This is a GREAT blog. well written with reserach to back it up. Thanks Selena 
Ever been to a cave? It’d be a great time to go this week with the heat index as it is! Okay… so caves are cool, but something else… caves are also a sensory challenge. I did a girl’s trip this last May to Mammoth Cave. We spent 4 hours many feet under the ground. Can you appreciate the darkness in Mammoth Cave from my photo? A single experience in Mammoth Cave has me thinking about the International Triathlon Union, the USA Triathlon and Aaron Scheidies, PT.
I’m jumping ahead of myself… the cave… when we first entered the cave and were all the way inside the cave, I had a really weird experience. I could see, but my vision was impaired by the darkness. I couldn’t see the ground. My daughter was just a shadow to my right (and she was like 2 feet from me). She was freaked enough initially that she had to hold onto my arm. Of course, there were other people doing the same cave tour, but I couldn’t see any of them clearly and basically kind of saw moving shapes. And the moving shapes weren’t crisp. Because I couldn’t see the ground, I was really, really using proprioception from my feet working with my vestibular system to keep me from falling. The ground wasn’t smooth – it was bumpy and there were dips and there were inclined areas and there were declined areas. There wasn’t anyone mentioning if the ground felt slippery or exactly which direction the ground was sloping or if there were little bumps of rocks. Somehow my brain was quickly processing this information and allowing me to remain upright as I walked. Initially, the experience made me think about some of the patients I treat and their visual impairments and their balance. And then, of course, because I’m a geek… I even started contemplating patients I have treated who have both visual deficits AND peripheral neuropathy. I realized just how much I take for granted without even realizing it! A lightbulb moment occurred: I have a better understanding of how difficult mobility and function can be for individuals with these types of issues. The experience provided me with a better grasp of the real fear of falling these people express to me.
Aaron Scheidies, PT is from Michigan and practices in Washington, I think. He’s been an athlete pretty much all his life. He inherited Stargardt’s disease from his parents. Stargardt’s disease is similar to macular degeneration. If you google him, you don’t find much about his physical therapy career, but you do find another passion. He is an elite athlete and competes in triathlons. When I say “elite,” I mean elite. I can’t imagine what it would be like to compete in triathlons and win 6 world championships and 7 national ones. (Maybe one day I’ll meet Aaron and I’ll ask him exactly how that kind of accomplishment feels!) Based on the World Health Organization (WHO) and the International Council of Ophthalmology classification system, Aaron’s visual deficit would be considered profound low vision (20/500). What this means is that Aaron can see something at 20 feet that those of us with “normal” vision can actually see at 500 feet.
The Mammoth Cave experience impacted me even more than I thought. When I read about Aaron battling the USA Triathlon’s enforcement of a rule set by the International Triathlon Union, it gave me reason to pause and critically think. This rule mandates all visually impaired athletes (visual acuity of 20/200 or worse) to wear black out glasses during the full portion of the run. It is quite apparent the International Triathlon Union highly values “fairness.” To a certain extent, I can appreciate the value of “fairness.” At the same time, even though black out glasses seem to equate the playing field for that division of athletes, is it really the right thing to do? Since this blog values evidence, I figured I’d share my findings on this particular topic of black out glasses for the visually impaired athletes competing in triathlons.
The standardized description of the cutoff point for defining visually impaired triathletes (20/200) is difficult for me to perceive, so I dragged my husband out and had him help me with a little experiment to better grasp what 20/200 visual acuity means. In the first photo, Scott is standing 200 feet from me. And in the second photo, he is 20 feet from me. (The zoom level is the same in both photos, so obviously I snapped the 20 foot distance first.)
By walking out in our yard, doing this AND seeing just how far 200 feet was and imagining a visual deficit of that degree, I think some of the research I found made complete sense to me. Now, honestly, there isn’t much research out there with triathletes on this particular topic of visual impairment and black out glasses. An odds ratio of pedestrian-motor vehicle collision for children who have abnormal vision is 4.25. I realize Aaron isn’t a child, but when one considers the speed of vehicles and his inability to see great distances, it seems logical that he could more easily be hit by an oncoming car than me. Now, the one thing I am very unsure of… training. If the rules mandate black out glasses, and the athletes also train in them (thinking specificity of training), this rule purposefully eliminates light perception which logically would increase the risk of serious injury in a population of people already at an increased risk.
Okay, you could argue that perspective is whacked because the likelihood of a person who is visually impaired going out for a run independently is probably slim to none. I understand there would be a guide and a tether. So, maybe not a pedestrian-motor vehicle accident, but thinking about the cave… ever been in a cave when ALL the lights were turned off? Zero light? Seriously, it’s a very scary feeling – shuffling your feet, putting your hands out in front of yourself and moving slowly and actually feeling somewhat unsteady. Is it reasonable to mandate these athletes put themselves into a blind situation? This kind of situation screams of disaster and injury.
Interestingly, in looking at WHO data, 14% of those with visual impairments are completely blind. The rest of those with visual impairments have some degree of light perception. I could not find any data depicting the number of athletes competing who are completely blind. I will assume it is a very, very small percentage.
I happened upon an ongoing debate. The use of technology was questioned in paralympic sports and continues to be questioned. I got lucky and actually found an article written by a colleague of a friend of mine in Australia. Dr. Brendan Burkett shared a paper he authored on the debate occurring in paralympic sport – that fine line between whether the technology is essential or whether it is enhancing performance.
All sorts of technology is used by athletes – and often times that technology does end up enhancing their performance. The division of athletes with visual impairments is having the opposite sort of occurrence. The ruling creates a situation where these athletes will be required to only depend on proprioceptive and vestibular inputs when they compete. Sure, over time, there may be neurophysiological changes that occur in their brains to adapt to a complete loss of vision (well, IF they wore the darn black out glasses 100% of the time). Is it truly reasonable to mandate a rule that immediately puts an athlete at a disadvantage and at an injury risk, especially when only a very, very small percentage of competing athletes are blind? And is the playing field truly more fair and equal between the visually impaired competitors? Don’t the athletes who are blind now have an advantage because of neuroplasticity in their brains that have adapted to no light perception?
Wouldn’t it be both more fair and safer to just create subcategories within the visual impairment division? Creating subcategories truly allows each athlete to compete with all his/her abilities.
Best wishes to you, Aaron. I hope you are able to safely compete with ALL the talent and ability you do have in the Nautica New York City Triathlon on August 7th. I’m sorry rules and decisions were made with a high focus on creating a perception of equality between all of you in the visual impairment division instead of considering evidence and determining risk/benefit ratios. I will definitely be checking online for results and cheering for you – both your athletic ability AND your courage to fight for safety for athletes.
