SPORTS VISION Visual Performance of

Contact Lenses

Nick Dash BSc MCOptom DipASSV Sports Vision Specialist, University of Loughborough in the UK. Optometrist to the British Olympic Association English Cricket Board Lawn Tennis Association England Rugby Premiership Football Clubs Others……

Nick Dash

Sports Vision – Visual Performance with Contact Lenses

Nick Dash Optometrist CEO Sports Vision Institute www.skiCPD.org

“Think outside the box”

Agenda: What is Sports Vision?

Sports Vision - Visual Performance with Contact Lenses

Golf (why CLs?)

Football – Rugby (activity based challenges)

Winter Sports (environmental challenges)

Vision is more than just 20:20

82% of all neural input to the brain during sport is visual

Vision Pathway

• Lights Journey

• Light path to the eye

• Cornea • Crystalline lens • Retina • Nerves • Brain

Station 1. Light Manipulation

• Refraction • Aberration control • Contrast control • Colour enhancement • Improve peripheral vision

Station 2. Eye co-ordination

We have six muscles acting on each eye.

But two eyes (12 extra ocular muscles) need to balance in all directions

Up

Down

Inwards

Station 3. Neural transmission

• Neural transmission • Do some athlete see quicker than others?

Station 4. Cortical vision • We see with our brain not our

eyes • This is learned over a life

time of seeing the world. • Our brains are most active

when we are younger. So that is why you need to practice and start at a early age.

• So called 10,000 hrs to be elite as described by K. Anders Ericsson, Swedish Psychologist The Acquisition of Expert Performance in the Arts and Sciences,Sports and games 1991

Final station. Motor response

• Reacting to the visual stimulus, in fast and accurate way.

Vision Journey

1. Light manipulation

2. Eye co-ordination 3. Neural

transmission 4. Cortical vision 5. Motor responses

HARDWARE SOFTWARE

Vision Journey

1. Light manipulation

2. Eye co-ordination 3. Neural

transmission 4. Cortical vision 5. Motor responses

HARDWARE SOFTWARE

Case Study: Golf

Preparation important

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distance to pin: 120 metres club: Iron 9 Tour Preferred

durability, stain resistance, and superior grip for wet and dry conditions glove: r9 Tour Glove

comfortable, moisture transportation, quick drying shirt : Climacool® with Coolmax® Shirt

breathable, quick drying, moisutre-management pants: Climalight® Pleated Tech Pants

stable stand, waterproof, rotation stability, anti-clogging cleats, impact absorption shoe: Tour 360 4.0

distortion free, contrast enhancement, comfortable fit, suitable for caps

eyewear: adivista

gggg distance, feel, spin, control ball: Penta TP

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Consider your 14th club in the bag!

Hole 1 – on the 1st Tee

Hole 1 – addressing the ball

Hole 1 – addressing the ball

Drive for Show, Putt for $

Shot 3 – putting

Hole 2 – Par 3

• PRISMATIC DISTORTION

Peripheral Vision

Peripheral Distortion

Hole 2 – Par 3 Size effects

Hole 2- Putting

2-base

8-base

Putting accuracy study • Induce a spectacle prescription by wearing contact

lenses

• Get players to wear the contact lenses and then neutralise the effect by wearing spectacles of different designs

• Prescription chosen was that of a professional golfer

Effect of distortion

Spectacles vrs Contact Lenses

Putting CLs vs Rx Spectacles

• 4ft,6ft,10ft,16ft putts

• No RX, 5 base

• PRO 3.6 shots • 12HC 5.4 shots

• 18HC 5.4 shots

Case Study Rugby

•Guess Who?

•&

•What is he wearing?

•

Rugby Football

Case Study Lewis Moody MBE (England Rugby)

Previous Daily Disposable SVS RE -2.00DS 6/4.5 LE -2.00DS 6/12-

15 deg exophoria (poor

compensation) Accepting but aware of disparity that he

had accepted as normal Handling difficult and team physio

struggled

Case Study Lewis Moody MBE (England Rugby)

Undiagnosed unilateral astigmatism • Unilateral astigmatism Daily Toric

• RE -2.00 DS 6/4.5 SDD • LE -0.75/-1.75 @ 180 6/6 SDDfAstigmatism (Well compensated squint) Improved Peripheral awareness, Catching, Better on field perception, Much better under floodlights.

Newer Variations of Dynamic Stabilisation Zones

Optic zone independent of

peripheral stabilisation reliable stability across

all powers

Representative blink

Perfecting a Lens Design - Lid Forces Static (Open eye)

Dynamic (Blink) Objective: • Develop a contact lens by

utilizing our expertise: – the eye’s anatomy – eyelid mechanics – blink / eye dynamics

Topograpy over CL showing intra blink instability of lens

Quick Alignment System

1 360 degree comfort chamfer

2. Prism Ballasting stabilising geometry

3. Refined optic zone

4. Balanced vertical thickness profile

• Aspheric Anterior Surface – adjusts spherical aberration to balance positive spherical aberration of the eye, and contributes to defocus (sphere power) correction

Front surface

• Posterior Toric Surface - corrects astigmatic cylinder error and completes defocus and spherical aberration correction

Back surface

Aberrated wavefront Aberration corrected wavefront

Advanced Lo-TorqueTM Design Optics

PRISM BALLASTING GEOMETRY • Optimized thickness from apex to base of lens • Provides fast, stable orientation

360

COMFORT CHAMFER • Uniform thin periphery • Reduces overall lens mass for synergistic lens/lid interaction • Enhances stabilization and maximizes comfort

REFINED OPTIC ZONES • Anterior/posterior optic zone diameters adjusted to minimize variations in thickness • Uniform fitting across the entire lens range

BALANCED VERTICAL THICKNESS PROFILE • Uniform mid-peripheral at apex, center, and base of optic zone for vision stability

1

1

Clear, stable vision

3

4

2

2

3

4

Knock Back

Left Trauma September 2011

Hyphaema Retinal Oedema Drop in acuity and central scotoma

• RE -2.00 DS 6/4.5 • LE -0.25/-2.25 @ 160 6/24 phni Left divergent squint 15 deg, loss of

stereopsis Treated with NSIA to speed resolution Treated suppression that subsequently

developed.

Proven training = Orthoptics

Eye muscle building for sport

Left Trauma Rehabilitation

• RE -2.00 DS 6/4.5 • LE -0.75/-2.00 @ 170 6/9- niph (refitted with -0.75/-1.75 @160 6/12) Treated suppression that subsequently

developed Visual training to improve peripheral

awareness and OMB Returned to Captain England 14 weeks

after injury

Case study Winter Sports : Environmental Challenges

• Glare • Contrast • Distortion • Dryness • UV & Health Issues

Nick Dash

Contact Lenses performance at altitude

3rd February 2013 www.skiCPD.org

Eye on the Real World

Vision is! Quality and Quantity

Visual performance

Ocular fatigue

• “mild headaches” • “grittiness of the eyes” • Conjunctival Hyperaemia

(Grade 2) • Corneal lower third

Exposure Keratitis • Contact lens wearer is

problematic resulting in removal and rewetting

UV altitude

• Every 300M altitude will increase the UV by 4 % (World Health Organisation, “W.H.O.”)

• At an altitude of 3900M there is 50% more UV than Sea Level.

UV Index

0

2

4

6

8

10

12

0 1000 2000 3000 4000

UV Index

Measurements taken by N Dash June 2009

Geneva, Chamonix, Aiguille Midi (Mont Blanc)

Peripheral light

Why do we get this nasal phenomenon when the temporal zones are relatively more exposed?

• 90 % of pingueculae are nasal and age related cataracts more evident in the nasal zones Coroneo et al, Kwok et al

• Optical ray tracing indicates a concentration of light on the nasal limbus and nasal lens cortex.

• Extreme circumference of the corneal dome refracts oblique light to focal areas within the eye..

• The light intensity arriving temporally on the eye is focused on the nasal limbus.

• Increasing UV levels by 20 times at the nasal limbus (Maloof et al)

Snow Blindness (Photokeratitis) Symptoms 1. Intense pain, eye watering unable

to open eyes. 2. Pain grade 8 out of 10 3. Lasts 48hrs to 72 hours 4. Incapacitates individual for 72

hours Pathophysiology UV rays irritate the superficial corneal epithelium,

causing inhibition of mitosis, production of nuclear fragmentation, and loosening of the epithelial layer.

• An inflammatory response includes oedema and congestion of the conjunctiva and a stippling of the corneal epithelium known as superficial punctate keratitis (SPK). If SPK is severe, it may be followed by total epithelial desquamation, with conjunctival chemosis, lacrimation, and blepharospasm.

• Reepithelialisation usually occurs within 36-72 hours

Peripheral Rays

• UV Fluorescence Photography • Shown UV damage as young at 9yrs • Increases with chronological age • Increases with exposure to UV

Why 90 % of pingueculae are nasal • Up to 50% of UV can still reach the eye in some

sunglasses (Meyer et al & Schneider)

•

• .

Eye Lids DNA damage

responsible for lid tumours

• 2% increase UV lead to increase 6% of

squamous cell carcinoma (=1% depletion of ozone)

• 90 % of skin carcinomas are UV induced (Trevini Graedel &Crutzen)

• Brief acute UV seems to cause Melanomas, >10 yrs gestation period.

• Twice as many deaths in Southern States of US vrs Northern

• Eye protection from orbit but exposes temporal lid tissue. Levels of UV being twice the amount of the nasal area.

• Temporal lids are 12 time more likely to develop tumours than the nasal areas (Sakamoto et al)

Dry Eye Visual Stability and Quality

• Dry Eye Symptoms • Air movement • Dry air • Loss of tear film

• Reduced Tears

exposes to UV and increases UV risk

Ocular exhaustion phenomenon (REE)

1. Questionaire to Mountain Guides based on McMonnies Questionaire.Early results suggest chronic and severe dry eye of all respondance with 5 or more years in mountain environment.

2. Chamonix Ophthalmogist report; awaiting questionaire…ie incidence of Pterygium/Pingueculae/Most Common cause of pateints presenting/Incidence of Cataract and Macula Degeneration.

Case study – Bob Skeleton

What factors contribute to dehydration and “Dehydration Blur”?

Lens Factors

Dehydration

Blur

Individual Factors

Environmental Factors

• decreased oxygen transmission • tighter fitting lenses • change in lens power • increased surface deposits

What works is Revolutionary Material – HyperGel™

Vision is key to performance Sports Performance Eyewear

delivers

Clearer Sports Vision Performance Enhanced Optics

Improved Visual Comfort

Raising Performance in Sports

Biggest impact on performance

• The biggest impact we can have on vision performance is to give the best optical correction or appliance.

See Better to Perform Better

THANK YOU