- Email: [email protected]
Eye Injuries in the National Basketball Association
Journal Pre-proof Eye Injuries in the National Basketball Association Jonathan A. Go, BBA, Sophie Y. Lin, BA, Katherine J. Williams, MD, Jeffrey Tran, MD, Adam R. Sweeney, MD, Rod Foroozan, MD, Michael T. Yen, MD PII:
S0161-6420(19)32368-1
DOI:
https://doi.org/10.1016/j.ophtha.2019.12.016
Reference:
OPHTHA 11040
To appear in:
Ophthalmology
Received Date: 13 October 2019 Revised Date:
16 December 2019
Accepted Date: 18 December 2019
Please cite this article as: Go JA, Lin SY, Williams KJ, Tran J, Sweeney AR, Foroozan R, Yen MT, Eye Injuries in the National Basketball Association, Ophthalmology (2020), doi: https://doi.org/10.1016/ j.ophtha.2019.12.016. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
1
Title: Eye Injuries in the National Basketball Association
2 3
Running Head: Eye Injuries in the NBA
4 5
Authors: Jonathan A. Go, BBA; Sophie Y. Lin, BA; Katherine J. Williams, MD; Jeffrey Tran,
6
MD; Adam R. Sweeney, MD; Rod Foroozan, MD; Michael T. Yen, MD
7 8
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston,
9
Texas
10 11
Financial Support: Supported in part by an unrestricted departmental grant from Research
12
Prevent Blindness, Inc. (New York, NY)
13
Conflict of Interest: No conflicting relationship exists for any author. No financial interests in
14
any of the products or techniques described herein.
15
Presentation History: None
16 17
Corresponding Author:
18
Michael T. Yen, MD
19
1977 Butler Blvd
20
Houston, TX 77030
21
Phone: (713) 798-6100
22
Email: [email protected]
23
24
ABSTRACT Eye injuries in the National Basketball Association during the 2018-2019 regular season
25 26
are not uncommon and resulted in significant negative financial and performance impacts to
27
teams.
28
29 30
REPORT Basketball is one of most common causes of sport-related eye injuries in the United
31
States.1 While the correlation between basketball and ophthalmic injury is well documented,
32
limited information is available regarding the circumstances and scenarios that drive these
33
injuries, especially at the highest level of competition. We performed a prospective cohort study
34
of National Basketball Association (NBA) players across all 1,230 games of the 2018-2019 NBA
35
regular season, compliant under Baylor College of Medicine Institutional Review Board and
36
Declaration of Helsinki. Injury information was tracked daily throughout the season by 5 of the
37
authors with a comprehensive online database hosted by Rotoworld (NBC Universal, New York,
38
New York), a fantasy sports news corporation. Eye injury-related updates were corroborated by
39
press releases and news reports. Game film of each eye injury was analyzed through the NBA’s
40
online, “League Pass” broadcast subscription. Additional injury information was obtained
41
through interviews with NBA team eye care providers to fill information gaps from the
42
aforementioned methodologies, when needed.
43
Inclusion criteria for injuries were as follows: 1) The injury occurred during the 2018-
44
2019 regular season, between October 16, 2018 to April 10, 2019. 2) The injury was reported by
45
the team and/or media. 3) The injury could be verified through public domain sources, game
46
film, and/or team eye care provider interview. Lost productivity was calculated by prorating an
47
injured player’s annual 82-game salary, as reported by the Entertainment and Sports
48
Programming Network (ESPN) (ESPN Inc., Bristol, Connecticut) NBA Player Salary Database,
49
by the number of games missed due to injury. Similarly, lost wins were calculated by prorating
50
an injured player’s annual 82-game “RPM Wins,” defined by the ESPN NBA Real Plus-Minus
51
Database as the number of wins the player has contributed to the team total based on
52
performance statistics, by the number of missed games due to injury.
53
Overall, eye injuries for the 2018-2019 regular season resulted in $2,389,197 in lost
54
productivity, 18 missed games, and 0.85 lost wins. However, in addition to direct lost
55
productivity, eye injuries may have partially contributed to even further lost financial and
56
branding opportunities due to the missed games and lost wins. This can be significant
57
considering the Eastern Conference postseason cut-off margin was separated by only 2 games,
58
and in the prior postseason, the Golden State Warriors reportedly grossed $130 million from
59
their home playoff games alone.2 Players missed between 0 and 3 games each, and the mean
60
average minutes per a game (MPG) for injured players was 25.99 minutes, indicating that these
61
injured players were active team contributors, not “benchwarmers” (Table S1, available at
62
www.aaojournal.org).
63
In 1995, a prospective survey of NBA team healthcare providers examined the eye
64
injuries across the 1992-1993 preseason, regular season, and postseason.3 Since this previous
65
report, the NBA has evolved tremendously, including the ascendency of the 3-point shot,4 which
66
may influence the rate and character of eye injuries. Our current study, which utilized a
67
technology-based, rather than survey-based methodology, revealed discrepancies between eye
68
injuries in 2018-2019 and 1992-1993, validating the need for updated eye injury analysis (Table
69
1). Clinically, 18 eye injuries were documented, and 14 were diagnosable. Injuries were more
70
likely during the fourth quarter of the game (50.0%) than during any other time. Injuries were
71
also more likely to occur in the “paint” (55.6%), the painted area of the court closest to each
72
basket, than any other area. More eye injuries occurred when the player was on offense than
73
defense (38.9% vs. 27.8%). 50% of injuries were caused by opponents, 16.7% of injuries were
74
caused by teammates, and 33.3% of injury agents were unknown.
75
The most common injuries were corneal abrasion in 2018-2019 (42.9%) and eyelid
76
lacerations and abrasions in 1992-1993 (38.0%). In both seasons, rebounding was the most
77
common activity associated with eye injury (33.3% and 30.5%, respectively). From 2018-2019,
78
the same percentage of injuries occurred on offense as defense (11.1%), but 1992-1993, more
79
injuries occurred on offense than defense (27.1% vs. 20.3%). Fewer eye injuries were reported
80
in 2018-2019 compared to 1992-1993. However, the 1992-1993 study included the preseason
81
and postseason in addition to the regular season, and increased eye injury volume may have been
82
a product of higher exposure. Additionally, due to the rise of advanced statistics and data
83
analytics, teams may be more reluctant to report injuries now than in prior decades, to avoid
84
disclosing a competitive advantage to opponents. Thus, eye injuries may have been overall
85
under-reported during the 2018-2019 season.
86
Since the 1990s, the game of basketball has been transformed by the ascension of the 3-
87
point shot4, a statistically efficient offensive strategy. As a result, the number of game exposures,
88
defined as the number of athletes appearing in games during a single season3, for guards, who
89
traditionally have strong shooting skills, rose from roughly 5,700 in 1992-1993 to roughly
90
13,400 in 2018-2019. Position eye injury rate was highest for guards in both studies (0.67
91
injuries/1000 exposures for 2018-2019 and 1.94/1000 for 1992-1993), but guards were involved
92
with a higher percentage of injuries for 2018-2019 (50.0%) compared to 1992-1993 (36.5%),
93
indicating that rising guard usage may have driven the spike in guard eye injuries (Table S2,
94
available at www.aaojournal.org). These findings suggest that NBA eye injuries may directly
95
correlate with the gameplay strategy. Thus, ophthalmologists may need to consider contextual
96
gameplay trends when analyzing sport-related injuries.
97
Proper protective eye wear has been estimated to avert 70,000 injuries and over
98
$10,000,000 in medical expenses annually.5 However, only 16.7% of 2018-2019 injured players
99
reported wearing protective eye wear upon return, similar to the 8.5% rate reported in 1992-
100
1993. Updated eye injury guidance and risk classifications may be warranted. For example,
101
Rodriguez et al.6 postulates that the American Medical Association’s classification of contact
102
sport may apply to eye injuries, since low contact sports, such as racquetball, carry greater risk
103
for eye injury than for general contact, and high contact sports with superior eye protection, such
104
as hockey, actually have lower eye injury risk.
105
In conclusion, as global basketball popularity grows, ophthalmologist-driven research is
106
needed to identify potential eye injury risks. Our study utilizes game footage for uniquely in-
107
depth analysis, quantifies the significant financial and corporate injury costs, and compares data
108
to findings from three decades earlier to identify trends, opportunities, and risks in basketball-
109
related eye health.
110
111
LEGEND
112 113
Table S1: Financial and performance costs of NBA eye injuries during the 2018-2019 regular
114
season
115 116
Table 1: NBA eye injuries during the 2018-2019 regular season compared to the 1992-1993
117
preseason, regular season, and postseason3
118 119
Table S2: Position and game exposures for NBA eye injuries during the 2018-2019 regular
120
season compared to the 1992-1993 pre, regular, and post season3
121
122
REFERENCES
123 124
1.
Ophthalmology. 1990;97(10):1265-1269. doi:10.1016/s0161-6420(90)32421-1
125 126
Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sports-related ocular trauma.
2.
Goldberg R. Warriors Reportedly Grossed Nearly $130M in 11 2018 Home Playoff
127
Games. Bleacher Report. https://bleacherreport.com/articles/2780589-warriors-reportedly-
128
grossed-nearly-130m-in-11-2018-home-playoff-games. Published 2018. Accessed August
129
27, 2019.
130
3.
National Basketball Association Eye Injury Study. Arch Ophthalmol. 1995;113:749-752.
131 132
4.
5.
137 138
Vinger PF. Sports eye injuries a preventable disease. Ophthalmology. 1981;88(2):108113. doi:10.1016/s0161-6420(81)35067-2
135 136
Ross TF. Welcome to Smarter Basketball. Atl. 2015. https://www.theatlantic.com/entertainment/archive/2015/06/nba-data-analytics/396776/.
133 134
Zagelbaum BM, Starkey C, Hersh PS, Donnenfeld ED, Perry HD, Jeffers JB. The
6.
Rodriguez JO, Lavina AM, Agarwal A. Prevention and treatment of common eye injuries in sports. Am Fam Physician. 2003;67(7):1481-1488+1494.
Confirmed Diagnoses Corneal abrasion Orbital contusion Eyelid abrasion/laceration Facial contusion Lower eye ecchymosis Ocular contusion Traumatic iritis Subconjunctival hemorrhage Conjunctival abrasion/laceration Conjunctival chemosis Orbital fracture Temple laceration Extraocular muscle contusion Eye Protection on Return No Yes Activity Rebound Offensive Play Defensive Play Loose Ball Dead Ball/Fighting Dribble/Transition Unknown Quarter 4th 2nd 1st 3rd Practice Unknown Location Paint 3PT Line + Mid-Range Unknown Possession Offense Defense Unknown Laterality Left Right Both Unknown
2018-2019 Regular Season n (%)
1992-1993 Pre/Regular/Post Season n (%)
6 (42.9) 3 (21.4) 2 (14.3) 1 (7.1) 1 (7.1) 1 (7.1)
7 (8.9) 17 (21.5) 30 (38.0)
7 (8.9) 5 (6.3) 4 (5.1) 4 (5.1) 3 (3.8) 1 (1.3) 1 (1.3) 15 (83.3) 3 (16.7)
54 (91.5) 5 (8.5)
5 (33.3) 2 (11.1) 2 (11.1) 0 (0.0) 1 (5.6) 1 (5.6) 6 (33.3)
18 (30.5) 16 (27.1) 12 (20.3) 5 (8.5) 1 (1.7) 1 (1.7) 6 (10.2)
9 (50.0) 2 (11.1) 1 (5.6) 0 (0.0) 1 (5.6) 5 (27.8) 10 (55.6) 1 (5.6) 1 (5.6) 6 (33.3) 7 (38.9) 5 (27.8) 6 (33.3) 9 (50.0) 5 (27.8) 2 (11.1) 2 (11.1)
Table 1: NBA eye injuries during the 2018-2019 regular season compared to the 1992-1993 preseason, regular 3 season, and postseason
S0161-6420(19)32368-1
DOI:
https://doi.org/10.1016/j.ophtha.2019.12.016
Reference:
OPHTHA 11040
To appear in:
Ophthalmology
Received Date: 13 October 2019 Revised Date:
16 December 2019
Accepted Date: 18 December 2019
Please cite this article as: Go JA, Lin SY, Williams KJ, Tran J, Sweeney AR, Foroozan R, Yen MT, Eye Injuries in the National Basketball Association, Ophthalmology (2020), doi: https://doi.org/10.1016/ j.ophtha.2019.12.016. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology
1
Title: Eye Injuries in the National Basketball Association
2 3
Running Head: Eye Injuries in the NBA
4 5
Authors: Jonathan A. Go, BBA; Sophie Y. Lin, BA; Katherine J. Williams, MD; Jeffrey Tran,
6
MD; Adam R. Sweeney, MD; Rod Foroozan, MD; Michael T. Yen, MD
7 8
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston,
9
Texas
10 11
Financial Support: Supported in part by an unrestricted departmental grant from Research
12
Prevent Blindness, Inc. (New York, NY)
13
Conflict of Interest: No conflicting relationship exists for any author. No financial interests in
14
any of the products or techniques described herein.
15
Presentation History: None
16 17
Corresponding Author:
18
Michael T. Yen, MD
19
1977 Butler Blvd
20
Houston, TX 77030
21
Phone: (713) 798-6100
22
Email: [email protected]
23
24
ABSTRACT Eye injuries in the National Basketball Association during the 2018-2019 regular season
25 26
are not uncommon and resulted in significant negative financial and performance impacts to
27
teams.
28
29 30
REPORT Basketball is one of most common causes of sport-related eye injuries in the United
31
States.1 While the correlation between basketball and ophthalmic injury is well documented,
32
limited information is available regarding the circumstances and scenarios that drive these
33
injuries, especially at the highest level of competition. We performed a prospective cohort study
34
of National Basketball Association (NBA) players across all 1,230 games of the 2018-2019 NBA
35
regular season, compliant under Baylor College of Medicine Institutional Review Board and
36
Declaration of Helsinki. Injury information was tracked daily throughout the season by 5 of the
37
authors with a comprehensive online database hosted by Rotoworld (NBC Universal, New York,
38
New York), a fantasy sports news corporation. Eye injury-related updates were corroborated by
39
press releases and news reports. Game film of each eye injury was analyzed through the NBA’s
40
online, “League Pass” broadcast subscription. Additional injury information was obtained
41
through interviews with NBA team eye care providers to fill information gaps from the
42
aforementioned methodologies, when needed.
43
Inclusion criteria for injuries were as follows: 1) The injury occurred during the 2018-
44
2019 regular season, between October 16, 2018 to April 10, 2019. 2) The injury was reported by
45
the team and/or media. 3) The injury could be verified through public domain sources, game
46
film, and/or team eye care provider interview. Lost productivity was calculated by prorating an
47
injured player’s annual 82-game salary, as reported by the Entertainment and Sports
48
Programming Network (ESPN) (ESPN Inc., Bristol, Connecticut) NBA Player Salary Database,
49
by the number of games missed due to injury. Similarly, lost wins were calculated by prorating
50
an injured player’s annual 82-game “RPM Wins,” defined by the ESPN NBA Real Plus-Minus
51
Database as the number of wins the player has contributed to the team total based on
52
performance statistics, by the number of missed games due to injury.
53
Overall, eye injuries for the 2018-2019 regular season resulted in $2,389,197 in lost
54
productivity, 18 missed games, and 0.85 lost wins. However, in addition to direct lost
55
productivity, eye injuries may have partially contributed to even further lost financial and
56
branding opportunities due to the missed games and lost wins. This can be significant
57
considering the Eastern Conference postseason cut-off margin was separated by only 2 games,
58
and in the prior postseason, the Golden State Warriors reportedly grossed $130 million from
59
their home playoff games alone.2 Players missed between 0 and 3 games each, and the mean
60
average minutes per a game (MPG) for injured players was 25.99 minutes, indicating that these
61
injured players were active team contributors, not “benchwarmers” (Table S1, available at
62
www.aaojournal.org).
63
In 1995, a prospective survey of NBA team healthcare providers examined the eye
64
injuries across the 1992-1993 preseason, regular season, and postseason.3 Since this previous
65
report, the NBA has evolved tremendously, including the ascendency of the 3-point shot,4 which
66
may influence the rate and character of eye injuries. Our current study, which utilized a
67
technology-based, rather than survey-based methodology, revealed discrepancies between eye
68
injuries in 2018-2019 and 1992-1993, validating the need for updated eye injury analysis (Table
69
1). Clinically, 18 eye injuries were documented, and 14 were diagnosable. Injuries were more
70
likely during the fourth quarter of the game (50.0%) than during any other time. Injuries were
71
also more likely to occur in the “paint” (55.6%), the painted area of the court closest to each
72
basket, than any other area. More eye injuries occurred when the player was on offense than
73
defense (38.9% vs. 27.8%). 50% of injuries were caused by opponents, 16.7% of injuries were
74
caused by teammates, and 33.3% of injury agents were unknown.
75
The most common injuries were corneal abrasion in 2018-2019 (42.9%) and eyelid
76
lacerations and abrasions in 1992-1993 (38.0%). In both seasons, rebounding was the most
77
common activity associated with eye injury (33.3% and 30.5%, respectively). From 2018-2019,
78
the same percentage of injuries occurred on offense as defense (11.1%), but 1992-1993, more
79
injuries occurred on offense than defense (27.1% vs. 20.3%). Fewer eye injuries were reported
80
in 2018-2019 compared to 1992-1993. However, the 1992-1993 study included the preseason
81
and postseason in addition to the regular season, and increased eye injury volume may have been
82
a product of higher exposure. Additionally, due to the rise of advanced statistics and data
83
analytics, teams may be more reluctant to report injuries now than in prior decades, to avoid
84
disclosing a competitive advantage to opponents. Thus, eye injuries may have been overall
85
under-reported during the 2018-2019 season.
86
Since the 1990s, the game of basketball has been transformed by the ascension of the 3-
87
point shot4, a statistically efficient offensive strategy. As a result, the number of game exposures,
88
defined as the number of athletes appearing in games during a single season3, for guards, who
89
traditionally have strong shooting skills, rose from roughly 5,700 in 1992-1993 to roughly
90
13,400 in 2018-2019. Position eye injury rate was highest for guards in both studies (0.67
91
injuries/1000 exposures for 2018-2019 and 1.94/1000 for 1992-1993), but guards were involved
92
with a higher percentage of injuries for 2018-2019 (50.0%) compared to 1992-1993 (36.5%),
93
indicating that rising guard usage may have driven the spike in guard eye injuries (Table S2,
94
available at www.aaojournal.org). These findings suggest that NBA eye injuries may directly
95
correlate with the gameplay strategy. Thus, ophthalmologists may need to consider contextual
96
gameplay trends when analyzing sport-related injuries.
97
Proper protective eye wear has been estimated to avert 70,000 injuries and over
98
$10,000,000 in medical expenses annually.5 However, only 16.7% of 2018-2019 injured players
99
reported wearing protective eye wear upon return, similar to the 8.5% rate reported in 1992-
100
1993. Updated eye injury guidance and risk classifications may be warranted. For example,
101
Rodriguez et al.6 postulates that the American Medical Association’s classification of contact
102
sport may apply to eye injuries, since low contact sports, such as racquetball, carry greater risk
103
for eye injury than for general contact, and high contact sports with superior eye protection, such
104
as hockey, actually have lower eye injury risk.
105
In conclusion, as global basketball popularity grows, ophthalmologist-driven research is
106
needed to identify potential eye injury risks. Our study utilizes game footage for uniquely in-
107
depth analysis, quantifies the significant financial and corporate injury costs, and compares data
108
to findings from three decades earlier to identify trends, opportunities, and risks in basketball-
109
related eye health.
110
111
LEGEND
112 113
Table S1: Financial and performance costs of NBA eye injuries during the 2018-2019 regular
114
season
115 116
Table 1: NBA eye injuries during the 2018-2019 regular season compared to the 1992-1993
117
preseason, regular season, and postseason3
118 119
Table S2: Position and game exposures for NBA eye injuries during the 2018-2019 regular
120
season compared to the 1992-1993 pre, regular, and post season3
121
122
REFERENCES
123 124
1.
Ophthalmology. 1990;97(10):1265-1269. doi:10.1016/s0161-6420(90)32421-1
125 126
Larrison WI, Hersh PS, Kunzweiler T, Shingleton BJ. Sports-related ocular trauma.
2.
Goldberg R. Warriors Reportedly Grossed Nearly $130M in 11 2018 Home Playoff
127
Games. Bleacher Report. https://bleacherreport.com/articles/2780589-warriors-reportedly-
128
grossed-nearly-130m-in-11-2018-home-playoff-games. Published 2018. Accessed August
129
27, 2019.
130
3.
National Basketball Association Eye Injury Study. Arch Ophthalmol. 1995;113:749-752.
131 132
4.
5.
137 138
Vinger PF. Sports eye injuries a preventable disease. Ophthalmology. 1981;88(2):108113. doi:10.1016/s0161-6420(81)35067-2
135 136
Ross TF. Welcome to Smarter Basketball. Atl. 2015. https://www.theatlantic.com/entertainment/archive/2015/06/nba-data-analytics/396776/.
133 134
Zagelbaum BM, Starkey C, Hersh PS, Donnenfeld ED, Perry HD, Jeffers JB. The
6.
Rodriguez JO, Lavina AM, Agarwal A. Prevention and treatment of common eye injuries in sports. Am Fam Physician. 2003;67(7):1481-1488+1494.
Confirmed Diagnoses Corneal abrasion Orbital contusion Eyelid abrasion/laceration Facial contusion Lower eye ecchymosis Ocular contusion Traumatic iritis Subconjunctival hemorrhage Conjunctival abrasion/laceration Conjunctival chemosis Orbital fracture Temple laceration Extraocular muscle contusion Eye Protection on Return No Yes Activity Rebound Offensive Play Defensive Play Loose Ball Dead Ball/Fighting Dribble/Transition Unknown Quarter 4th 2nd 1st 3rd Practice Unknown Location Paint 3PT Line + Mid-Range Unknown Possession Offense Defense Unknown Laterality Left Right Both Unknown
2018-2019 Regular Season n (%)
1992-1993 Pre/Regular/Post Season n (%)
6 (42.9) 3 (21.4) 2 (14.3) 1 (7.1) 1 (7.1) 1 (7.1)
7 (8.9) 17 (21.5) 30 (38.0)
7 (8.9) 5 (6.3) 4 (5.1) 4 (5.1) 3 (3.8) 1 (1.3) 1 (1.3) 15 (83.3) 3 (16.7)
54 (91.5) 5 (8.5)
5 (33.3) 2 (11.1) 2 (11.1) 0 (0.0) 1 (5.6) 1 (5.6) 6 (33.3)
18 (30.5) 16 (27.1) 12 (20.3) 5 (8.5) 1 (1.7) 1 (1.7) 6 (10.2)
9 (50.0) 2 (11.1) 1 (5.6) 0 (0.0) 1 (5.6) 5 (27.8) 10 (55.6) 1 (5.6) 1 (5.6) 6 (33.3) 7 (38.9) 5 (27.8) 6 (33.3) 9 (50.0) 5 (27.8) 2 (11.1) 2 (11.1)
Table 1: NBA eye injuries during the 2018-2019 regular season compared to the 1992-1993 preseason, regular 3 season, and postseason