Eye injuries in NHL cost franchises more than $32 million

While eye injuries are a serious risk to professional hockey players and have resulted in career-ending injuries, visors remain optional for the majority of hockey players in the NHL and whether visors should be mandatory has been greatly debated in the media. This is the first study to examine the mechanism of injury, the incidence of eye injury across multiple seasons, and to calculate the associated financial loss. These factors can better inform NHL policy decision-makers.

The researchers, based at the University of Toronto and Harvard Medical School, examined data from The Sports Network (TSN) and The Hockey News annual visor survey over the last 10 seasons from 2002 to 2013 in the NHL.[i] They found that the 149 eye injuries identified to have occurred in the study's timeframe cost the NHL more than $32 million in missed games. In addition, the risk of eye injury is 4.23 times higher for players who do not wear a visor.

The study also found that the majority of eye injuries are caused by being hit by the puck or struck by a high stick (37 percent and 28 percent, respectively). Only 18 percent of eye injuries were caused by a fight or scrum, while the researchers could not identify the cause of injury for 17 percent of eye injuries. Additionally, players without visors had a more aggressive style of play, measured by penalty minutes, hits and fights in a case-control study. There was also a weak, but positive correlation between eye injuries and penalty minutes.

In June 2013, the NHL and the National Hockey League Players' Association (NHLPA) agreed to require visors be worn by players who are new to the league. Players who had played more than 26 games in the NHL may elect not to wear visors through a grandfather clause.[ii] The mandate came three months after New York Rangers defenseman Marc Staal suffered a puck hit that resulted in a retinal tear (in which part of the retina, light-sensitive tissue lining the back of the eye, gets pulled out of place) and orbital fracture (a fracture in the bone structure that support the eye). He was not wearing a visor at the time.

Many players who come to the NHL from other leagues may already be accustomed to wearing the visors, as they are required in the Canadian Hockey League and the American Hockey League -- leagues that feed athletes into the NHL.

"Although it may seem like common sense to wear visors, until now there was little evidence that they decrease injuries or could save the league money," said lead researcher Jonathan Micieli, MD, of the department of Ophthalmology and Vision Sciences at the University of Toronto. "Quantifying these factors can make a big difference in the NHL's policy discussions. The majority of hockey injuries are accidental in nature, so it is not good enough for players to try to be more cautious."

As the games become faster and players get stronger the risks will continue to increase and it is important to maximize protection. The researchers recommend further study to examine if wearing a visor makes players more violent and, if so, if the visors could potentially cause injury to hands and wrists in fights.