Visual processing, visual fields, and visual reaction times are essential to the performance of numerous sports and play a role in athletic injuries. Vision training, a process using visual exercises as part of a structured sports conditioning program, can be used to both enhance sports performance and prevent injury by improving neurovisual processing.   In this review, evidence and methods concerning vision training programs are presented with the results suggesting performance enhancement and/or injury prevention, primarily concussion. Multiple studies are reviewed and utilized as examples that vision training programs designed to improve athletic performance or prevent injury are effective.   We conclude from the collected evidence and theoretical considerations that vision training for numerous sports can be implemented with goals to improve performance and/or decrease injuries, specifically concussion.   Key Points: 1) In this opinion paper we believe that vision training improves neurovisual processing. The vision training improves certain brain functions. 2) That vision training programs as part of athlete conditioning can improve athletic performance. Eye hand coordination, reaction times and peripheral awareness improve on the field of play. Obviously this benefit can be sport specific with some sports benefiting more than others. 3)  There is emerging evidence that concussion rates can be decreased following pre-season vision training programs. The cause and effect needs to be better established and future research should address this opinion. 

ObjectiveIn this paper we present a case series of concussion patients' VEP as well as a single concussion patient with a VEP baseline and post concussion VEP data.BackgroundVisual Evoked Potentials (VEP) are a means of measuring the electrical behavior of the brain following a visual stimuli. The use of VEP for diagnostics following traumatic brain injury (TBI) is emerging with additional data concerning sports related concussion coming.Design/MethodsDuring the 2016 spring football season there was 1 concussion of a subject who had a VEP baseline and a VEP performed during the acute phase of the concussion. Concurrently we have been using VEP for concussion patients who have not had a baseline. Fifteen subjects in the post acute phase; while symptomatic, had VEP performed using White, Red, Blue and Green for the evoked potentials.ResultsThe patient with a VEP baseline had increased voltages with subtle slowing of N75 and P100. N75 increased from 67.5 msec at baseline to 75.1 msec post concussion. Voltages went from 19.3 mVolts to 24.6 mVolts post concussion. Also, the colored flashes associated with the lowest voltages were consistent with mitigation of frequency specific photophobia; 20.9 mVolts for mitigation color compared (red) to 24.6 for white. In the concussion population studied (N = 15) the voltages where the color corresponded to symptom relief were: 10.9 ± 5.7 mVolts compared to symptom evoking voltages 12.7 ± 6.3 (p = 0.0031) mVolts.ConclusionsIn this paper we present evidence of VEP changes in one acute concussion patient as well as a population of concussion patients where voltages are increased post concussion. The increased voltages associated with color VEP may be a useful technique to assess frequency specific photophobia as well as helping manage post concussion photophobia. Futures studies to assess the utility of VEP as a concussion management tool are needed.

IntroductionThe University of Cincinnati has been doing NeuroVisual Training (NVT) as part of an injury prevention and performance enhancement program since 2010. We recently noticed that some athletes have substantial differences in visual reaction time based on color, specifically red versus green. We set out to assess if they may have had any color processing deficiencies.MethodsWe identified 4 out of 107 screened athletes with deficiencies in their ability to react to green compared to red. After identifying these color deficiencies, we developed a protocol to assess and manage the said deficiencies. The protocol included assessing for color blindness with the Ishihara plates, color Visual Evoked Potentials (cVEP), and color-based visual reaction times.ResultsNone of the individuals had color blindness based on the Ishihara plates. There were significant differences in visual reaction times for red and green with red being significantly slower. cVEP mean red P100 latency was 115.5 ± 3.2 ms versus 104.4 ± 1.3 ms for green, and mean voltage was 7.30 ± 1.4 µV versus 9.20 ± 1.4 µV for green. DiscussionNVT is becoming a mainstream means to improve performance and safety for athletes in competitive sports. It was interesting to note that high caliber athletes in a division 1 college football program were showing relatively slow visual reaction times. We were able to train them to a higher level of NVT proficiency once we included color-based tasks that best suited their ability to see and process quickly. People performing NVT on athletes may wish to be aware of and consider checking for color processing deficiencies such that one can train the athletes to the highest level possible.