Hard to believe it’s only 10 days until the movie Concussion makes its debut.

Will Smith admitted that he was conflicted in taking the role of Dr. Bennet Omalu because he is a big football fan. He loved the four years of bonding when his son played football, and having grown up in Philly he is still a big Eagles’ fan. The story of an Eagles’ player is featured in the film – the late Andre Waters, a former Eagles’ safety in Buddy Ryan’s defensive schemes known for his ferocious hits during which both he and opposing players experienced cumulative TBI and ultimately died from CTE. I confess being conflicted because I am still a football fan (and yes – like Will – an Eagles’ fan) yet am very concerned about the effects on young athletes who stay at it for a number of years.

For that reason, vision and concussion was my top story of the year for Elsevier’s Practice Update for Eyecare.

Expert Opinion / Commentary · December 14, 2015

2015 Top Stories in Eye Care: Adding Vision to Concussion Testing

Written by: Leonard J Press OD, FAAO, FCOVD

The public harbors a misconception that concussion is only significant if it results in a loss of consciousness, or an impairment in function so obvious that an individual is confused about time, space, location, or orientation. We now know that the detrimental effects of concussion resulting in mild traumatic brain injury can be far more subtle. By allowing the athlete to continue to play, we unwittingly set the stage for serial concussions. Cumulative effects can result in serious long-term damage that can impair visual function and cognition, and, in severe cases, lead to encephalopathies.

Galetta and colleagues call much-needed attention to this problem in their article published in the Journal of Neuro-Ophthalmology.¹ The NFL and CFL have now added sideline visual testing through the King–Devick (K-D) test (https://nfllabor.files.wordpress.com/2015/08/15cflnflpartnership-2.pdf) to basic tests of balance and cognition, and efforts to extend this type of testing to college and youth teams should be supported by the research presented in this study.

Where will this ultimately lead? The key to having meaningful data to assess the impact of concussion resides in baseline testing in the individual that can be used for comparison. Policy changes underway will eventually make baseline testing for eye movements mandatory for continued sports participation. This is crucial in determining when the athlete should be removed from play, but should also play a role in assessing when the individual is competent to return to play.

There are, however, deeper implications here. The population studied by Galetta and colleagues comprises youth and collegiate athletes. These are individuals who are not yet engaging in contact sports as their livelihood. Activities of daily living for these athletes therefore revolve around learning in the classroom as much as it does in playing sports. In protecting the future of these children it should therefore be our obligation to focus on assessing their visual competence to learn as much as it does in continuing to develop these sensitive indices for continuing to play.

Evolving policy changes will affect athletic trainers, team consultants, and athletes. Results of this research will eventually trickle down to those involved in education so that guidance counselors and health personnel who deal with these children can adopt a broader view of impaired visual function and its remediation.