This study aims to systematically evaluate the impact of visual training (VT) on athletes' decision-making skills and sport-specific performance, while assessing the moderating effects of participant- and training-related factors. A systematic literature search was conducted across Web of Science, PubMed, MEDLINE, and SPORTDiscus, with the search limited to publications available as of January, 2025. Only randomized controlled trials with baseline and follow-up measures were included if they examined the effects of VT on at least one measure of decision-making skills and sport-specific performance in healthy athletes. The search yielded 3435 articles, of which 27 studies involving 669 participants met the inclusion criteria for meta-analysis. The results revealed that VT significantly improved decision-making response time (SMD = 0.85; 95% CI = [0.45-1.24]; I2 = 30%; p < 0.01) and sport-specific performance (SMD = 0.49; 95% CI = [0.13-0.85]; I2 = 61%; p = 0.01). Subgroup analyses revealed that no statistically significant differences were observed across groups, either based on participant characteristics or training protocols. However, trends in effect sizes and significance levels indicate that VT exhibited a slight advantage in some subgroups, suggesting that individual differences and training design may partially modulate its effects. VT demonstrates considerable potential as a supplementary training intervention, effectively enhancing response time and sport-specific performance in athletes. Future research should focus on extending intervention periods and refining training protocols to further elucidate VT's long-term benefits and its applicability across different athlete populations. Trial Registration: PROSPERO ID: CRD42024568547
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