title: Impact of visors on eye and orbital injuries in the National Hockey League.
abstract: OBJECTIVE
  Eye and orbital injuries are a significant risk to professional hockey league players and have resulted in career-ending injuries. The goal of this study was to determine the incidence, value lost, mechanism, and effect of visors on eye and orbital injuries over the last 10 National Hockey League (NHL) seasons: 2002-2003 to 2012-2013.
  
  
  METHODS
  Retrospective case-control study.
  
  
  METHODS
  Participants were 8741 NHL players who had played at least 1 game during the last 10 seasons.
  
  
  METHODS
  Using The Sports Network (TSN), ProSportsTransactions, and the Sporting News Hockey Register, NHL players were searched to identify eye and orbital injuries. The mechanism of injury was obtained from media reports and direct observation from online videos. The number of players wearing visors each year was obtained from The Hockey News annual visor survey.
  
  
  RESULTS
  A total of 149 eye or orbital injuries over the last 10 seasons resulted in an overall incidence of 2.48 per 10 000 athlete exposures. A total of 1120 missed games led to a lost financial value of more than $33 million. Visor use among players grew from 32% in 2002-2003 to 73% in 2012-2013, and there was a significantly increased risk for having an eye or orbital injury when a visor was not worn (OR 4.23, 95% CI 2.84-6.30). Most injuries were a result of being hit by a deflected or direct puck (37%) followed by being struck by a high stick (28%). Players who did not wear a visor were found to be involved in more fights, hits, and penalty minutes (p < 0.001).
  
  
  CONCLUSIONS
  Eye and orbital injuries are mostly accidental in nature and represent a significant risk and cost to the NHL and its players. Eye and orbital injuries are significantly more likely in players who do not wear visors.
authors.affiliation: Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ont.. Electronic address: jonathanmicieli@gmail.com.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Micieli
authors.affiliation: Departments of Anesthesiology and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ont.; Trillium Health Partners; Credit Valley EyeCare, Mississauga, Ont.
authors.forename: Iqbal Ike K
authors.initials: II
authors.lastname: Ahmed
mesh_terms: D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D005131:Eye Injuries / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D005135:Eye Protective Devices / Q000706:statistics & numerical data*; D006260:Head Protective Devices; D006688:Hockey / Q000293:injuries*; D006801:Humans; D015994:Incidence; D008297:Male; D009915:Orbit / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D013177:Sports; D019876:Sports Equipment