Fishing hooks, rods, and weights: A look at eye injury patterns from the sport

What happens when a routine day of casting a line turns into an ocular emergency? A long-term epidemiologic study of fishing-associated ocular injuries (FOIs) found that fishhooks, rods, and weights were among the most common mechanisms of injury, with pediatric patients comprising 38.2% of cases despite an overall decline in FOIs over the study period.¹ The findings, published in the American Journal of Ophthalmology, offer ophthalmologists and emergency physicians a framework for anticipating injury severity based on mechanism, from penetrating trauma to blunt-force complications such as open globe injury, infection, or orbital fracture.¹

In this Q&A conversation with Ophthalmology Times (OT), study authors Sean E. Pak, a medical student in the Class of 2027 at the University of Tennessee Health Science Center College of Medicine, and Natalie C. Kerr, MD, MBA, FACS, FAAP, the Hiatt Professor and Executive Vice Chair of Ophthalmology at the university’s Hamilton Eye Institute in Memphis, Tennessee, discuss what motivated the research, the injury patterns they identified, and how eye protection standards used in other sports might translate to recreational fishing.

Note: Transcript edited lightly for clarity and length.

OT: Your study provides a long-term epidemiologic look at FOIs. What motivated you to examine this topic, and why is it important for ophthalmologists to understand these injury patterns?

Sean E. Pak: I just love to fish! My family has an annual tradition of going salt-water fishing in the Gulf, and it was after one of these trips that I got the idea of looking into what injury patterns existed with FOIs.

With fishing being such a notable and popular outdoor activity, my hope is that ophthalmologists can be provided more context on how FOIs can present as, especially if they practice in areas popular among anglers.

Natalie C. Kerr, MD, MBA, FACS, FAAP: I have taken care of numerous children with fish hook injuries, and when Sean approached me with his research, I was motivated to help him publish this work to promote more effective prevention of FOIs, which can be devastating and result in severe vision loss. Providing information about the epidemiology of FOIs reminds us as ophthalmologists to advocate for protective eyewear in all sports, including fishing, which present risk of eye injury.

OT: Fishhooks, rods, and weights were among the most common mechanisms of injury identified. From a clinical standpoint, how do these mechanisms influence the type and severity of ocular trauma encountered?

Pak: These common mechanisms of injury are characteristically projectile in nature, and from there you can think about whether to expect sharp/penetrating or blunt trauma and the risks of complications depending on the culprit (ie, an open globe, infection, periocular injury or fracture). I hope the context of these injuries that our study describes can help provide a framework approaching these injuries for ophthalmologists and emergency physicians.

OT: The data suggest a decline in fishing-related eye injuries over time. What factors do you believe may be contributing to this trend, and were there any demographic patterns that stood out?

Pak: Interestingly, the American Sportfishing Association (ASA) reports an upward trend in fishing interest in recent years, with at a record number of fishing participants in 2024 (57.9 million participants).² Factors that may be contributing to the observed decline in fishing-associated ocular injuries (FOIs) may be attributed to its overall infrequency, limited available sample size, and that FOI patients are also likely to present to their local optometrist or ophthalmologist’s office instead of an emergency department.

We also found pediatric patients to comprise 38.2% of FOIs in our study, and with children and adolescents constituting over 20% of total fishing participants in 2024 per the ASA,² I believe it is important to watch out for fishing safety for our demographic of young fishers.

OT: Many of these injuries occur during recreational activities among otherwise healthy individuals. What prevention strategies—particularly regarding eye protection—do you believe could have the greatest impact?

Pak: We have already seen the historic success visor protection has had in the world of hockey and eye injury prevention. Similarly, recognition of the risks and patterns of fishing-associated ocular injuries by fishermen, fishing organizations, and businesses alike can help highlight the importance of structural eye protection. Since most fishers already utilize sunglasses or visors to protect against UV and glare, incorporating structural standards into already existing refractive protection could have a significant impact on the future of ocular safety in the fishing realm.

OT: How has this research influenced your own approach to patient counseling, injury prevention, or management of ocular trauma in clinical practice?

Pak: As a medical student pursuing ophthalmology as my future career, this project has really taught me the importance of patient counseling when it comes to using ocular protection with risky recreational activities (especially fishing when it’s time for spring break) and the role of advocacy that ophthalmologists can fulfill to promote ocular health within our communities.

Kerr: People who need refractive error correction will often wear glasses when engaging in activities such as fishing, which provide protection from projectile and penetrating trauma. When glasses are not necessary for sight, such as when contact lenses are used, after refractive surgery or cataract surgery, or when the patient has no need for refractive correction, eye care providers should remind patients that they still need eyewear to protect their eyes from the long-term effects of ultraviolet light as well as trauma. Sunglasses for sports are available in polycarbonate material at sporting goods stores for children and adults and can provide added comfort and protection when engaging in outdoor sports. Having a high index of suspicion for penetrating trauma or intraocular damage from fishing injuries is an important aspect in the management of fishing-related trauma.

Natalie C. Kerr, MD, MBA, FACS, FAAP
E: [email protected]

Kerr is the Hiatt Professor and Executive Vice Chair of Ophthalmology at the University of Tennessee Health Science Center’s Hamilton Eye Institute in Memphis, Tennessee.

Sean E. Pak
E: [email protected]

Pak is a medical student in the Class of 2027 at the University of Tennessee Health Science Center College of Medicine, where he serves as a student leader with the Christian Medical and Dental Associations, class representative on the Clinical Sciences Subcommittee, and senior chair of the Cardiology Interest Group.

Neither author has any relevant financial disclosures.

References

1. Pak SE, Kerr NC. The epidemiology of fishing-associated ocular injuries. Am J Ophthalmol. 2026;282:128-134. doi:10.1016/j.ajo.2025.10.039

2. American Sportfishing Association. Accessed August 28, 2026. https://asafishing.org