The Eyes Could Be the Window to Concussion Prevention

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November 30, 2018

By Jeremy D. Howard, MS, LAT, ATC

The old adage is that the eyes are the window to the soul; however, recent research has suggested that the eyes could be the window to a concussion prevention strategy. In 2015, I attended the National Strength and Conditioning Association (NSCA) national conference in Orlando, Florida and one of the presenters spoke on a concern that athletes are training themselves to be cross-eyed and eliminating their peripheral vision by spending too much time training eye adductor muscles staring at their smart phones. This eye-opening lecture led me to expand my research into this concept to see how I could better treat concussed patients and the body of literature has only continued to expand on the subject.

There are 1.6-3.8 million sport-related concussions occurring in the United States annually.1 This notable number of annual concussions has sponsored an increase in concussion prevention research, including education, legislation, additional equipment and training collision anticipation. Peripheral vision training falls under the collision anticipation training domain of prevention and has been posited to decrease concussion incidence in a study conducted over 4 years, though the review did note that a lack of a control group does hinder the strength of this study.1 Peripheral training aids and programs have seen an increase in use in recent years well beyond the concussion prevention and management domains and into the sport performance domain. Now, it seems appropriate to dive into the rationale and outcomes seen based on implementing this intervention.

The global notion surrounding the effectiveness of vision training suggests that the demands placed on perceptual vision increase cognitive processing of visual input, oculomotor and mechanical tasks of the eye, and improved response and reaction times.2 Diving deeper into the mechanisms of vision training, we see improved capacity in hand-eye coordination associated to visual-motor reaction times bilaterally, near point convergence and minimalization of suppression, speed, accuracy, and efficacy of the eyes, reflex reaction time and bracing, recognition and processing speed, and depth perception.3

Further research went on to suggest the increased capacity in these domains would result in improved prevention rates due to increased competence in the peripheral range of vision.3 They cited an example of a wide receiver being better able to process an incoming defender approaching from his peripherals allowing him time to either implement impact protective or avoidance strategies. Though even 2.5 weeks of implementation has demonstrated increases in reaction time in the peripheral zones.3 The best results for concussion prevention were reported with implementation over 6 weeks coinciding with the sport’s preseason training allowing the patients to develop safer skillsets to implement during game-like scenarios throughout the season.4

As previously alluded to, vision training holds beneficence and can be implemented across the spectrum of concussion from prevention to return-to-play. Research suggests that vision-based simple reaction time demonstrated deficits from baseline when tested within 2 weeks of concussion mechanism of injury.5 Through the rehabilitation process vision training has been shown to increase reaction time and was positively associated to concussion vital sign improvement when measured on computer-based neurocognitive tests.6 Further supporting this concept, the Vestibular/Ocular Motor Screening (VOMS) has an 89 percent positive prediction rate with concussion, solely based on symptoms and near point convergence or NPC greater than 5cm.7 The NPC test from the VOMS, could be a beneficial inclusion to qualify an athlete to take their neurocognitive test for comparison to baseline and consideration of preparedness for return-to-play protocol.

Keep in mind, many of the vision training programs available come with a notable price tag. There are some free programs or tests like VOMS that can be adapted to your rehab protocols. Other low costs or easily created programs and protocols include Brock’s String Method, Tachistoscope, Pinhole glasses, Saccade Charts and Near and Far Placement Charts. Consider the benefits that a peripheral visual training protocol might offer to your program.


  1. Schneider, D.K., Grandhi, R.K., Bansal, P., Kuntz, G.E., Webster, K.E., Logan, K., Foss, K.D.B., & Myer, G.D. (2016). Current state of concussion prevention strategies: A systematic review and meta-analysis of prospective, controlled studies. British Journal of Sports Medicine, 0, 1-11. doi: 10.1136/bjsports-2015-095645.
  2. Applebaum, L.G., & Erickson, G. (2016). Sport vision training: A review of the state-of-the-art in digital training technique. International Review of Sport and Exercise Psychology, doi: 10.1080/1750984X.2016.1266376.
  3. Clark, J.F., Colosimo, A., Ellis, J.K., Mangine, R., Bixenmann, B., Hasselfeld, K., Graman, P., Elgendy, H., Myer, G., & Divine, J. (2015). Vision training methods for sports concussion mitigation and management. Journal of Visualized Experiments, 99, 1-11. doi: 10.3791/52648.
  4. Clark, J.F., Graman, P., Ellis, J.K., Mangine, R.E., Rauch, J.T., Bixenmann, B., Hasselfeld, K.A., Divine, J.G., Colosimo, A.J., & Myer, G.D. (2015). An exploratory study of the potential effects of vision training on concussion incidence in football. Optometry & Visual Performance, 3(2), 115-125. doi:
  5. Maruta, J., Spielman, L.A., Rajashekar, U., & Ghajar, J. (2018). Association of visual tracking metrics with post-concussion symptomatology. Frontiers in Neurology, 9 (611), 1-8. doi: 10.3399/fneur.2018.00611.
  6. Fahrner, K.M., Wheeler, B.M., & Bruce, S.L. (2017). Comparison from Dynavision training on concussion vital signs performance. Journal of Sports Medicine and Allied Health Sciences, 3(30), 1. doi: 10.25035/jsmahs.03.01.20.
  7. Mucha, A., Collins, M.W., Elbin, R.J., Furman, J.M., Troutman-Enseki, C., DeWolf, R.M., Marchetti, G., & Kontos, A.P. (2014). A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions. American Journal of Sports Medicine, 42(10), 2479-2486. doi: 10.1177/03635465145437751.


About the Author

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Jeremy Howard is the State Health Promotion Officer for Florida Army National Guard under the Resilience, Risk Reduction, and Suicide Prevention Program. Howard graduated with a Bachelor of Science in Athletic Training from Florida Gulf Coast University (#DunkCity) and from the University of Saint Augustine for Health Sciences’ Master of Health Science in Athletic Training programs. He is currently pursuing an Educational Doctorate in Health Sciences at the same institution. In 2002, Howard enlisted in the Florida Army National Guard and is still currently serving; he is also a veteran of Operation Enduring Freedom-Afghanistan. His professional interests include Concussion/TBI, Injury Prevention Programs and Manual Therapy.

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