AS THE NEW York Knicks and San Antonio Spurs prepare for the deciding Game 5 of the NBA Finals in June, most of Scott Foster's pregame routine is what you would expect for a referee. Foster, in his 32nd season as an NBA ref, does typical warmups and stretches, helms the officiating crew's pregame meeting and manages some logistics such as selecting the game ball he'll later toss for the opening tip.
Inside the officials locker room, though, Foster is doing something else altogether to prepare for the biggest game of the season.
An hour to 90 minutes before tipoff, Foster dons a Meta Quest 3 virtual reality headset he keeps with him on the road for every game. He pulls up a program in which 10 virtual balls move around in his sight line, seven green and three orange. He's instructed to track the three orange balls. Then the orange balls turn green, blending in with the others. Foster is prompted to continue tracking the original three until the balls stop moving, when he's asked to correctly identify them.
"If I get a perfect score on the first stage, I'm like, 'Oh, I'm going to have a good game tonight,'" Foster tells ESPN. If he doesn't, he repeats it until he's error-free.
The drill gets more complex from there. Foster has to use headset joysticks to "block" separate balls that are launched at him, all without losing track of the three balls he's monitoring. Later, a virtual boomerang is tossed in his direction and he's told to choose whether or not it will "hit" him on its current path; his score drops if he answers incorrectly or loses track of one of his initial three balls in the process. It typically takes Foster around 15 minutes to complete the full drill, including possible repetitions for errors.
Foster is using what's known as cognitive priming, designed to warm him up for the intense visual and processing load that comes with officiating an NBA basketball game. This is one of a few such drills Foster has available, each with its own nuances. Foster and nearly a dozen other NBA refs have visited Ares Elite Sports Vision, a high-performance vision clinic in the Indianapolis area, in the past few years. Many are ongoing clients, carrying VR headsets and other tech with them on the road for virtual sessions and visiting the facility when they're in town.
"It's like jumping jacks for your eyes and your brain," says Dr. Joe LaPlaca, founder of Ares.
LaPlaca designs personalized programs for each of his clients. Some are focused primarily on pregame warmups, while others are for maintenance sessions between games.
"It's almost like eye yoga, if you will," says Marc Davis, a 28-year veteran referee and another Finals regular who uses cognitive priming before every game. "We spend so much time warming up our bodies before the game. But I literally take 10 minutes and I warm up my eyes and my reactions."
Cognitive training like this is becoming all the rage in sports, and not just for refs. Ares works with clients across the landscape, particularly athletes who rely on visual processing to drive their performance -- hockey goalies, golfers, auto racing drivers and other groups have begun diving headfirst into cognitive programs. Multiple teams have even outfitted their home facilities with tech straight out of the Ares lab. They aren't the only vendor in the space, either.
The trend isn't confined to high-level sports. Aided by improving technology, eye-based cognitive assessments and training methods have begun to make a massive impact in the medical world -- and might even hold the key to more effectively diagnosing and treating some of humanity's most well-known conditions.
"ALMOST EVERY ORGAN in the human body has a vital sign. Whether it's the lungs, heart, blood," says Mark Edwards, co-founder and CEO of ViewMind, a leader in brain health tracking. "But we don't have a vital sign for the brain."
Edwards says ViewMind wants to change that. They're one of a few major entities in the cognitive field working to understand more about our brains using the eyes as their primary gateway.
The medical community has long hypothesized basic connections between the eyes and brain, and looked to technology to help identify them. The first commercial fundus camera was invented a century ago in 1926, allowing for imaging of the back of the eye. This marked a major improvement in science's ability to understand the structure of the retina and its impact on visual processing.
Technology improved over subsequent decades, helping with the early detection of eye conditions such as glaucoma and retinal damage. It eventually became pivotal in identifying ocular tumors and similar problems. But there's only so much prodding or light exposure you can perform on the eye without injuring it, which limited these early methods that often involved these invasive actions.
"The eyes have very specific movements that are related to how we're processing and bringing in information. The length of these fixations, or the count of these fixations, is really important for understanding how people are making decisions or how they're processing information." Amanda Bentley, Tobii executive
Across the past decade or two, though, camera technology has caught up. Computer cameras, VR headsets and even smaller options such as pen-tip-sized cameras inside glasses make it possible to safely track granular eye movements without risking eye damage. And even in the early stages, the results have been impressive.
"The eyes have very specific movements that are related to how we're processing and bringing in information," says Amanda Bentley, an executive for Tobii, a company that's been in eye tracking for over 20 years. Bentley refers to the concept of "fixation," or how long the eye stops to focus on a specific input. "The length of these fixations, or the count of these fixations, is really important for understanding how people are making decisions or how they're processing information."
Another vital eye metric is the saccade, a quick simultaneous movement of both eyes from one visual stimulus to another. As Edwards puts it, our eyes "know what we're going to look at next before we're conscious of it." They essentially preprogram that move, a subconscious combination of eyes and brain that repeats itself constantly as we take in the world around us.
Combined with elements such as eye openness, pupil dilation and other more specific assessments, researchers have begun to understand quite a bit about our brains. They can precisely measure cognitive load and visual stress, qualities that previously could only be crudely estimated.
Bentley says Tobii's programs can also monitor "quiet eye," a term that has become ubiquitous around golf in the past decade. Research has shown connections between intent focus on the golf ball in the seconds preceding a shot and improved performance.
This isn't purely theoretical, either. Tobii combined with golf equipment manufacturer PING to bring this concept to life, running studies in which golfers wore eye-tracking glasses to test how different visual elements on a putter affected gaze and quiet eye focus. They reported a 23% average increase in quiet eye duration; 67% of golfers across multiple studies performed better when using the new, gaze-optimized putter.
This sector is full of subdisciplines and approaches, both inside and outside sports. Companies such as Tobii and ViewMind (the latter buys and utilizes many products from the former) focus on those distinct eye movements and how they translate to brain activity. Groups such as Ares, on the other hand, focus on using the eyes to test and hone cognition with more precision than what has previously been possible.
And athletes are beginning to take notice of the benefits.
DROP BY ONE of Cam Gray's training sessions, and you're liable to see several hulking hockey goalies immersed in VR exercises.
For one such drill, the VR joysticks essentially become the goalie's glove and blocker. They're placed in a setting with various "launchers" dotted around the environment, each of which can fling either a virtual ball or a virtual bomb at the goalie. If it's a ball, the goalie has to identify and block it. If it's a bomb, they have to click a button to slow it down, then dodge it. Items are launched in rapid succession, with varying levels that introduce speed and complexity. Each individual drill takes 3-4 minutes, with goalies often running the same drill two or three times.
"It's just a series of making decisions, getting your eyes to the next target, having an open peripheral view," Gray tells ESPN. "A lot of those things are very applicable to being a goalie."
Gray is the goalie coach for both the Indy Fuel and Chicago Steel minor league hockey clubs, plus a recently retired professional goaltender himself who played three seasons with the Fuel. He met Dr. LaPlaca (most clients call him "Dr. Joe") and worked with Ares near the end of his playing career. When he stepped off the ice and into coaching ECHL- and USHL-level hockey, he knew he wanted the technology to be part of his program.
The first step for Gray's goalies, as for any athlete, is a battery of eye and cognitive tests run by Dr. Joe. Some of these are similar to a traditional optometrist appointment, including eye measurements and analysis. LaPlaca does tests with lenses in front of the eyes to identify near and farsightedness.
Ryan Ouellette, a Fuel goalie, says LaPlaca discovered a basic vision issue he was totally unaware of.
"It's just a series of making decisions, getting your eyes to the next target, having an open peripheral view. A lot of those things are very applicable to being a goalie." Cam Gray, Indy Fuel coach, on eye-tracking exercises
"I've played hockey my entire life as a goalie, which is big for tracking and eyes, and I just found out now that I have a minor astigmatism," Ouellette says. LaPlaca recommended contacts that instantly improved his vision. "It was an eye-opening experience."
(Ouellette did not clarify whether the pun was intended on that last line.)
Other elements of the initial assessment are more novel. VR headsets, light displays, strobe glasses and screen-based drills can all be part of the program, which is designed to create a baseline for each athlete in a few key metrics.
Some cover areas such as peripheral vision or ability to move between visual stimuli effectively. Others involve a more granular look at key cognitive functions that can drive athletic success.
Reaction time is a headliner, one that contains a few important sub-categories: Raw reaction time is how fast one can respond to a simple stimulus. Choice reaction time refers to how quickly they can make a simple decision (such as yes/no or right/left) based on that stimulus. Choice decision time describes the delta between those first two metrics.
"That's really the space we operate in," LaPlaca says. "How do we decrease that number, choice reaction time?"
From here, LaPlaca designs a personalized program for each athlete tailored to their cognitive goals. Players are given a VR headset, weighted hand equipment and a tablet, all of which they can use on the road. Some of these drills are in specialty programs specifically designed for cognition; others leverage popular existing VR titles such as Beat Saber and Synth Riders, for which LaPlaca has designed corresponding translation metrics that convert game scores into useful cognitive data.
Some athletes use these primarily for periodic maintenance sessions, others for specific pregame preparation, many for both. Every athlete can view their progress in key metrics over time, comparing to (and improving on) that initial baseline.
LaPlaca's "milliseconds matter" slogan is especially applicable to goalies. Ouellette says that in the single season he has been using this tech, he shaved around 100 milliseconds off one of his major reaction time averages. A tenth of a second isn't that much, is it?
"[That] seems like nothing to everybody but us," Gray says. "We understand that that's the difference between a save and not making a save, a championship and not winning a championship."
Ouellette's save percentage jumped from .879 to .936 (the latter an elite figure) this past season as he began using the tech. A sample of one doesn't prove how effective the programs are, of course, but it's notable nonetheless.
Gray is such a big fan of LaPlaca's approach that the Steel have built an entire Ares setup in their home facility, allowing for regular testing checkups without leaving Chicago.
Ares also works on several related elements of cognition that are useful across different sports. Lydia Martyn, a middle blocker for Major League Volleyball's Indy Ignite, has found value in how the tech has helped sharpen her peripheral vision after just a few months.
The middle blocker role involves monitoring multiple opposing hitters and staying positioned to contest their attempted "spikes" at the net. The ability to track multiple objects across a single sightline is paramount to success.
"I was able to use my whole peripheral vision to know, OK, I have a girl in the back row who's available to hit," Martyn says. "I have three girls in the front row. The setter could still dunk the ball over.
"Before I could really only see tunnel vision, like maybe two people on the court to keep track of. As the season went on, I was able to keep track of all four and know who I had to defend against."
Auto racing is another sport making inroads with eye tracking, and not just for drivers -- Chip Ganassi Racing, a powerhouse IndyCar team, offers Ares tech to its pit crew members, helping them squeeze every fraction of a second out of their cognitive functions. Like the Steel, Ganassi has outfitted its human performance center with an in-house Ares facility that drivers and pit staff can use.
Chris Wheeler, director of driver development for Ganassi, thinks the tech has had a distinct impact. He lauds the ability to precisely track things such as reaction time and peripherals that are common across the landscape, but he also talks about another important concept: the impact the tech has on mental fortitude.
"I think it allows [our athletes] to perform better, but I also think it boosts their confidence," Wheeler says.
That confidence element comes up regularly with athletes and referees who use cognitive training technology, even if it's tougher to define with hard data.
"What my brain and my eyes capture, I can trust it a little bit more. [Cognitive training] has forced me to trust my peripheral vision, because I'm training my peripheral vision to make it a sharper focus." Marc Davis, NBA referee
Martyn talks about having less hesitation on the volleyball court after working with the program, saying the same effect even extends to other areas of her life off the floor. Multiple NBA refs mention being more assured in what their eyes are telling them, even in the toughest cognitive settings.
"What my brain and my eyes capture, I can trust it a little bit more," says Davis, who is one of the refereeing community's most forward thinkers regarding the way officials process the game. He has advocated for refs taking longer to make certain decisions, replaying the action in their head before blowing (or not blowing) the whistle. "[Cognitive training] has forced me to trust my peripheral vision, because I'm training my peripheral vision to make it a sharper focus."
Tyler Ford, an 11-year NBA official who worked his second consecutive Finals in June, calls LaPlaca a "personal trainer for my eyes and brain." Ford started with Ares in 2021, the first NBA ref to do so and one of LaPlaca's earliest sports clients.
He's credited with introducing it to nearly every other official who uses it, a number LaPlaca estimates at around 10. Ford, like Davis, says he uses the drills before every game.
"Similar to how you feel like you get a little edge from coffee or adrenaline, it sort of does that," Ford says. "You can lock in."
Many Ares users who are athletes naturally enjoy the competitive element of the drills. Most of them have leaderboards where they can compare themselves to competitors in other sports.
"You're trying to break your own record, but you've got these 20-year-old hockey goalies [Dr. Joe] is working with, or racecar drivers that have young eyes," Ford says. "Some of it feels like a game."
Foster takes that concept to hilarious lengths: He'll often bust out his VR headset with friends and offer them the chance to top him at some of the drills -- but they never do. "My friends are amazed that I can hit the red lights 244 times, and they only get 99," he jokes.
In the next sentence, though, Foster turns serious when talking about how, in that same drill, his initial baseline score was around 135. Some of the gains he has made in just a year of working with Ares have been striking. Foster was already considered one of the top refs in the sport, and he thinks the program has made a serious difference in his job on the court. It's quite the endorsement.
But it's far from the most important connection Foster has to cognitive technology.
"ONE OF THE things that got me going in this direction with the eyes and the brain is my wife has early-onset Alzheimer's," Foster discloses to ESPN.
Foster's wife of 30 years, Paula, was diagnosed in 2023 at age 54. When he began looking into potential therapies to help her manage the condition, eye and cognitive programs kept popping up.
Many uses of this technology in medical fields like these are even further along than its sports applications, in fact. Some of ViewMind's most interesting work is in the Alzheimer's space, where they've developed multiple tests that track the eyes and decipher early, previously undetectable signs that point to likely or even certain development of the condition.
In a peer-reviewed study from 2025, ViewMind tests identified asymptomatic carriers of the PSEN1 gene with 96% accuracy -- including for subjects in their 40s or even younger. The gene is the most common known cause of early-onset Alzheimer's; ViewMind's test also boasts 96% sensitivity, meaning negative results are a near-certainty that the subject does not carry the gene.
That's using an easy, non-invasive test that takes about 10 minutes, per Edwards, and has a cost that pales in comparison to other industry assessment methods. The PET scan, generally considered the gold standard for advanced Alzheimer's detection, costs thousands of dollars per scan and involves shooting an uncomfortable radioactive tracer into the brain.
"Normally when somebody is diagnosed and gets to the stage where symptoms become very evident, they've already been living with the disease even though they perhaps didn't know for many years." Mark Edwards, CEO of ViewMind, on Alzheimer's disease
ViewMind also has other related tests, including some that look to capture brain activity indicating the presence of another common indicator of Alzheimer's known as amyloid plaques. The potential ability to bring effective early identification to a wider group of people is a huge deal to Alzheimer's and dementia researchers.
"Normally when somebody is diagnosed and gets to the stage where symptoms become very evident, they've already been living with the disease even though they perhaps didn't know for many years," Edwards says.
Research shows that dementia can be avoided or significantly delayed by early modification of risk factors, including everything from alcohol consumption to air pollution exposure -- if it's properly identified soon enough.
Sadly for the Fosters, Paula's diagnosis came too late for most of these interventions. She tried out a few Ares drills and had some initial success, but her comfort waned as her symptoms worsened. It hasn't changed his belief in the technology, though.
"I think people who are at the early parts of that diagnosis, these kinds of drills would really help them," Foster says. "It's preserving the brain, keeping the brain young, keeping the brain moving."
Cognitive technology is also showing promise in several other medical conditions where early identification is key. Edwards says ViewMind has tests that identify distinct eye patterns unique to Parkinson's disease, Huntington's disease, long COVID and more. Some of these tests are still undergoing research and would require a formal approval process to become actual treatment standards.
To Karen Pierce, a neuroscience professor and co-director of the Autism Center of Excellence at UC San Diego, effective early diagnosis of autism as young as possible in a child's life is hugely important -- but badly lacking in the field. Pierce cites a national average of around 4 years old for diagnosis, which she says is far too late.
"The brain is incredibly plastic during early development," Pierce says. "You can sculpt the brain a lot more easily from birth to 2 or 3 [years old]."
Piece has developed a six-test exam battery for autism using eye tracking and related technology to try to combat the problem.
Because some kids with autism struggle with audio cues from other people, the "auditory-social" portion of the exam takes an interesting approach. Children might hear either a woman's voice speaking or "non-human" sounds such as cars on a road, depending on where they're looking on a screen. Pierce's program uses the time spent on each as a key data point.
In the social-visual attention segment, kids view side-by-side videos on a screen: One of children's faces or kids playing, the other of "non-social" stimuli such as geometric shapes. The tech is tracking how long they look at each (greater focus on non-social can be a signal of autism). "Shifting attention," or how often babies' eyes perform the vital saccade process of jumping between stimuli, is another key exam element.
Pierce says the exam, which is most effective in children 40 months and younger, has roughly 60% accuracy today -- around 40% of kids with autism can still pass it. But roughly 99% who do fail end up clinically diagnosed. The exam is part of an ongoing National Institute of Health (NIH) grant through which it's being used in doctor's offices, and Pierce hopes it could eventually become an accepted diagnosis method.
"Even if you could just gain 10 IQ points, that could help the child quite a bit as they age and as they go through school," Pierce says.
Some envision a day when cognitive technology isn't used only to diagnose problems but also for broader brain maintenance.
"In the past, that has been the focus of the brain -- is something impaired or not impaired? It's kind of a taboo label, people don't want to get tested if that's the result," Edwards says. "Let's work on improving and optimizing brain health. ... We would like there to be a brain vital sign."
"The brain is incredibly plastic during early development. You can sculpt the brain a lot more easily from birth to 2 or 3 [years old]." Karen Pierce, co-director of the Autism Center of Excellence at UC San Diego
Lofty goals like those will involve some challenges. Cost is one, though less for medical providers and more for individual patients; at least for now, insurance tends not to cover tests like these. The potential for scammers and ineffective tech is another.
Pierce thinks time is the bigger roadblock. Her autism battery takes 10 to 15 minutes, the result of a yearslong development process she takes pride in. But 15 minutes is a long time during standard child checkups. The same goes for most age groups.
Changing this clinical process will require altering expectations for doctor visits. Pierce has another NIH grant aimed at investigating how to fit her autism exams into typical child visits.
Widespread use among athletes might help raise the technology's profile. Edwards says ViewMind has dabbled in sports partnerships, including with the Dow Center, an elite basketball training facility in Argentina founded by former NBA player Pepe Sanchez (legend Manu Ginobili is also involved, per Edwards).
Part of ViewMind's initial goal was to use Dow Center athletes as a control baseline for some of their cognitive tests. Quickly, though, Edwards says they realized that every player they tested was well above average in most cognitive areas, rendering them useless as controls. It begs an interesting theoretical question: Do high-level sports self-select for athletes with exemplary cognition in addition to physical attributes?
And some of the most compelling work in this field fittingly straddles the line between athletes and the general population.
SEVERAL PEOPLE WHO spoke to ESPN for this piece share another trait beyond their desire to improve cognition: They've dealt with concussions.
Wheeler, who spent 20 years as an IndyCar spotter before his current role with Ganassi, sustained several concussions and brain bleeds. Martyn says she has had five documented concussions and six total, all from volleyballs to the head while defending shots. Gray sustained several across his goaltending career and describes them as a driving factor in his retirement.
They all found concussion treatment and return protocols cumbersome and unhelpful, a common opinion within the athletic world. Most involve a series of progressing requirements a player has to check off before being cleared, typically based largely on self-reported symptoms (or lack thereof) that are rife for manipulation.
"When I'm done officiating, I'll still do this." Scott Foster, NBA referee, on cognitive testing
"We're legitimately in the stone ages in terms of that stuff," Gray says. "There were times where I knew something wasn't right, but I could pass a test. I could get by, and nobody had any idea."
Cognitive testing could provide a big upgrade backed by real data. When an Ares athlete sustains a head injury, LaPlaca can test them and compare the results to their typical baseline to see exactly where their functions have diminished, then design a treatment plan to restore them.
Edwards describes a similar process in which ViewMind deliberately activates brain networks showing deficiencies following a concussion. He describes one case at the Dow Center in which a severe concussion was resolved in just three weeks.
The eyes have long held the keys to unlocking insights to the brain -- technology is now suited for the task. The ability to make athletes and refs better at what they do is simply icing on the cake if it's also keeping people healthier and happier.
As someone with experience on the athletic and medical sides of the tech, Foster perhaps sums it up best.
"When I'm done officiating, I'll still do this."
