Test batteries and normative reference standards for visual function and visual performance assessment in athletes: A systematic review of global evidence

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Athletic performance is largely shaped by vision, and visual assessment is increasingly being used in athlete screening, talent identification, injury and concussion management, and performance support. However, there are currently no recognised normative reference values or consensus test battery in the sports vision field that can be used to interpret the results of individual athletes. The constructs that practitioners choose to assess, the instruments they employ, the procedures by which tests are conducted, and the standards by which they determine whether a result is normal, sub-optimal, or elite differ greatly. The sports vision field has been broadly defined in earlier reviews, but none has systematically established which test batteries are used, how they are administered, or what reference criteria exist. Practical consequences of this gap include the inability to compare results between studies, laboratories, or sports in the absence of established constructs and reference data, as well as the lack of guidance for practitioners in resource-limited settings regarding which tests are worth the investment. The purpose of this systematic review is to synthesise the global evidence on visual function and visual performance test batteries used with competitive athletes, as well as the normative reference standards provided alongside them. In particular, the review will map the availability of normative data across sports, competitive levels, sex, age groups, and countries to identify athlete populations for which reference values are currently unavailable. Additionally, the review will identify which constructs are assessed and with which instruments, document administration protocols and reference standards, as well as assess whether studies report descriptive statistics sufficient for normative interpretation. The review will seek to comply with PRISMA 2020 reporting guidelines and Joanna Briggs Institute methodological approaches. We will search MEDLINE, SCOPUS, and SPORTDiscus without a time restriction. An additional search for grey literature will be carried out in Google, ProQuest Dissertations & Theses Global, SciELO, and Google Scholar. Eligible studies will assess visual function or visual performance in athletes competing at any level and in any sport, and will report quantitative results or normative reference values. Measures will be classified as non-sport-specific visual performance, sport-specific visual performance, or visual function. Two reviewers will independently screen records and extract data using a piloted extraction form, with a third reviewer resolving any disagreements. For each test identified, the review will extract the construct assessed, the instrument used, the administration protocol, the reference standard applied, whether the reported raw descriptive statistics are sufficient for normative interpretation, and whether normative data are reported. Two reviewers will independently evaluate methodological quality using the Joanna Briggs Institute critical appraisal checklists appropriate to each study design. The checklist for analytical cross-sectional studies will be applied to majority of the included studies, while the case-control, cohort, and prevalence checklists will be used when appropriate to the study design. Four pre-specified factors that are particularly pertinent to normative reference data will be evaluated in addition to the standard checklist items. These include the representativeness of the sample for the target athlete population, the suitability of the sample size for normative interpretation, the reporting of instrument calibration and standardisation of administration conditions, and the completeness of descriptive statistics. Disagreements will be resolved by discussion or by a third reviewer. Appraisal results will be tabulated and reported for each included study, rather than being used as a basis for exclusion. They will be used to contextualise the synthesis and inform confidence in the reported reference values. The results will be tabulated by construct, sport, competitive level, sex, age, and country, and summarised narratively. Expected outcomes include a comprehensive catalogue of visual assessment tests currently used with athletes, organised by construct, an appraisal of the degree to which current research reports data sufficient to support normative interpretation, and a clear map of the gaps in normative coverage across athlete populations, with particular attention to underrepresented sports, competitive levels, and geographic regions. It is expected that the evidence will be heterogeneous and that normative reference data will likely be sparse for many populations. Accordingly, a significant contribution of this review will be to identify the areas most in need of primary normative investigations. As this is a secondary analysis of already published literature, no ethical approval is required.

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