Objective The purpose of this study was to determine the effect of protective helmets (i.e., football, lacrosse, and ice hockey helmets) on vision and sensory performance.

Design Experimental cross-over study.

Setting Clinical research centre.

Subjects A convenience sample of 24 healthy college-aged males who played American football (n=14), lacrosse (n=5), or ice hockey (n=5) at a minimum of a high school level.

Intervention Participants completed vision and sensory performance assessments under two counterbalanced conditions: helmeted and unhelmeted.

Outcome measures The Senaptec Sensory Station assesses visual clarity (LogMAR), contrast sensitivity (logarithm of contrast sensitivity), depth perception (arcsec), near-far quickness (# cycles complete), target capture (threshold response time), perception span (# correct responses), multiple object tracking (tracking capacity), eye-hand coordination (average response time), go/no go (correct minus incorrect hits), and hand reaction time (average reaction time). The overall helmet effect and helmet-by-sport interactions were assessed.

Results Participants performed 40.7ms slower on eye-hand coordination (95% Confidence Interval [CI]: −66.64, −14.83; p<0.01) and 3.4 points lower on go/no go (95% CI: 1.56, 5.32; p<0.01) when wearing a helmet. Hockey helmets significantly affected visual clarity (95% CI: −0.3701, −0.0883; p=0.01) and hand reaction time (95% CI: −38.67, −9.73; p<0.01), but football and lacrosse helmets did not.

Conclusions Vision and sensory performance was negatively impacted by wearing a helmet. This inability to see and respond to visual stimuli could have implications for athlete safety and performance, and should be explored further in other at-risk populations such as youth and female athletes.

Competing interests Kramer: None.

Wasserman: None.

Teel: None.

Mihalik: Dr. Mihalik has an equity interest in Senaptec LLC

Keywords: Concussion, Injury prevention, Vision, Helmet, Facemask