Tennis requires a unique combination of stamina, hand-eye coordination, and agility. The ability to keep focused on the tennis ball, often reaching up to 100–130 miles per hour on serves, requires intense reaction time speeds that are built upon fundamental neuro-ophthalmic principles. These fundamentals play an essential role in the proficiency of tennis players, including dynamic visual acuity, visual field, line-of-sight, saccades, and smooth pursuit. In this chapter, we discuss these fundamentals with close detail on how they impact the game of tennis. We aim to provide knowledge for ophthalmologists, sports medicine providers, and athletes on how these aspects of neuro-ophthalmology play a critical role in tennis.