Pickleball, the so-called fastest growing sport in America, poses underappreciated health risks to the eye, particularly in seniors, according to a recent report by a Houston Methodist ophthalmologist.

In the report in the journal Eye, Dr. Andrew G. Lee, chair of the Blanton Eye Institute at Houston Methodist, called for players to use wrap-around protective glasses designed to stay on the head. He added that greater surveillance of the sport's eye injuries and understanding of the eye injury risk is needed.

"While pickleball is generally considered to be a safe sport due to its non-contact nature, the risk of eye injuries cannot be overlooked," Dr. Lee wrote in the report. "The high velocity of the ball and small court poses a significant risk for eye injuries."

Dr. Lee told MedPage Today that a pickleball also can cause significant optical injuries because it is smaller than the protective eye socket. "The smaller a ball is, the more it can fit into the eye socket without hitting the bone," he said. "That's why smaller balls like racquetballs and squash balls are actually more likely to cause direct eye injury than tennis balls, footballs or baseballs, which are bigger."

Pickleball, a cross between tennis, badminton and ping pong that features two or four players using paddles to hit a whiffle ball over a 34-inch-high net, has surged in popularity in the U.S. in recent years, especially among people 60 and older. Dr. Lee wrote that participation in the sport has increased by 158.6% in the past 3 years, according to the Sports and Fitness Industry Association

More than 80% of players are over the age of 60. Dr. Lee emphasized that people in that age group are particularly vulnerable to eye injuries.

(Related: Playing Pickleball? Here Are 5 Tips for Avoiding Injuries)

The report highlights case reports of optical pickleball injuries. They include corneal abrasion, retinal tears, vitreous hemorrhage, retinal detachment, posterior vitreous detachment and traumatic lens subluxation.

Dr. Lee noted in the report that no protective eyewear is mandated to play pickleball at any level, unlike squash and racquetball, which have "mandatory eyewear rules across various levels of the game." He recommended plastic lenses to minimize the risk of glasses shattering on impact from the ball.

In particular need of protective eyewear, Dr. Lee singled out those individuals at higher risk of retinal detachment, such as individuals with a family history of retinal detachment, those aged between 60 and 70 years and those with high myopia or wearing artificial lens.

Dr. Lee told MedPage Today that Houston Methodist Hospital sees pickleball-related outpatient cases about once every three to four months, more serious cases about once a year. In the report, he added that pickleball injuries are likely underreported and may not always present to emergency departments.

"Most of the injuries that we see with pickleball are minor or mild and self-resolving," Dr. Lee told MedPage today. "But some are more dangerous, especially when you have a fracture or open globe injury with retinal detachment. Those require surgery."