1/4 Hour LabO #94: "The Role of the Eye in Postural Stability" - Frédéric Sabre

Introduction: The Unexpected Importance of Vision in Posture

Frédéric Sabre, an optometrist in Lausanne, sheds light on the fundamental link between vision and postural stability. His journey has taken him from functional optometry to a more holistic approach, incorporating primitive reflexes. He emphasizes that the eye should not be viewed in isolation when assessing posture.

This interview explores the subtleties of the optometrist's profession compared to that of the orthoptist, highlighting the impact of optimal visual correction, especially in athletes, to reach their full genetic potential.

Optometrist vs Orthoptist: Clarifying the Roles

An essential distinction must be made between the optometrist and the orthoptist. Although their fields may sometimes overlap, particularly in Switzerland where Frédéric Sabre practices, their roles are specific.

The Orthoptist: Specialist in Visual Rehabilitation

The orthoptist, with approximately two years of training, focuses on the rehabilitation of visual axes and the stimulation of amblyopic eyes, especially in children. They primarily work on the rehabilitation of vergences and strabismus issues.

The Optometrist: From Assessment to Comprehensive Care

The optometrist, whose training in Switzerland can last up to six years (three years of optician training plus three years of specialization), is the first point of contact for vision exams and the prescription of lenses or glasses. Their role includes screening and referring to an ophthalmologist in case of physiological pathology. In France, regulations differ, with optometrists being linked to opticians and rehabilitation remaining the domain of orthoptists.

The Vision Pyramid and Optimization for Performance

Vision is not limited to simple acuity. There exists a "vision pyramid" with several layers, each essential for optimal visual function. Frédéric Sabre stresses the importance of correcting vision beyond 20/20 for athletes to achieve their "100% genetic potential".

Iso-Acuity and Visual Balance

A solid foundation rests on iso-acuity, where both eyes are stimulated equally. An asymmetric effort between the eyes, even for equal performance, can create postural orders. The dominant motor eye plays a crucial role in posture, and an imbalance between the dominant eye for perception and that for posture can lead to dysfunctions.

Beyond 20/20: Aiming for 20/14 or 20/16

While for most patients, 20/20 is sufficient for daily life, for athletes or children with functional issues, it is crucial to aim higher. Achieving 20/14 or 20/16 can make a real difference in performance, although measurements beyond 20/20 are rare.

Hierarchy of Visual Exercises and Accommodative Blockages

Visual rehabilitation follows a hierarchical logic. Frédéric Sabre emphasizes accommodation as the first step, before vergences. Accommodative blockages are common, particularly in children, and resolving them can unlock other visual functions.

Accommodation Before Vergences

The visual pyramid places accommodation (the eye's ability to focus) before vergences (the ability of the eyes to work together at different distances). Often, rehabilitating accommodation is sufficient to significantly improve fusion reserves and vergences. This is a motor approach that, by resolving the initial problem, has positive repercussions on other levels of the pyramid.

Glasses or Contact Lenses: Equipment Tailored to Needs

The choice of visual equipment has a direct impact on performance and comfort, especially in a sports context.

The Limitations of Glasses in Sports

Glasses, while corrective, can introduce unexpected prismatic effects, especially during lateral eye movements. For athletes, this can lead to perceptual delays and instability in task execution, making eye-hand coordination difficult. In contact sports, they can even pose a danger.

The Preferred Option: Contact Lenses

For athletic performance, contact lenses are highly recommended, as they eliminate the drawbacks of glasses and provide more stable and natural vision. Regular follow-up by a healthcare professional is essential to ensure their proper use.

Vision, an Often Underestimated Factor in Performance

Many issues perceived as technical in sports, such as repetitive shooting or catching errors, can actually be of visual origin. The athlete, often unaware of an ocular issue, compensates unknowingly, limiting their progress.

Seeing is Not Always Perceiving with Balance

It is crucial to distinguish between "seeing" (having good acuity) and "seeing in a balanced and comfortable way". Even 20/20 vision can mask functional imbalances that affect performance without causing daily discomfort. Most visual problems can be resolved through a thorough eye examination. Since the eye is responsible for 70% to 90% of sensory input, optimizing this pathway is essential for any pursuit of performance.

Conclusion: The Eye at the Heart of Excellence

In conclusion, any pursuit of performance, whether athletic or general, must include a comprehensive visual assessment. An examination by a qualified professional ensures a healthy visual foundation. Even in the absence of apparent issues, striving for optimized vision, even beyond usual standards, is a powerful lever to achieve one’s "100% genetic potential".