Multiple-object tracking Peripheral eye-hand response
Contrast sensitivity Mental imagery Go/no-go
Refractive status Vision and balance
Stereopsis Coincidence-anticipation timing
Vergence and accommodation facility
Oculomotor function
Gaze performance
Peripheral vision

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 Visual Performance Assessments for Sport — Erickson

contrast sensitivity measurement is an essential part of the evalua- accommodative facility in athletes: the use of prisms or lenses to
tion of athletes who wear contact lenses during sports participation. alter the demands at a fixed distance and the use of charts at two
Assessment of refractive status is an essential element of the vi- different distances, with fixation being rapidly alternated between
sual evaluation of the athlete. Only a few reports in the literature the two charts. Christenson and Winkelstein52 found athletes per-
concern the percentage of athletes who use vision correction (spec- formed better on a vergence facility test using 8Δ base out and 4Δ
tacles or contact lenses).29,35,37,45,46 Studies of athletes partici- base in at 6 m than did nonathletes, and Omar et al.37 also found
pating in the Amateur Athletic Union Junior Olympic Games better performance using 12Δ base out and 3Δ base in. However,
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found that approximately 20 to 35% of athletes had refractive error Hughes et al.53 did not find significant differences among elite, inter-
greater than ±0.75 D.29,45 A similar study of teenaged athletes mediate, and novice table tennis competitors using 10Δ base out and
found a similar range and mean refractive error to those found in 4Δ base in. Most athletes need to look between far, intermediate, and
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age-matched nonathletes.37 A study of professional football (soc- near distances quickly, requiring rapid accommodative-vergence
cer) players found that approximately 16% were myopic and responses. When a prism is introduced, the vergence system must
20% were hyperopic, whereas only 25% used vision correction.37 adjust ocular alignment to regain image fusion; however, the ac-
Interestingly, a study of professional baseball players found a high commodative system must remain focused close to the plane of
rate of small myopic refractive errors.46 The incidence of refractive the target for image clarity. Similarly, when a lens is introduced,
error (myopia, hyperopia, and astigmatism) found in these studies the accommodative system must adjust ciliary muscle tonus to re-
is similar to that found in the general population, dispelling the per- gain image clarity; however, the vergence system must remain
ception that athletes have a lower incidence of refractive error. aligned with the plane of the target to prevent diplopia. This sepa-
The precise alignment of the two eyes, triggered by retinal im- ration of accommodation and vergence is a standard method to as-
age disparity, is responsible for providing a significant amount of sess relative accommodative or vergence facility at near in patients
information regarding object location.47 The amount of innervation with asthenopia during near work, but it is generally not a factor in
exerted by each of the six extraocular muscles in each eye to align the visual task demands of sports. Therefore, use of a near-to-far al-
on a target or object provides some of the information necessary to ternating fixation procedure may provide a better simulation of
judge depth and is logically a critical feature of sports performance real-world accommodative-vergence facility demands. Studies that
when precise depth judgments are necessary for success. Athletes used lenses (at near and far distances) to assess accommodative
are commonly found to have good ocular alignment, especially facility in athletes found no significant difference in performance
when viewing at a far distance.30 A study of Olympic athletes found compared with nonathletes,37 but performance was found to be
that competitors in fencing, softball, soccer, and speed skating ex- better in intermediate and advanced volleyball players compared
hibited better contour and random dot stereopsis at 20 ft compared with beginners and nonplayers.54 The Haynes distance rock test
with those in track-and-field and archery.31 In contrast, a study of was used to provide normative data for a population of elite athletes
collegiate baseball players found no correlation between distance and therefore did not compare performance with that of nonath-
stereopsis and any pitching or batting statistics.48 Similarly, there letes.55 A study of athletes in interceptive sports found slightly bet-
were no correlations found between stereopsis and batting statis- ter performance on a near-far accommodative facility test in the
tics in youth baseball players or when comparing athletes in athletes.30 Near-far quickness on the Nike and Senaptec Sensory
interceptive sports with nonathletes, although the stereopsis test- Stations has been associated with better ability at avoiding strike-
ing was performed at 40 cm rather than at a far distance in these outs in professional baseball.56
studies.30,49 Studies conducting stereopsis testing at 40 cm have The ability to maintain fixation of a rapidly moving object, as
found better stereopsis in youth and professional baseball/softball well as to change fixation from one location to another rapidly
players compared with nonballplayers and in elite cricket players and accurately, may be an important oculomotor function for
compared with near-elite or general population data.36,50,51 The allowing for visual processing of crucial information in sports. In
differences in study findings may be the result of the variety of test- nondynamic sports such as precision target shooting, the ability
ing distances and procedures used. to maintain steady fixation is a vital aspect of successful perfor-
An assessment of vergence subsystem function is frequently mance.57 Assessment of oculomotor function can include evalua-
recommended for athletes. The underlying premise is that strength tion of pursuit eye movements, saccadic eye movements, and
and flexibility in vergence function provide better stability of visual steadiness of fixation. A study of racquet-sport athletes found
information to the athlete, particularly when the athlete must deal quicker saccadic responses to positive positional errors compared
with excessive fatigue and psychological stress. Similarly, an as- with nonathletes.58 Elite shooters have shorter saccadic latencies
sessment of accommodation subsystem function is frequently rec- on both simple reaction to a sudden target appearance and dis-
ommended for athletes. A correlation between stability of vergence crimination between targets and distractors,57,59 and shorter laten-
information, rapid focusing, and spatial judgment consistency typ- cies for the first saccade were found to distinguish good from poor
ically required in rapid-action sports has been assumed. Omar cricket batsmen.60 Further study found elite cricket batsmen used
et al.37 found better vergence break values in teenaged nonathletes two predictive saccades to anticipate a pitch: one to the location of
compared with athletes for both base-in and base-out ranges at the ball bounce and then to the location of the bat-ball contact
6 m, but only significantly better on recovery values in the point.61 These predictive saccades were coupled with head move-
base-in direction. The measurement of vergence ranges at 6 m ments to help maintain pursuit eye movement of the ball. Studies
may only be valuable as an assessment of motor compensation with college and professional baseball players found similar head
ability when an athlete has a large heterophoria at 6 m. An evalua- tracking of pitches from a ball machine or live pitcher that assists
tion of vergence and/or accommodative facility has been recom- the maintenance of gaze position close to the ball.62–65 A study
mended because the visual demands of many sports involve the comparing saccade speeds into cardinal gaze positions using
ability to adjust accommodative and vergence posture rapidly. RightEye (RightEye LLC, Bethesda, MD) measurements found
Two methods have been used to measure vergence and the professional baseball players had significantly faster speeds

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 Visual Performance Assessments for Sport — Erickson

in several directions when compared with amateur prospects and

nonathletes.66 Similar differences in head movement have been DECISION MECHANISM ASSESSMENTS
noted with tennis strokes between experienced and inexperienced
players.67 Positive positional errors are created by displacing the The ability to process visual information rapidly has been con-
saccadic target in the same direction as the saccadic movement sidered an essential element for success in fast-action sports. Ath-
after initiation of the saccade. These results open questions of letes must analyze available temporal and spatial information
innate skill versus motor learning through experience and the during sports situations relatively quickly to make accurate deci-
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modulation of attention with eye movement performance. Inter- sions concerning performance responses. The processing speed
estingly, in a study comparing experts in ball sports with con- can be measured psychophysically and has been referred to as in-
trols, athletes did not show shorter latencies in the prosaccade spection time. Most studies have found that experienced athletes
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condition (eye movements toward a suddenly appearing stimulus), can evaluate information more rapidly compared with inexperi-
whereas antisaccades (eye movements away from a suddenly enced observers.32,56,86,87 An in-depth analysis of 252 profes-
appearing stimulus) showed significantly shorter latencies.68 Sac- sional baseball players using a series of Bayesian hierarchical
cade accuracy has been found to be better in fencers and tennis latent variable models found that the perception span assessment
players compared with other athletes and nonathletes.69 Pursuit on the Nike Sensory Station had strong associations with on-base
eye movements have been shown to correlate with expertise in percentage and strikeout rate.56 The frequent use of numerical
gymnasts of different levels and better performance compared with stimuli may be a confounding factor in the assessment of speed
nonathletes.70 Accuracy of smooth pursuit eye movements has of recognition in athletes; use of target parameters that more
also been correlated with better batting performance in profes- closely simulate the visual information processed in sport situa-
sional baseball.71 tions may yield better discrimination of inspection time abilities
The gaze patterns of expert athletes during specific sport situa- that correlate with sports performance. For example, the projection
tions have become a valuable area of study. This area of assess- of photographs of baseball pitchers shown at the moment of ball re-
ment has been largely absent from clinical practice because lease may better assess how rapidly a baseball player can identify
these systems are generally prohibitively expensive; however, the the type of pitch being thrown.87 A study using a metric combining
development of lightweight portable eye tracking technology has variables of target size, contrast, and presentation time was shown
revolutionized the evaluation of eye movement performance during to correlate with several plate discipline metrics in baseball
sporting activities. Studies with mobile eye tracking systems have (InzoneSwingPct, inzoneFbSwingPct, ChasePct, FbChasePct,
commonly found that experts have a lower number of fixations that BBperPa).88 Similarly, oculomotor processing speed has also been
occur for longer durations than do novices during the viewing of correlated with better batting performance metrics in professional
specific sport situations, especially when the subjects are required baseball.71
to move while gaze behaviors are recorded.72–76 Studies of aiming In many dynamic, reactive team sports athletes must track
and interceptive tasks have found that experts typically demon- teammates and opponents while simultaneously moving in re-
strate longer fixation durations before initiation of the motor perfor- sponse to the game. These sports require athletes to extract the
mance. These eye movement patterns are also found when crucial visual information from a dynamically changing environ-
comparing trials with successful performance with those that were ment in order make the best decision on how to respond appropri-
unsuccessful. This long-duration fixation that occurs just before a ately. These visual abilities that are critical to success in many
specific motor response has been called the quiet eye period.77 sports have been called multiple-object tracking, first described
The exact neural mechanisms that guide gaze behavior are still un- by Pylyshyn and Storm.89 Research has demonstrated that this
der investigation; however, it seems there is a period of cognitive form of visuospatial cognition is enhanced in expert athletes.19,90–96
processing that is advantageous for computation of force, direc- Professional athletes have been found to have better multiple-object
tion, and velocity that guides and fine-tunes the motor response.20 tracking scores compared with high-level amateur athletes and
The visual field is the entire extent of the external world that can nonathletes,94 and a study of National Basketball Association players
be seen without a change in fixation. In many sports situations, es- found that multiple-object tracking motion speed thresholds mea-
pecially team sports, processing of information from the peripheral sured in the preseason correlated with a number of in-game statis-
visual fields is a beneficial element to successful performance. The tics, including assists, steals, and assist-to-turnover ratios during
factors studied regarding assessment of peripheral vision in ath- the following season.95 As the number of targets increases in a
letes include the extent of the visual fields, the sensitivity of the vi- multiple-object tracking task, limitations in attentional resources
sual fields, the visual response speed to peripheral information, lead to diminished performance.97 In a study of basketball players,
and spatial localization accuracy of peripheral stimuli. Some study elite athletes displayed better tracking performance compared with
results indicate that athletes have a larger extent of visual fields the intermediate-level or nonathletes when tracking three or four
than do nonathletes.33,78 A study of basketball players found that targets; however, no differences were observed among the three
skilled players showed significantly higher response accuracy and groups when tracking two targets.98
faster response times compared with lesser-skilled players in three Visualization, or mental imagery, is the act of constructing mental
video-based viewing conditions of basketball scenarios, demon- images of an object or event that resembles the actual appearance of
strating superiority in information extraction when presented in ei- the object or event. Elite athletes have been repeatedly shown to use
ther central and peripheral vision.79 The Vienna Test System (www. imagery strategies in preparation for performance.99–108 Studies
schuhfried.com) contains several measures of peripheral percep- suggest that mental imagery of motor skill performance shares cog-
tion and has been used to evaluate performance in athlete popula- nitive processes with the actual performance of motor tasks.109
tions.30,80–84 Moderate to good reliability has been found with the Motion imagery has also been shown to correspond to attention
peripheral perception subtests, indicating reasonable applications for visuospatial imformation.110 Task difficulty and expertise level
for assessment in sports.85 have also been shown to affect the time required for mental

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 Visual Performance Assessments for Sport — Erickson

imagery more than for physical performance.111–113 Athletes with decision to either generate a motor response or inhibit it. A study
lower skill levels require more time to execute mental imagery of a of baseball players found more variable reaction times in a
physical performance than the actual time required to perform the baseball-specific go/no-go task based on level of experience, but
physical act. Although the value of visualization and mental imagery this variability was not found in nonathletes or tennis and basket-
in sports performance has been acclaimed, no objective assessment ball players.118,125 A subsequent study found that go/no-go reac-
of individual ability exists. Many subjective assessment procedures tion time is affected by sport-specific stimuli.126 A study of
are used by sports psychologists, such as the Sport Imagery Ability professional baseball players found that better eye-hand peripheral
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Questionnaire, which has demonstrated good validity, internal and response correlated with better plate discipline batting metrics
temporal reliability, invariance across sexes, and an ability to dis- (e.g., fewer at bats before gaining a walk, swinging less often at
tinguish among athletes of different competitive levels.114 pitches outside the strike zone, and the ability to gain a walk), as
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well as longer playing time and an increased likelihood of compet-

ing at the major league level.127
EFFECTOR MECHANISM ASSESSMENTS The ability to maintain balance while processing complex,
fast-action visual information is a task demand fundamental to
Visual-motor reaction time, also referred to as psychomotor many dynamic sports. The athlete is frequently required to preserve
speed, refers to the amount of time that elapses between the initi- balance while the oculomotor system is engaged in pursuit and/or
ation of a visual stimulus and the completion of a motor response to saccadic eye movements. Investigations have evaluated the role
the stimulus. This is the full completion of the visual-motor reac- of vision on dynamic balance in gymnastics, reporting that vision
tion time reflex, including the period required for the retinal cells played an important role in skill acquisition.128–131
to detect the stimulus, the time necessary for the transmission of Coincidence anticipation timing is the ability to predict the ar-
the retinal cell information to the visual cortex, and the time re- rival of an object or stimulus at a designated place and is usually
quired for the neuromuscular system to send the information to measured with a motor response. Theoretically, coincidence antic-
the muscles that need to be stimulated to make the appropriate ipation timing contributes to the attempt to catch or hit an ap-
motor response. The time interval between the onset of the stimu- proaching ball in sports. Predictive visual information concerning
lus and the initiation of the response has been referred to as the re- the space-time behavior of critical factors in fast-action sports
action or premotor element of the overall reaction time, and the rest can provide a significant advantage in determining and executing
of the response has been referred to as the motor element.55,115 the most appropriate motor responses.132,133 Research results
Soccer players have shown shorter premotor reaction times com- have suggested that timing accuracy improves with increasing ve-
pared with nonathletes, although the sample was small in this locity and decreasing range of movement response,134–136 but no
study.115 Studies have found faster simple reaction times in ath- differences in coincidence anticipation timing performance re-
letes (both eye-hand and eye-foot) in various sports compared with sponse accuracy were found when comparing binocular and mon-
nonathletes, or as a discriminator between types of sports and ex- ocular viewing conditions with the Bassin Anticipation Timer
pertise levels.8,116–120 Sex differences have also been reported, (Lafayette Instrument, Lafayette, IN).137 Physiological arousal, ex-
with male athletes achieving faster times than female athletes on ercise, and caffeine ingestion all seem to sustain coincidence an-
average,55 but other studies have not found this difference.33,121 ticipation timing performance accuracy.138–140 Studies of racket
Peripheral eye-hand response assessment, also sometimes sports, including tennis, badminton, and table tennis, have found
called eye-hand coordination, is the ability to make synchronized differing coincidence anticipation timing abilities that correspond
motor responses with the hands to visual stimuli that appear in to the speed of the ball/shuttlecock based on each sport.120,141
the peripheral parts of the visual field. Many sports require the ath- Several studies have reported sex differences with coincidence an-
lete to react with hand movements to rapidly changing visual infor- ticipation timing, and a review of the literature concluded that ab-
mation, such as in baseball, tennis, hockey, and football. Studies solute error on coincidence anticipation timing is better, on
have been designed to provide normative information for athletes average, in male than in female players.142
with available instrumentation to evaluate peripheral eye-hand re-
sponse.3,31,37 The instrumentation designed for evaluating periph-
eral eye-hand response has usually been a 2D panel mounted on a CURRENT TECHNOLOGY FOR AN
wall with an array of lights. The athlete is required to press a randomly ASSESSMENT BATTERY
lit button as rapidly as possible with one hand; then another button is
lit in a random position on the instrument, and the reaction time reflex Computerized assessment and training instruments, such as
cycle is repeated for the established period. Peripheral eye-hand re- the Senaptec Sensory Station, Sports Vision Performance (M&S
sponse has been found to be better in athletes than in nonathletes.52 Technologies, Inc., Niles, IL), Vizual Edge Performance Trainer
Sex differences that are most likely related to differences in visual (http://vizualedge.com), RightEye Sports Vision EyeQ, and the
reaction times have also been reported, with male athletes achiev- sports vision software available from Centro de Optometria
ing faster times than female athletes on average.55,122 Internacional (https://coi-sl.es/software), have been developed to
Another peripheral eye-hand response option has been referred provide a testing battery to evaluate several visual, cognitive, and
to as a go/no-go task.123,124 The test setup is similar to other sensorimotor skills in order to generate a performance profile.
visual-motor reaction time measures of peripheral eye-hand re- The Senaptec Sensory Station was developed using the same
sponse; however, the light is either a “go” stimulus (e.g., green platform as the Nike Sensory Station. The evaluation battery in-
color) or a “no-go” stimulus (e.g., red color). Athletes are instructed cludes 10 assessments that are commonly performed as part of a
to hit the go stimulus lights and to not hit the no-go stimulus. This sports vision evaluation. These assessments include visual clarity
test paradigm adds a layer of quick decision making to the task to (analogous to static visual acuity), contrast sensitivity, depth per-
determine how effectively an athlete can make an uncomplicated ception, and multiple-object tracking, near-far quickness, target

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Copyright © American Academy of Optometry. Unauthorized reproduction of this article is prohibited.

 Visual Performance Assessments for Sport — Erickson

capture (analogous to dynamic visual acuity), perception span, far, eye-hand coordination, visualization, minimum perception
eye-hand coordination, go/no-go, and eye-hand reaction time. Eval- time, and “central-peripheral care.” The only research on reliability
uation results are transmitted to a central database to provide com- found that the DinVA 3.0 (Centro de Optometria Internacional;
parison of performance with any sports cohort by competition level https://coi-sl.es/software) is a valid and reliable measure of dy-
and also can compare with previous personal assessments. Re- namic visual acuity.145
search with the Nike version of this system has demonstrated that These computer-based assessment systems provide a useful
many tasks in the battery are reliable and cross-validated.123,143 platform for measuring important component sensorimotor and
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Sports Vision Performance by M&S technologies offers several cognitive vision skills in athletes by providing a standardized evalu-
computer-based visual performance assessments, including visual ation. Use of this type of system provides a consistent platform for
acuity, contrast sensitivity, eye alignment, depth perception, measurements, so that athletes can be compared with other ath-
CX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/15/2023

fusional ability, and developmental eye movements. The system al- letes in a data set or with their own previous performance. These
lows for the comparison of performance with an athlete database. systems also offer the benefit of requiring less physical space than
There have been no published studies on the reliability or validity the use of several different instruments to complete a test battery.
of this system, but there should be reasonable reliability owing to Of course, not all assessment options are offered in any one sys-
the use of standard psychophysical assessment protocols. tem, so supplemental assessment may still need to be completed,
The Vizual Edge Performance Trainer provides an assessment of as needed.
eye alignment, depth perception, convergence, divergence, visual
recognition, and visual tracking. This system generates a quantita-
tive score for each assessment and a combined performance score SUMMARY
for the complete evaluation. There is no research evidence regard-
ing the reliability or validity of this system. Most sports vision evaluations do not assess all the areas de-
RightEye Sports Vision EyeQ includes a remote eye tracker for scribed in this review for all athletes. The eye care practitioner's ob-
assessments of dynamic visual focus, smooth visual pursuit, eye jective is to identify those areas that seem to be important for
movement speed, simple reaction time, choice reaction time, dis- success in performing the visual tasks required of the athlete and
criminate reaction time, binocular vision skills, visual concentra- those areas that are beneficial to overall performance. This review
tion, and contrast sensitivity. A report is generated detailing reveals that the visual skills that correlate with successful sports
relative performance in each category. The only research regarding performance have not yet been definitively identified. The instru-
reliability of this system is with the three measures of dynamic vi- ments and procedures that yield the most relevant assessment of
sual acuity, which have shown good test-retest reliability.144 targeted visual skills have yet to be identified definitively as well.
The sports vision software available from Centro de Optometria Ultimately, the sports vision practitioner must identify the vision
Internacional includes several assessments of visual acuity, con- factors thought to be essential to the performance of the visual
trast sensitivity, horizontal and vertical fixation disparity, vergence tasks critical for success in the sport and then determine the most
ranges, Hess Lancaster extraocular muscle function, stereopsis at appropriate, valid, and reliable methods for assessment.

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6. Abernethy B, Russel DG. Skill in Tennis: Consider- 15. Wolfe JM, Horowitz TS. What Attributes Guide the
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