Surge in Pickleball Correlated with Increased Rate of Eye Injury

Eye protection should be emphasized for pickleball players, especially for those with high myopia or family history of retinal detachment and those with cataracts who may experience blur of gaze. Photo: Jon Matthews/Unsplash. Click image to enlarge. While going outdoors and participating in sports and other outdoor activities is great from a health perspective, any pastime will come with potential negative outcomes. Concerning sports, injuries often top the list. In particular, pickleball has seen a marked increase in popularity, especially in the last decade. To assess incidence and identify demographic factors, researchers from Rutgers Medical School and the VA service evaluated data from the National Electronic Injury Surveillance System (NEISS)—a database based on a nationally representative probability sample of hospitals in the US. Their work was published last week in JAMA Ophthalmology.From this representative dataset, it was found that 73 pickleball-related ocular injuries occurred between 2005 and 2024, with 33 occurring in 2024 alone; as a weighted equivalent, the researchers projected these numbers to reflect an estimated 3,112 total injuries and 1,262 taking place in 2024. It was also found with weighted analysis that estimated pickleball-related eye injury incidence increased by 405 cases annually from 2021 to 2024. More people aged 50 or older experienced these injuries.In the discussion section of their paper, the authors relay that surveys reveal the growth in this sport is due to greater number of casual players, which could result in these players being more susceptible to injury from limited experience, game unfamiliarity or lower fitness levels. However, more telling is that 70% of all injuries occurred in players aged 50 or older, which may be mapped onto greater injury rate influenced by decreases in muscle mass, bone density and balance. Thus, they recommend that “for players in this age group, potential strategies to prevent eye injuries include strength and balance training, stretching and warming up prior to play, and use of proper equipment, including court shoes.”1Less severe injuries included periocular lacerations, corneal abrasions, iritis, periocular contusions, posterior vitreous detachments, subconjunctival hemorrhage and traumatic mydriasis, while severe injuries were retinal detachments, globe trauma, orbital fractures and hyphema.Importantly, the authors also point out the concerning fact that eye protection is not required for casual or professional players. Without formal guidelines, the American Academy of Ophthalmology recommended in 2024 that eyewear for pickleball should meet the American Society for Testing and Materials F3134 guidelines—the current standard for most racket sports. Related to this sentiment, the authors urge that “establishing standardized guidelines for eye protection is recommended to reduce the risk of ocular injuries among players.”1However, commentators also writing in JAMA Ophthalmology highlight some of the limitations of this study. Databases like NEISS and the Nationwide Emergency Department Sample are based on emergency department data, whereas other sets include data from outpatient practices—including community-based or private practices as well as academic or university-based clinics—or from broader surveillance systems, surveys or administrative data.They elaborate that the NEISS is limited by the number of hospitals sampled, lack of follow-up data for each patient and the restriction to emergency department visits. Conversely, other databases may include additional information like visit types, diagnoses, procedures, prescriptions and billing summaries. Other relevant information lacking from this study could pertain to non-ocular comorbid conditions, laboratory values, or ocular and other radiologic images, which may foster examining associations between ocular conditions and other general clinical phenotypes. Additionally, longitudinal data—once again, absent in this investigation—may allow for assessment of practice patterns, disease progression or responses to therapies.As well as with other potential limitations, the commentators still believe that “using a registry such as the NEISS may be the best mechanism to analyze injury data across the country to better understand the risks related to recreational sports and other sources of eye injury.”2 They advocate for educational programs and campaigns to promote eye safety, which has been successfully implemented with other sports.Click here for the study and here for the commentary. 1. Lacher CR, Koc I, Tsui JC. Pickleball-related ocular injuries among patients presenting to emergency departments. JAMA Ophthalmol. October 16, 2025. [Epub ahead of print].2. Padovani-Claudio DA, Glassman AR. Benefits and limitations of using population databases for eye research—more than meets the eye. JAMA Ophthalmol. October 16, 2025. [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.