Kicking, punching, elbowing, wrestling ... Nope, Michael J. Fliotsos, MD, wasn’t describing a schoolyard brawl. During a Saturday session on sports-related ocular trauma (Sym12), he presented research on mixed martial arts (MMA), delving into the prevalence, patterns, and characteristics of MMA-related eye injuries.
For their recent study, Dr. Fliotsos and colleagues crunched data from the Ultimate Fighting Championship (UFC), the largest mixed martial arts organization in the world.
First, a little UFC background. Since it launched in 1993, the UFC has put on more than 500 live events, which typically include numerous fights. Each bout involves three rounds that last five minutes. The main-event fights include two additional rounds (if no one gets knocked out before then). Rules and regulations have increased significantly since the UFC’s inception. It now requires a ringside physician, but no ophthalmologist is on hand.
“The overall injury rate in MMA is quite high,” said Dr. Fliotsos. It’s been estimated that there are between 228 and 246 injuries per 1,000 athletic encounters. The head is the most injured anatomic location by far, ranging from 32% to 76% of all injuries.
MMA lacks eye injury data. “Few studies have specifically evaluated eye injuries in MMA fighting,” said Dr. Fliotsos, noting that two previous studies show a range from 5.8% to 8.3%.
For their study, the researchers set three goals: to assess the frequency and grade of eye injuries per fight, to clarify the type of eye injuries experienced by athletes, and to describe the characteristics of injuries sustained by fighters in each match.
Their retrospective review relied on data from MMA fights held in Las Vegas, Nevada, from September 2001 to March 2020, excluding amateur fights. They collected data on gender of fighters, date of match, match outcomes (wins and losses), how the match ended (by knockout, technical knockout, decision, draw, no decision, or submission), and the type and laterality of the eye injury sustained.
Injuries were reported by a physician at ringside. “It’s very important to realize that none of these physicians are ophthalmologists. And there’s no radiographic or diagnostic testing occurring at the time of diagnosis,” said Dr. Fliotsos, but he noted that follow-up with an eye expert often occurs later.
Study findings. The researchers reviewed 256 promoted events (events involving multiple bouts) in which eye injuries were classified as the following: injury to eye, eye lacerations, eyelid and eyebrow lacerations, orbital fractures, “retinal injuries,” and corneal abrasions. Of the 256 events analyzed, 187 (73%) involved at least one eye injury.
Of 2,208 individual fights—involving 4,416 fighters—369 eye injuries were recorded in 363 fighters. Of all fights, 17% involved an eye injury, and 8.2% of fighters were injured with an eye injury.
Common injuries. Eyelid and eyebrow lacerations (43%) were the most common injury category, followed by eye lacerations (27%), which Dr. Fliotsos noted was “a poorly defined category and a limitation of our data set.” Orbital fractures (17%) ranked third. The majority of eye injuries were on the left side (56%).
The researchers reported that 18% of eye injuries required follow-up and clearance by an ophthalmologist, and the mean injury clearance time was 5.74 months.
A risky sport for eyes. Given the study findings, Dr. Fliotsos said, “That’s a lot of people getting injured.” What’s more, most fighters who sustained an injury (74%) ended up losing their match.
The findings can help stimulate discussions about how ringside physicians can be trained “in an interdisciplinary way to have as much eye expertise as possible,” he said.
Study limitations. Researchers relied on the reports of ringside physicians who are not ophthalmologists, as well as limited ophthalmic exams and fighter-reported symptoms. For example, Dr. Fliotsos said an injured fighter may say, “I have decreased vision and floaters,” and the ringside physician may suggest a retinal issue. “But we know that’s not always the case,” he added.
Also, the data were culled only from Las Vegas-based fights, and while Las Vegas is a popular locale for the UFC, the organization hosts events in venues worldwide. The researchers did not assess the impact of weight class on rate of injury, which could yield additional findings. And they did not review videos of matches in order to determine mechanism of injury.
Busted MMA myth. “There is some word on the street that UFC fights are particularly violent, but in this study we did not find them more likely than non-UFC fights to lead to eye injury,” Dr. Fliotsos said.
—Mary Brophy Marcus
Financial disclosures: Michael J. Fliotsos, MD: None.
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