运动员视觉保健

视觉作为在人类多种感观认识功能中占主导地位的感知方式，对体育竞技中的各类感觉运动性活动具有举足轻重的作用。运动视觉的医疗职能包括：①预防和治疗体育和竞技运动中造成的眼部损伤。②评估和矫正某些影响协调性运动机能的视功能异常。③针对体育运动的环境性因素展开专业性的角膜接触镜业务，并对一些对眼动、视力和应急状态具有特殊要求的竞技项目提供帮助。④基于视觉和环境等因素的考虑，向专业运动员提供特制的眼部保护装置和助视仪器。⑤评估与某些竞技运动项目密切相关的视觉功能及技巧。⑥通过对运动员的视功能强化训练进而提高其运动成绩。⑦向运动员、教练员或整个团队提供有助于提高运动成绩的视觉功能及技巧的咨询。人们一直都很关注视觉功能与运动成绩之间的联系，许多专家与临床医生都试图寻求与特定的运动技能相关的特殊视觉技巧，进而建立精确的方法予以评估。运动员具有比非运动员更好的视觉功能，而与一般的运动员比较，顸尖水平的运动员往往从优异的视觉功能中获益更大。不同的视觉功能对于帮助运动员取得优秀成绩的作用在运动项目中是有所差异的。运动视觉专家必须区分出哪些视功能是与运动相关的关键性的视功能，并用最恰当的方法对其进行评估。不同的运动项目，对视觉功能的要求也常常不同。运动员的验光矫正包括运动或娱乐过程中配戴特制的框架眼镜及角膜接触镜。在决定最佳处方的同时，应考虑最适合的镜片种类、镜框设计、染色特征和应考虑的安全防护因素。基于运动和环境需要的角膜接触镜染色工艺是目前正在研究和发展中的高新技术，其产品即将面世，在运动或娱乐场所的不同光照环境下能够减少眩光，提高视觉舒适性，增强视功能。运动型太阳眼镜光学性能的改善和上述染色型角膜接触镜的发展，将为运动员们减少眩光提供了可能的解决方法。为运动员们提供视觉保健时，首先应予考虑的问题是减少在训练和比赛中的眼部损伤。通常在采用了这些眼保措施后，绝大多数损伤是可以避免的。运动员所接收的视觉信息的质量和各种感观接收器提供的大量反馈信息是影响其赛场表现的关键因素。技巧性动作的熟练程度和运动员以往的经验对于运动系统(肌肉)运行的有效性和效率的影响是不可估量的。有天赋的运动员能够稳定而持久地在赛场发挥出色，而且似乎一点都不费力。通过筛选出对运动影响显著的视功能并加以强化训练，进而提高运动员成绩已成为可能。专业人士已经设计出多种视功能训练方案以改善视觉技巧和与视觉相关的运动技巧，并提高视觉信息传递过程中的效率。眼科保健工作者可以采用很多方法来帮助运动员尽量发挥其潜能。通过分析与运动员从事的运动最相关的视功能，可以指导眼科保健工作者选择最适合的矫正模式，如最佳的配戴设计、染色、角膜接触镜参数以及保护方案等。当眼保健工作者选择视觉训练来矫正功能不足或强化与运动相关的视功能时，需要和运动员进行交流，使其积极配舍。结果表明，不但是那些顸尖的运动员能从我们的医疗服务中获益，而且各种人群因为接受训练进而改善了视功能并提高了自身的生活质量。     

AOA Sports Vision Section screening of basketball officials

Members of the Sports Vision Section of the AOA screened 60 basketball officials. Tests included: visual acuity, ocular motilities, accommodative facility, Brock string, Wayne saccadic fixator, vectogram, Keystone visual skills, and tachistoscope. Results demonstrated that officials' vision was at a very high level and compared favorably with the results from the recent National Sports Festival screenings.     

Specialization in low vision rehabilitation and visual therapy.

A questionnaire was mailed to members of the Low Vision Section (LVS) of the American Optometric Association (AOA) and the Council on Visual Development (COVD) to determine the practice patterns of low vision clinicians, amount and source of specialty training and the extent of dual specialization in both low vision rehabilitation and visual training by members of COVD. Results indicate that 61.1 percent of AOA/LVS members and 20.9 percent of COVD members examine more than four patients per month who require low vision services. Yet, only 2.1 percent of COVD respondents and 32.2 percent of AOA/LVS respondents spend more than 20 percent of their practice time providing low vision services.     

Sports vision and the high school student athlete.

Thorough sports vision evaluations (SVE) utilizing a 30-test battery of established sports vision tests, variations of commonly accepted procedures, and newly designed instruments and/or methods were performed by the Wisconsin Sports Vision Project (WSVP) staff on 232 teenage male and female high school student athletes. Tests are described and results reveal that a state tournament qualifying girls volleyball team (n = 8) demonstrated significantly better visual skills and abilities than 1) the male and female general high school athlete sample (n = 224), 2) the female athlete sample (n = 78), and 3) the other female volleyball players in the sample (n = 46) in some areas of dominant eye vision contrast sensitivity, distance judgement, dynamic visual acuity, tachistoscopic skills, low light and glare-affected vision.     

Paediatric Vision and Optometry

ABSTRACT Until recent times remarkably little attention has been paid to the visual problems of children. Few children seek professional eye care, and vision screening services provided by the school health authorities have been shown to be inadequate. National Children's Vision Week (NCVW) in 1979 was the first stage of an AOA programme to inform the public, particularly teachers, of optometrists' unique role in paediatric eye care and the importance of early intervention. The paper presents information resulting from optometry's participation in NCVW, and suggests strongly that all optometrists should be informed as to their responsibilities in paediatric eye care.     

Visual skills of athletes versus nonathletes: development of a sports vision testing battery

The field of sports vision has a fundamental premise that athletes require superior visual abilities to succeed in their sporting activity. This study takes a scientific look at what appear to be sports-related visual abilities using a clinical battery of vision tests to compare the visual performances of athletes to nonathletes. Significantly better visual performances were found to exist in the athletic population for certain visual skills: vergence facility, saccades, visual reaction time, peripheral awareness and near point of convergence. The tests for accommodative facility, visual proaction time, span of recognition distance phoria and distance stereopsis did not yield a statistically significant difference between the groups. These results provide a foundation for the development of a research-based sports vision testing battery.     

运动视觉及视觉训练的研究进展

运动视觉也称运动视力,是人在运动过程中通过观察环境和事物的变化后,对自己的动作及时做出反馈调整的能力。运动视觉是视觉领域的一个新学科,主要包括评价和提高视觉表现力,对视觉问题进行诊断,并提供必要的视觉训练帮助。视觉训练是一种眼睛和大脑的训练方式,是对大脑视觉神经认知系统的刺激与训练。目前该研究在很多体育运动项目中受到广泛关注,已成为一个新兴热点。运动员的运动视觉能力基本上是在长期的训练和比赛实践中得到增长的,现就其国内外的研究成果作一综述。     

[In Press] Visual efficiency among teenaged athletes and non-athletes

AIM: To compare visual efficiency, specifically accommodation, vergence, and oculomotor functions among athletes and non-athletes. METHODS: A cross-sectional study on sports vision screening was used to evaluate the visual skills of 214 elementary students (107 athletes, 107 non-athletes), aged between 13 and 16 years. The visual screening assessed visual parameters such as ocular motor alignment, accommodation, and vergence functions. RESULTS: Mean visual parameters were compared between age-group matched athletes (mean age 14.82±0.98y) and non-athletes (mean age 15.00±1.04y). The refractive errors of all participants were corrected to maximal attainable best corrected visual acuity of logMAR 0.0. Accommodation function assessment evaluated amplitude of accommodation and accommodation facility. Vergence functions measured the near point of convergence, vergence facility, and distance fusional vergence at break and recovery point. Ocular motor alignment was not statistically significant between both groups. Athletes had a statistically significant amplitude of accommodation for both the right eye (t=2.30, P=0.02) and the left eye (t=1.99, P=0.05). Conversely, non-athletes had better accommodation facility (t=-2.54, P=0.01) and near point of convergence (t=4.39, P<0.001) when compared to athletes. Vergence facility was found to be better among athletes (t=2.47, P=0.01). Nevertheless, non-athletes were significantly better for both distance negative and positive fusional vergence. CONCLUSION: Although the findings are still inconclusive as to whether athletes had superior visual skills as compared to non-athletes; it remains important to identify and elucidate the key visual skills needed by athletes in order for them to achieve higher performance in their sports.     

Visual efficiency among teenaged athletes and non-athletes

AIM: To compare visual efficiency, specifically accom-modation, vergence, and oculomotor functions among athletes and non-athletes. METHODS: A cross-sectional study on sports vision screening was used to evaluate the visual skills of 214 elementary students (107 athletes, 107 non-athletes), aged between 13 and 16y. The visual screening assessed visual parameters such as ocular motor alignment, accommodation, and vergence functions. RESULTS: Mean visual parameters were compared between age-group matched athletes (mean age 14.82±0.98y) and non-athletes (mean age 15.00±1.04y). The refractive errors of all participants were corrected to maximal attainable best corrected visual acuity of logMAR 0.0. Accommodation function assessment evaluated amplitude of accommodation and accommodation facility. Vergence functions measured the near point of convergence, vergence facility, and distance fusional vergence at break and recovery point. Ocular motor alignment was not statistically significant between both groups. Athletes had a statistically significant amplitude of accommodation for both the right eye (t=2.30, P=0.02) and the left eye (t=1.99, P=0.05). Conversely, non-athletes had better accommodation facility (t=-2.54, P=0.01) and near point of convergence (t=4.39, P<0.001) when compared to athletes. Vergence facility was found to be better among athletes (t=2.47, P=0.01). Nevertheless, non-athletes were significantly better for both distance negative and positive fusional vergence. CONCLUSION: Although the findings are still inconclusive as to whether athletes had superior visual skills as compared to non-athletes, it remains important to identify and elucidate the key visual skills needed by athletes in order for them to achieve higher performance in their sports.     

Detection of vision impairment in people admitted to aged care assessment centres

Vision is not routinely tested when the health of older people is assessed, and the aim of this study was to detect older people with vision impairment for referral to appropriate eye care services. People admitted for assessment and or rehabilitation in three aged care assessment centres had distance and near visual acuity assessed with a simplified vision test. A pinhole test was used when necessary. Referral criteria were distance visual acuity of less than 6/12; near vision of less than N8, and people with diabetes who had not attended a dilated fundus examination in the last 2 years. Visual acuity results were obtained in 93% of patients (685/735). Those unable to perform the vision test were very ill or had severe cognitive impairment. Forty-three per cent of patients (266/646) had impaired vision and, of these, 70.6% (188/266) were referred to eye care specialists. Forty-five per cent were referred to ophthalmologists, 36% to optometrists and 20% to low vision services. This significant proportion of patients with poor vision suggests that vision screening is warranted.     

Enhancing sports performance through clinical and experimental optometry

The roles of clinical and experimental optometry in the improvement of sports performance are considered in the light of existing research knowledge in vision and sport. A parallel is drawn between the manner in which the human performer uses vision to control skilled movement and the operation of a highspeed computer and a distinction is made between the reception and perception stages of visual information-processing. It is suggested that the reception of visual information is largely limited by the physical characteristics of the visual system (‘hardware’) and a role for the clinical optometrist is proposed in terms of ensuring that adequate levels of visual ‘hardware’ exist for athletes. It is further suggested that enhancement of visual ‘hardware’ beyond normal levels is unlikely to improve sports performance substantially as perceptual performance appears to be primarily limited by the strategies (‘software’) performers have developed to mpe with the unique processing demands of their particular sports. Some examples of ‘software’ differences between expert and novice performers are provided and the effectiveness of altering perceptual strategies as a means of enhancing sports performance is considered.     

The efficacy of sports vision practice and its role in clinical optometry*

For years it has been recognised that many sports place demands on vision and particular visual skills. There is much evidence to show that the correction of visual dysfunction such as ametropia and binocular and accommodative anomalies results in improved sporting performance for those sports. More controversial and of special interest is the suggestion that it is possible to train visual abilities of subjects who do not present with traditionally recognised functional disorders of vision. It has been proposed that sporting performance can be improved as a result of this training. However, this review found the evidence to be inconclusive. In addition, there are studies that suggest athletes have better visual abilities than non-athletes and good athletes have better abilities than less skilled athletes. However, it has not been determined whether these superior abilities are innate to the athlete or have developed through practice. A review of the available literature was unable to prove (or disprove) either of these proposals. However, there appears to be enough evidence to warrant further investigation of these questions, in order that the area of sports vision and vision training can be more fully understood. This will enable clinicians to take full advantage of the potential of sports vision practice to assist athletes. (Clin Exp Optom 1995; 78: 3: 98–105)     

Ocular and visual defects amongst people with intellectual disabilities participating in Special Olympics

PURPOSE: To analyse data from vision screening of people with intellectual disabilities from the UK participating in Special Olympics during the National Summer Games in Cardiff 2001, in order to determine visual status and access to eye care. METHODS: Athletes were invited to take part in vision screening, according to Special Olympics protocols. RESULTS: Testability rates were high. Findings confirmed the high prevalence of eye and vision defects reported in other studies of people with intellectual disabilities. In particular, visual acuity was below normal for most athletes. Significant improvement to acuity could be achieved with spectacles although correction after full refraction did not always provide normal vision. Over 40% of athletes undergoing full refraction had below normal corrected acuity. CONCLUSIONS: Athletes with intellectual disabilities were no more likely to access eye care and have adequate spectacle correction than other people with intellectual disabilities. Optometrists and carers need to be aware of the high prevalence of defects and the importance of regular eye examinations in people with intellectual disabilities.     

上海市学龄前儿童视力现况分析

目的了解学龄前儿童视力现况,为儿童眼保健计划提供依据。方法选择上海市具有代表性的三个区部分学龄前儿童（〉3～6岁）进行常规远视力检查,对视力结果按眼别、性别、年龄等进行统计与分析。结果〉3-4岁、-5岁、-6岁视力低常率分别为90．46％、66．99％和36．75％。女性高于男性。以人数计高于以眼数计。不同眼别结果差异无显著性。不同地区视力低常率有显著性差异。视力低常者中,轻度低常占95．57％。结论学龄前儿童远视力普查是儿童眼保健的重要指标,结果受多种因素影响,必须正确分析检查结果。     

Hornhautstoffwechsel unter Kontaktlinsen im Sport

The corneal metabolism during the use of contact lenses plays an important role for permanent corneal health, especially in competitive sports. Thus, it is important to understand the steps of corneal metabolism in general and during highly competitive sports activity in particular. The aim of this review is to summarize the current knowledge on physiological and biochemical effects of contact lens wear. Of the energy requirements of the cornea 75 % is supplied by aerobic processes; therefore, the eye needs the highest possible amount of oxygen and sufficient glucose which can be obtained from external air and to a lesser degree from within the anterior chamber. If the oxygen supply is too low this results in hypoxic edema. Fitting athletes with contact lenses must still be viewed with caution as the visual needs of athletes are usually much more demanding than those of the general public. An indiscriminate choice of lens design can adversely affect athletic performance and may even create a hazardous situation. An intelligent choice of contact lens can provide some subtle advantages that may improve athletic performance and provide the decisive margin for victory.     

Awareness and use of eye care services in Fiji

PURPOSE: To determine the awareness, use, and barriers to use of eye services in Fiji's Central Province. METHODS: A cross-sectional survey study design with random clusters of households was used. Semi-structured interviews were conducted (152 females and 22 males). For 267 household members, presenting distance and near visual acuities were measured, and the perception of and satisfaction with their vision were recorded. RESULTS: Most (86%; 150/174) respondents were aware of at least one conventional eye care service. However, only 66% (121/183) of household members with previous eye problems had consulted one of these; the proportion was even lower for those in the older age groups (p < 0.01). Rural dwellers expressed satisfaction with their vision, despite being more likely to regard it as limiting their activities and being less likely to seek conventional care. A higher proportion of females were reported to have (or have had) eye problems (60:40) and were found to have bilateral visual impairment (60:40). Despite this, females and males attended the hospital eye clinic (47:53) or sought treatment from conventional services (51:49) nearly equally. The reasons given for not seeking conventional care were "fatalistic attitude" ("did not bother", "could manage", or accepted the condition: 57%), expense (12%), and fear (8%). CONCLUSION: Central Province Fijians, particularly the old, rural, and female, under-utilise conventional eye care services. As in developing countries elsewhere, fatalistic attitudes to visual impairment are a significant contributor to this. To improve eye health, planning and implementation of eye care services must overcome under-utilisation by addressing local barriers to uptake through community participation in education and affirmative action.     

Utilization of eye care services in Victoria

PURPOSE: To determine baseline eye care utilization by older Victorians in order to assess change in 2 years after an eye health promotion campaign. METHODS: A letter of invitation to participate was sent to all people aged 70-79 years in randomly selected Melbourne postcode areas. A questionnaire was designed to allow gathering of eye health-related information. Eye exams included autorefraction, frequency doubling technology and non-mydriatic fundus photography. Results were compared with the Melbourne Vision Impairment Project . RESULTS: A total of 1695 people with a mean age of 74 years were recruited. The overall proportion with visual impairment was 8% (134/1695), of which 27% (36/134) was due to non-refractive causes. Only 31% (11/36) of visually impaired people knew about low-vision services, of whom 20% (7/36) had used them. Of all people with diabetes, only 52% (96/184) had a dilated eye exam within the recommended 2 years (Melbourne Vision Impairment Project 44%). CONCLUSIONS: Compliance rates with recommendations for 2-yearly eye exams for people with diabetes have not improved since the last major eye health study in Victoria 10 years ago. The same is true for the rate of undiagnosed glaucoma, suggesting that messages about eye examinations need to be promoted for older people at high risk of vision loss, for example, those with diabetes and at risk of vision loss from glaucoma.     

Geriatric optometry questionnaire.

A national survey of American Optometric Association Low Vision Section members was conducted by the newly formed Geriatrics and Low Vision Committee during the fall of 1989. The "Geriatric Optometry Questionnaire" was designed to establish a greater understanding of the nature of comprehensive professional services for the unique needs of visually impaired older persons. Of the 481 surveys mailed, 289 were returned for a response rate of 60 percent. Seventy-eight percent of the respondents had completed their formal optometric education after 1970. Results indicated that geriatric optometric care is predominantly delivered in private practices and in low vision agencies. Approximately 69 percent of the patients are above the age of 65, with the majority of those being under 85. Although the average initial low vision appointment lasts 60-90 minutes, this generally represents the low vision examination and evaluation of low vision devices only. Complete ocular health assessments combined with low vision evaluations are provided by only 33.5 percent. While 80 percent of the optometrists responding take psychosocial histories, only 60 percent routinely refer patients for social services and rehabilitative training. Similarly, 57 percent of those responding referred patients for independent daily living skills instruction and only 53 percent for orientation and mobility training. These data suggest that optometrists have not yet completely incorporated the multidisciplinary approach to geriatric health care and that continuing education in this area is needed.     

Barriers to accessing eye care services among visually impaired populations in rural Andhra Pradesh, South India

PURPOSE: To understand the reasons why people in rural south India with visual impairment arising from various ocular diseases do not seek eye care. MATERIALS AND METHODS: A total of 5,573 persons above the age of 15 were interviewed and examined in the South Indian state of Andhra Pradesh covering the districts of Adilabad, West Godavari and Mahaboobnagar. A pre-tested structured questionnaire on barriers to eye care was administered by trained field investigators. RESULTS: Of the eligible subjects, 1234 (22.1%, N=5573)) presented with distant visual acuity < 20/60 or equivalent visual field loss in the better eye. Of these, 898 (72.7%, N=1234) subjects had not sought treatment despite noticing a decrease in vision citing personal, economic and social reasons. The analysis also showed that the odds of seeking treatment was significantly higher for literates [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.38 to 2.65], for those who would be defined as blind by visual acuity category (OR 1.35, 95% CI 0.96 to 1.90) and for those with cataract and other causes of visual impairment (OR 1.50, 95% CI 1.11 to 2.03). Barriers to seeking treatment among those who had not sought treatment despite noticing a decrease in vision over the past five years were personal in 52% of the respondents, economic in 37% and social in 21%. CONCLUSION: Routine planning for eye care services in rural areas of India must address the barriers to eye care perceived by communities to increase the utilization of services.