Why performance vision evaluations matter for athletes

Amanda Nanasy, OD, ties every performance vision evaluation finding back to an athlete’s sport, an approach shaped by her early work with professional teams and her own concussion, she told Optometry Times in an exclusive interview. Nanasy first entered the field as an optometry student at Nova Southeastern University, after the Orlando Magic’s team optometrist, Richard Ross, OD, brought her in to evaluate players. Since graduating, she has gained experience working with a variety of teams, including the Miami Dolphins and Florida Panthers.

Motivation to work with athletes

One of Nanasy’s most memorable cases came early in her career, when she aided in the discovery of a brain tumor. The patient, a cheerleader, came in for a routine comprehensive eye exam. During the exam, it was evident she was missing areas on her confrontation fields. The patient had surgery within 3 days.

Nanasy’s focus on concussion began after she sustained one herself after a car accident in 2018. She described the concussion as one of the best things to happen to her professionally, as it gave her a new perspective on her patients’ experiences. “I understood all of the visual symptoms that were possible, and how I don’t think that we were serving that population as well as we could as eye came providers. I’ve…made that one of my things that I want to change,” Nanasy stated.

Intersection of eye and neurological care, emphasizing a comprehensive approach

Nanasy recently treated a university athlete who suffered a concussion after being hit in the face by a basketball. The patient reported headaches and floating spots in her visual field. Nanasy dilated the patient to confirm a healthy retina and rule out structural damage to the eye, then moved on to functional testing. The functional workup revealed a significantly receded near point of convergence, lag of accommodation, and a small uncorrected refractive error. The athlete presented with visual acuity of 20/40.

The athletic trainer reported no previous vision complaints, leading Nanasy to suspect the patient had squinted through the team’s Snellen chart. Nanasy focused on correcting the athlete’s vision, and urged optometrists to think “a little bit outside of the box” when it comes to athletes. “She's an athlete, she’s not going to want to wear glasses on a regular basis, but I can clear her up, [and] make her edge-to-edge clear,” Nanasy said.

“That little bit of a focusing issue that she had should go away … and then when she’s hopefully back to normal, she’ll wear her contacts when she’s on the court,” she continued.

Advice and clinical pearls for optometrists

Nanasy advises optometrists who treat athletes in their practice to take an extra step to educate patients on how each clinical decision relates to their sport. For example, when a tennis player’s toric lenses lost stability as she moved laterally during play, Nanasy explained to the athlete why a stable lens matters in a dynamic sport. Another athlete may describe glare while tracking a ball against stadium lights, prompting Nanasy to examine visual acuity and the ocular surface.“My best piece of advice is to connect the dots, that is a huge difference maker for athletes,” she stated.