Eye Care Enters the Ring

On the second of August 1980, middleweight Olympic gold medal winner Sugar Ray Seales’ brilliant career was already in peril. Since the tremendous title-ending blow received from Marvin Hagler in 1976, his eyesight in the left eye gradually worsened, exposing him to new and painful jabs, both to the head and his career.

That day, while facing last-minute replacement Jamie Thomas, Seales’ grit was shattered by his opponent’s thumb digging into his right eye, causing a severe retinal detachment, leading to eye surgery. Four months later, Seales was back in the ring, fighting and winning, but things kept getting worse. After defeating Max Hord in 1983, Seales was declared legally blind and, despite undergoing surgery several times, his career abruptly ended, leaving him broke and crippled in debt.

Along with Sugar Ray Leonard, Seales is considered one of the strongest examples of the risks of blindness associated with contact fighting sports. According to a study by Giovinazzo (et al.), two-thirds of boxers show signs of ocular injuries, with almost a quarter with signs of retinal tear.¹

The toll boxing takes on the eye is seldom an instant consequence of one trauma but the cumulative effect of several adding up over time, Professor Ferenc Kuhn MD, PhD said. This causes the vitreous gel to break down at a faster pace than a normal eye, increasing the risk of a retinal tear on every hit—eventually leading to retinal detachment. And it is not instantaneous, Prof Kuhn remarked. Some patients could suffer retinal detachment years after they retire.

Prof Kuhn recalled the case of one of his patients, an active professional boxer presenting with retinal detachment. After a vitrectomy and 360-degree laser prophylaxis on both eyes, the patient asked if he could return to boxing. “I could not answer the question at the time, and there was nothing in the literature about it,” he said. Fortunately, the country already had a rule on eye injury preventing the patient from going back to the ring. “However, it should not be up to us to tell a person that his life has to change completely, but rather to prevent this from happening.”

Prevention of retinal detachment is not an easy task, and, as Prof Kuhn underlined, it has no consensus. Data now shows the old approach of frequently treating areas of the peripheral retina at risk may not be sufficient because most of the problems come from those that appear normal at examination.

For this reason, advocating for protection can indeed be the most effective solution. Before Thomas Joseph Pashby CM, a few hundred hockey players went blind every year. Thanks to his advocacy and the introduction of mandatory protection, these cases went down to zero, Prof Kuhn observed, stressing prevention’s efficacy. Everything can happen in a split second, he said, and it is better to be safe than sorry.

Ferenc Kuhn MD, PhD, Helen Keller Foundation for Research and Education, Birmingham, Alabama, US; Department of Ophthalmology, University of Pécs Medical School, Hungary; International Society of Ocular Trauma, Jacksonville, Florida, US. fkuhn@mindspring.com

1. VJ Giovinazzo, et al., “The Ocular Complications of Boxing,” Ophthalmology, 94(6): 587–596.