In reply
Dr Buettner raises the important issue that causes other than thermoelectric damage should be considered as an explanation for the pathologically low electro-oculogram (EOG) and unilateral RPE defect in the left eye following a left-temple lightning strike in this 13-year-old boy. Dr Buettner suggests that vitelliform dystrophy (Best's disease) is likely to account for these findings. Although unilateral cases have been described, Best's disease is usually a bilateral, autosomal dominant disorder with variable penetrance and expression. As stated in our article,1 the patient's familial ocular history was unremarkable. In particular, both parents and grandparents were reported to have had normal vision without ocular problems as children or adults. Evaluation of the 47-year-old mother demonstrated a visual acuity of 20/20 with normal findings on electroretinogram and EOG of both eyes. The father and siblings were not available for ophthalmoscopic evaluation. Since even ophthalmoscopically normal "carrier" states can be