"They tell me a test was made during the season, and they found that he's got 30 percent better peripheral vision than anyone. I mean, here's a kid who isn't big, who doesn't look like he's skating very fast, and nobody seems to catch him. Nobody can hit him. It must have something to do with how quickly he sees the puck."
- An opposing player’s explanation of what made Wayne Gretzky so dominant as the highest-scoring hockey player of all time.
It is estimated that about 80% of perceptual input in sports is derived from visual information received through the eyes.1 Sports vision specialists focus on assessing the visual abilities necessary for optimal performance in sports.
They work closely with athletes and develop personalized training programs aimed at enhancing skills such as visual acuity, depth perception, object tracking, peripheral vision, eye-hand coordination, and reaction time.
Although the majority of eyecare professionals are not sports vision therapists, almost all are in the position to prescribe contact lenses for their patients.
Consider this article a primer on contact lens prescribing options for the athlete in your chair looking to up their game—whether they are a professional e-sports player or simply tossing a ball back and forth in their backyard.
What are the benefits of contact lenses in sports?
Wearing contact lenses for sports and recreation is one of the many reasons why our patients start wearing contact lenses in the first place.
Research supports that contact lenses do have advantages over glasses as well, such as:
- A wider field of view: Contact lenses can increase the peripheral field of vision by approximately 15% over glasses.2
- More stable vision: With contact lenses, the patient will always be looking through the center of the lens. Considering the amount of eye and head movement that can take place, this helps eliminate potential distortions or blind spots that can occur with glasses—especially as they may occasionally be looking through the carrier portion of the glasses rather than the optical center.
- Reduced distortions and glare: Contact lenses resting directly on the eyes help to minimize the glare and reflections that can occur off of the surface of glasses. This allows for enhanced visual clarity and reduced distractions, allowing more time for visual processing instead.
- Improved safety: Glasses may break or shatter. Wearing contact lenses removes this risk and is therefore a safer option for the athlete. While some glasses are made for high impact resistance, these materials often decrease optical quality.
- Compatibility with protective gear: Some sports require helmets, goggles, or other protective headgear, posing a challenge for glasses wearers. Contact lenses eliminate these compatibility issues, allowing athletes to wear the necessary protective gear without compromising their vision.
What are the prescribing considerations for sports-performance contact lenses?
Sports-performance contact lenses can serve a variety of purposes. Some are focused on eliminating visual distractions, improving contrast sensitivity, and/or reducing glare by using different colored tints. Other sports-performance contacts are intended to provide the sharpest, clearest, and most stable visual acuity possible.
We'll start by discussing the variety of tints available and what they are beneficial for.
Tinting options
By using specific tints, we can diminish and help eliminate visual noise with the wide range of lighting conditions that a player may encounter in their environment. With color filtration, we selectively allow specific wavelengths of light to pass through while blocking others, altering the color composition of light.
Color filtration serves specific purposes and effects. For some individuals, it aims to enhance contrast sensitivity, enabling the identification of small objects in dynamic environments. For others, it focuses on reducing glare in outdoor settings, particularly in water or snow sports.
Yellow- or amber-tinted contact lenses
Yellow or amber-tinted contact lenses are used to enhance contrast and improve depth perception. They are particularly useful in low-light conditions, such as early morning or evening sports activities, or in cloudy conditions. These tints can improve visual clarity, making them beneficial for sports like tennis, baseball, and golf, where tracking fast-moving objects is essential.
Figure 1 illustrates an amber-tinted contact lens.
Figure 1: Courtesy of author Noha Seif, OD.
Green-tinted contact lenses
Green-tinted contact lenses can enhance contrast and reduce glare. They are suitable for sports played on grassy fields or under bright sunlight. I typically will consider a green-tinted contact lens when the environment takes place in nature, such as hiking, cycling, surfing or any other water-sports activity.
A green tint can also enhance visual clarity and depth perception, making them beneficial for sports such as soccer, cricket, and baseball, where reduced visibility due to dirt and sand is common.
Figure 2 illustrates a green-tinted contact lens.
Figure 2: Courtesy of author Noha Seif, OD.
Brown-, gray-, and blue-tinted contact lenses
Brown contact lenses enhance contrast and are ideal for sports played on green backgrounds, such as golf, archery, or fishing (with grassy bottoms). They can improve depth perception and help athletes judge distances accurately on grassy terrain.
Gray-tinted contact lenses provide a neutral tint that reduces brightness and glare while maintaining true color perception. By reducing the brightness, it allows for truer color rendition. They can also enhance visual comfort and reduce eye strain. They are versatile and suitable for a wide range of sports, including running, cycling, and water sports.
Lastly, blue-tinted contact lenses can enhance visual acuity and improve color perception. They are suitable for sports like basketball and tennis, where tracking fast-moving objects against a neutral background is important. The blue tint can enhance contrast and make objects appear more defined.
There are areas of overlap when it comes to what tint to use for what sport, and many times the choice comes down to patient preference.
Table 1 is a guide to understanding which contact lens tints best match specific sports.3
| Sports/Activity | Lens Tint |
|---|---|
| Snow sports | Browns, coppers, and ambers. Oranges and reds also work well. |
| Water sports | Dark gray is the best for fishing. Ambers, browns, and yellows are most effective in low light conditions. |
| Cycling and skating | Browns and coppers, with yellows being more effective in low light conditions. |
| Shooting sports | Yellows and ambers are useful for providing more contrast and lightening up the athlete’s view. |
| Golf | Ambers. |
| Tennis | Blue or aquas. |
Table 1: Courtesy of Adventure in Colors.
Considerations for prescribing color-tinted contact lenses
One thing to note is that tints may cause a color imbalance, so they will need to be tested out in the appropriate environment to assess their benefits. For example, an amber-tinted contact lens will turn a yellow-green tennis ball completely white.
This may allow the player to see the ball more easily. Some players, however, find that this advantage is counteracted by no longer being able to see the white stripes on the ball. These players who are used to gauging the spin on the ball will dislike this tint.
When prescribing a tinted contact lens, as with any type of soft contact lens, you'll need the patient's spectacle prescription and keratometry measurements. Depending on the lab that you are working with, certain tints may not be available in all prescription powers, and a custom design may be necessary.
A unique consideration for tinted lenses is determining if the patient benefits most from a fully tinted contact lens, or if only a certain iris diameter of tint with a clear periphery is needed. Cosmesis is also a factor—your patient may not want to take to the field with bright red eyes. Discuss with your lab consultant the availabilities of the prescription wanted and iris diameters available.
The custom soft lens in Figure 3 has an amber tint and clear periphery. This is an older lens from my fit set and, as you can see, the tint has started to bleed.
Figure 3: Courtesy of author Noha Seif, OD.
Types of contact lenses to consider
Once you and your patient decide that a contact lens makes sense, the next choice is determining the particular type of lens. This will primarily come down to their prescription and the acuity needs for their sport.
Standard soft contact lenses
The most convenient option will be a soft contact lens. Daily disposable soft lenses are a particularly good choice, providing a fresh lens for each use and eliminating the need for cleaning and storage. Standard soft contacts are a great starting point for young patients, spherical and low-cyl prescriptions, and recreational athletes.
Custom soft contact lenses
For patients with any amount of cylinder correction, a custom soft lens should be considered. A custom soft lens allows the eyecare provider to prescribe the exact prescription necessary, whether they have a 0.25D of cylinder or 3D, at any axis.
For an athlete, a prescription that is 5 to 10° off could slow information processing. In highly competitive sports, where the difference between success and failure is measured in inches or seconds, eliminating that delay will provide an advantage. A custom soft lens also allows for a much broader variety of tinting options.
Gas-permeable (GP) contact lenses
For athletes who require highly accurate and rotationally stable vision, gas-permeable lenses should be on the table. These lenses provide the sharpest vision and correct for astigmatism more precisely than any type of soft contact lens. They also offer good durability and do not rely on water content to hold their shape in dry environments.
However, they are not suitable for all sports. In a dusty or outdoor field environment, there is a potential for an increased risk of dust/debris particles getting caught in the lens. There is also an increased risk of dislodge (compared to soft lenses) during vigorous activities with dynamic head movement. No athlete wants to be on the field looking for their contact lens while play is going on around them.
One of my favorite sports vision success stories is when I was privileged to prescribe lenses for an Olympic sharpshooter. Precise visual acuity was of the utmost importance, and head/body movement was at a minimum, making GP lenses a perfect choice.
Hybrid contact lenses
Hybrid contact lenses aim to provide the best of both worlds. They combine a GP center (precise vision) and a soft peripheral skirt (comfort, stability, lower risk of capturing debris on the field). However, all magic comes with a price. Hybrid lenses may not be suitable for young patients due to the necessity of proper hygiene and the need to follow a regimented replacement schedule.
The insertion/removal process and cleaning routines are more involved compared to other contact lens modalities. Additionally, hybrids are a more expensive proposition than their soft and GP lens counterparts, given their complex fitting process, higher lens costs, and need for consistent follow-up visits.
Orthokeratology (Ortho-K)
Ortho-K lenses allow athletes to forgo both glasses and contact lenses, giving them the most freedom of movement possible. This type of contact lens is placed on the eye before bed. Overnight, the patient’s corneas are reshaped underneath the lenses, giving them clear vision when they remove the lenses the next morning.
Ortho-K lenses are a great choice for water sports and swimming, minimizing the sight-threatening risk of acanthamoeba. They are also helpful in cases where contact lens-related dryness is a factor. On the other hand, playing sports in the evening may prove difficult as the quality of the vision correction will degrade throughout the day.
Furthermore, a regular sleep schedule is necessary, which might be difficult for professional athletes who frequently travel across time zones.
Scleral lenses
For athletes with irregular corneas or keratoconus, a scleral lens will provide the best and most stable vision correction achievable. There is a lot to like about scleral lenses: the GP material allows for precise vision correction, the large diameter allows for good comfort, and the semi-seal fit of the lens provides fantastic stability during dynamic eye and head movements.
For regular corneas, however, there is a chance of inducing higher order aberrations,4 presenting visual issues that are not present when soft, GP, or hybrid lenses are being used. In these cases, a wave-front guided scleral lens may be necessary to reduce any visual noise.
Scleral lenses are similar to hybrids in that they necessitate a specialized fitting process with regular follow-up visits to ensure proper fit and vision correction. I typically lean toward other contact lens modalities for patients with regular corneas.
Thinking outside the ball: Contact lens considerations for e-sports players
Given the popularity of video games, the possibility of an e-sports athlete in your chair is high. In fact, e-sports viewership is beginning to rival and may eventually exceed that of traditional sports. Like all athletes, they will be looking to improve their performance and gain a competitive edge over their opponents. Visual acuity, object tracking, eye-hand coordination, and reaction time are similarly at a premium.
The main difference here is the environment: players can spend dozens of hours staring at screens daily, with reduced blinking and higher-than-average demands of eye-tracking. What specific contact lens considerations should be made for this population?
Prescription
Depending on the patient's prescription, a choice to proceed with glasses vs. contact lenses will need to be weighed. For example, with a high myopic prescription, the patient may have reduced peripheral vision and/or have a minification effect, reducing their visual clarity with glasses.
Dryness
For any device user, we are aware that the blinking rate is reduced.5 For an e-sports player, acting in accordance with the 20-20-20 rule will likely be impossible during play—every second is necessary to visually intake. A lens with a low wetting angle may be necessary, potentially alongside other dry eye regimens when not competing or training.
Tints
A variety of tints are useful for e-sports. Tints that enhance contrast, such as green, brown, and gray, will improve visual clarity, enhance details, and allow characters on the screen to appear sharper and more defined.
Other tints, such as amber/yellow, are useful in reducing glare from the screen, reducing the impact of excessive brightness, and are useful in low-light environments when playing games with dark scenes. For a general reduction in brightness or for those prone to light sensitivity and migraines (especially from fluorescent lighting), a rose tint is comforting.3
Figure 4 shows a patient who requested a contact lens with a yellow tint for computer gaming purposes.
Figure 4: Courtesy of author Noha Seif, OD.
As you can see in Figure 5, the result was striking in one way, turning a blue eye to green. However, only the center of the lens was tinted for aesthetic purposes so that it was not striking to others.
Final thoughts
Contact lenses are an excellent option for sports vision patients due to their ability to improve peripheral awareness, provide freedom to make dynamic eye/head movements, and the potential to provide enhanced visual acuity. Optometrists should carefully consider the patient's refractive error, material, tints, and fit when prescribing contact lenses for these patients.
When discussing these options with patients, it is essential to explain both the benefits and limitations of the various options. Based on their prescription, visual demands, and the environment in which they are performing, there are several variables to consider when attempting to achieve an edge in visual performance.
Set realistic expectations, ensure regular follow-up, and consider onboarding other specialty eyecare providers to their team, such as a sports vision therapist, a specialty lens fitter, and a great optical with a variety of tints and protective eyewear options available.
By providing clear communication and education on wear and care, optometrists can help sports vision patients excel while ensuring maximum comfort and safety.
