Some pickleball players took a direct hit from a fast-moving ball. Others were struck by a paddle. Some fell on the court. All suffered injuries to their eyes.
The injuries have spiked in recent years among players of pickleball, the fastest-growing sport in the United States, according to a study published on Thursday. As the sport has gained popularity, it may have also attracted less experienced and less fit players, who may be less agile and more susceptible to injury, the authors noted.
“We’ve seen a lot more players who are not familiar with the sport entering the court, and that creates a lot of opportunity for injury,” said Dr. Jonathan C. Tsui, the study’s senior author and a professor at Rutgers New Jersey Medical School.
“They’re not used to how fast the projectiles are moving and how close to the other players on the court they are,” he added. Dr. Tsui became interested in the subject when a colleague came to work with an injury after a weekend pickleball game.
Some injuries were serious enough that they could lead to vision loss. They included retinal detachments, fractures to one or more of the bones that make up the eye socket, and hyphema, blood collecting in the front of the eye.
Dr. Tsui urged players to wear protective eye gear, because hollow, perforated pickleballs meet little air resistance and travel quickly.
The study, published in the journal JAMA Ophthalmology, analyzed the number of eye injuries that brought pickleball players to hospital emergency rooms from 2005 to 2024. Dr. Tsui and his colleagues extrapolated from a database of injuries that relies on a nationally representative sample of hospitals.
From 2014 to 2021, the number of eye injuries stood at about 200 a year. But as the sport took off in recent years, the number of eye injuries started to climb, growing to about 405 cases a year from 2021 to 2024, the study found.
While there were just over 3,100 pickleball-related eye injuries that brought players to emergency rooms between 2014 and 2024, over one-third of them — some 1,262 injuries — occurred in 2024 alone.
Players 50 and older, who were more likely to sustain ocular injuries than younger players, accounted for 70 percent of all eye injuries. Age-related decreases in muscle mass, bone density and balance may have made them more vulnerable, the authors said.
Yet the biggest group of pickleball players are 25- to 34-year-olds, according to the Sports & Fitness Industry Association.
The new study is not the first report of eye injuries on pickleball courts. Several case reports in recent years have described patients who sustained retinal tears or detachments that required treatment with cryotherapy and laser treatment.
Other patients experienced dislocation of the crystalline or intraocular lenses. Among them was a 76-year-old woman who sought medical care after developing blurry vision immediately after being injured, and a 77-year-old man who saw a doctor 10 days after a game, when he noticed his vision was worsening.
Ocular injuries in sports like tennis and baseball have been declining.
Pickleball is played on a small court with participants often positioned only 14 feet apart, leaving them little time to react to avoid a ball or flying paddle.
Newer paddles can send balls speeding up to 60 miles per hour, the study said. Biomechanical analyses have shown that a pickleball traveling 30 miles per hour or more can deform the cornea, retina and vitreous of the eye, exerting enough pressure to dislocate the lens, the study said.
Eye protection is not required for professional or casual play, the authors of the study noted. USA Pickleball, the sport’s governing body in the United States, last year disapproved of a rule change that would require players to wear eye protection in its tournaments, saying it would be difficult to enforce.
Pickleball clubs and courts also do not require eye protection. But the American Academy of Ophthalmology last year recommended players wear eyewear that meets the American Society for Testing and Materials F3164 guidelines, which are the standard for most racket sports.
In an editorial accompanying the study, Dr. Dolly Ann Padovani-Claudio of the Kellogg Eye Center at the University of Michigan and Adam R. Glassman of the Jaeb Center for Health Research in Tampa, Fla., cautioned that there were limitations to data drawn from registries like the one used in the new study, which included just 2 percent of all U.S. hospital emergency departments.
Nevertheless, the writers urged USA Pickleball to develop guidelines on protective eyewear in order to stem injuries and to introduce educational programs to raise awareness of the risk.
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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