I read with interest the photo essay by Dr Lagrèze and colleagues1 in the August 1995 issue of the Archives. However, I am surprised that the authors attribute widespread dysfunction of the retinal pigment epithelium (RPE), demonstrated by pathologically low amplitudes of the electro-oculogram, to thermal injury from lightning without considering other possible explanations.
Thermal injury to the extent postulated by the authors approaches temperature levels in the RPE encountered in photocoagulation.2 It is very unlikely to not detect widespread, clinically visible changes of the RPE. The authors do not report RPE changes other than the window defect in the left macula depicted in the fluorescein angiogram.
A possible explanation for the fundus and electrophysiologic findings is Best's disease. This disorder is a common cause for a subnormal electro-oculogram. The macular lesions are compatible with Best's disease, which is known to have an extremely variable fundus appearance and
Buettner H. Lightning-Induced Ocular Injury. Arch Ophthalmol. 1996;114(4):501. doi:10.1001/archopht.1996.01100130497038