As pickleball popularity skyrockets, eye injuries from sport also on rise

(Image Credit: AdobeStock/Наталия Кузина)

As pickleball continues to gain popularity across the country, the potential for players to get hurt participating in the sport is also on the rise.

Daily, more and more people are hitting the pickleball courts, with investment bank UBS estimating there has been a 150 percent increase in the number of people playing the game this year with 22.3 million people now on the courts, making it the fastest growing sport in America over the last two years, according to the Sports & Fitness Industry Association (SFIA).

In the sport, which is a hybrid of badminton, ping-pong and tennis, players use a plastic-perforated ball, slightly heavier than a whiffle ball, and wooden or composite paddles that are about twice the size of ping-pong paddles.

According to Pickleball Magazine, a pickleball can travel at one-third the velocity of a tennis ball, or about 40 mph. The magazine noted that when the players are positioned at the “no-volley line,” it can take 350 to 400 milliseconds - less than half a second - for the ball to travel from one paddle to the other. This does not leave players any time to avoid being hit in the eye with a ball. In addition to injuries from being hit by a ball, serious damage can occur from being hit in the eye with a paddle.

The magazine also suggests that players suffering eye trauma while playing the sport see an ophthalmologist should an injury result in a change or loss in vision, substantial pain, bleeding or bruising.

Annette Hoskin, PhD,a Research Fellow at the Save Sight Institute, University of Sydney and the Lions Eye Institute, University of Western Australia in Perth, noted that with the increase in popularity of the sport, ophthalmologists are likely to see an increase in eye injuries connected to the game.

“Eye injuries in sport are a mix of factors relating to the presence of a bat or ball, the size of the court and opportunity for impact with other players increasing the risk of eye injury,” Hoskin said.

Hoskin pointed out that some analysis of the game, planed a smaller court, indicate the energy transfer from a pickle ball is around 4.2J - which is lower than a squash ball (which is 6-9J). Squash and badminton are particularly problematic as the ball/ shuttlecock fits nicely into the orbit.

“Also the ball is a similar size but more than half the weight of a tennis ball,” Hoskin explained. “So with all of that in mind I suspect the most likely injury is associated with blunt trauma, with possible orbital fractures or hyphemia as result.”

Moreover, players at higher risk include high myopes, those with previous surgery, cataract, and are more likely to sustain an eye injury with more severe consequences.

“In terms of recommended protection I would suggest a plastic (or equivalent frame) with lateral protection and a polycarbonate lens, and if playing outside UV and glare protection,” she said.

A study¹ outlined cases of pickleball players who suffered retinal tears due to an eye injury suffered while playing pickleball. In one case, a 66-year-old male patient presented with a symptomatic retinal tear, localized retinal detachment, and mild vitreous hemorrhage nine days after he was hit in his left eye while playing pickleball.

According to the study,¹ the patient, who was not wearing any eye protection, was with cryotherapy, and 3 weeks after the treatment, the vitreous hemorrhage and retinal detachment resolved.

In the second case, a 60-year-old patient presented with a posterior vitreous detachment and a symptomatic retinal tear 1 month after blunt trauma to her left eye from a pickleball injury. The patient underwent successful laser retinopexy treatment.

According to the researchers, the sport is gaining popularity among older Americans, who many not have the quickness or agility to avoid contact injury. USA Pickleball, the sport’s governing body in the United States, estimates that about 17% of pickleball players are 65 and older.

“In addition, visual impairment is more common in this population because of cataract, macular degeneration, and other causes, making it more challenging for participants to see and avoid a wayward ball or racquet,” the researchers said in the study.

The researchers concluded that eye protection is vital when playing the sport, especially players who are at higher risk for retinal detachment.

The costs of all pickleball injuries, including eye injuries, could result in health insurance costs ranging from $250 million to $500 million in 2023 alone, according to estimates from UBS.

Lori Pacheco, RN, CRNO, discussed sports-related eye injuries and how to prevent them with Ophthalmology Times at the recent ASCRS annual meeting in San Diego.

“Any type of racquet sport is at high risk,” she said. “Not only do you have the rackets and the arms and everything, but you also have the ball coming at you at a very high rate of speed.”

When it comes to the eyes, injuries can include permanent or partial loss of vision, torn retinas, bleeding in the eye, cuts requiring stitches, and black and blue eyes, similar to injuries ophthalmologists seen people injured in other racquet sports like tennis, squash and racquetball.

According to the American Academy of Ophthalmology (AAO), about 40% of eye injuries each year occur during sports and recreational activities, and 53% of ophthalmologists surveyed in a report pointed out that most sports related eye injuries they treat are among teenagers (ages 13-19), followed by young adults (20s), children (12 and under), adults (30-50) and older adults (50+).

Moreover, the AAO noted there are about 30,000 sports related eye injuries annually the United States, many of which could be avoided with adequate eye protection.

“So, these are all preventable injuries by using the right pair of protective equipment,” Pacheco said.

In its report, UBS has calculated medical costs for the year and is forecasting 67,000 visits to the ER room, 366,000 outpatient visits, 8,800 outpatient surgeries, 4,700 hospitalizations with 20,000 follow-up 'episodes' relating to injuries caused by pickleball, including eye injuries.

A total of $377 million in medical costs can be attributed to pickleball, with $302 million (80 percent) in outpatient settings and $75 million (20%) in inpatient settings.

'While we generally think of exercise as positively impacting health outcomes, the "can-do" attitude of today's seniors can pose greater risk in other areas such as sports injuries, leading to a greater number of orthopedic procedures,' UBS's analysts wrote in their conclusion.

Reference:

1. Catherine F. Atkinson, BA, Mark E. Patron, MD, Brian Joondeph, MD, MPS. Retinal Tears Due to Pickleball Injury. Retinal Cases & Brief Reports. Published January 2020. DOI: 10.1097/ICB.0000000000000965.