When it was announced that Errol Spence Jr. had sustained a retinal tear and would not be able to fight Manny Pacquiao on August 21, there was a collective sense of disappointment that boxing had lost perhaps its biggest fight of the year. However, there should have also been a feeling of relief, as the injury being discovered ahead of time may have preserved the career of one of the sport’s brightest stars. 

During a pre-fight medical examination, doctors with the Nevada State Athletic Commission discovered the tear and recommended emergency surgery. Spence flew home to Dallas and had surgery two days later.

“I was telling the doctor let me fight this fight and I’ll get surgery right after. Doc wasn’t (having) it,” said Spence in an Instagram post showing his bandaged eye. 

Of course, going through with the fight was never a consideration, and it’s a good thing the doctor wasn’t having it. While athletic commissions across the world often draw the ire of the boxing public, this finding highlighted the importance of medical oversight in the sport and was an example of a commission acting firmly and appropriately. According to NSAC regulations, fighters who wish to compete in Nevada “must submit a dilated ophthalmological exam administered by a licensed ophthalmologist. This exam must be done more than 24 hours before the fight and is valid for one calendar year.”

This may sound like a no-brainer for commissions to require. But in a list of state medical requirements compiled by the Association of Boxing Commissions and Combative Sports, there are a number of state commissions who either do not require an eye exam of any sort or do not offer confirmation that they do. 

That means that had Spence-Pacquiao been staged in a different state, or if Spence had completed an eye exam within the calendar year but had sustained the tear since the test, the fight would be happening, putting Spence in serious danger. 

“The retina is a membrane filled with light-sensing cells in the back of the eye. It acts like film in a camera to capture light and transmit it to the brain. If someone is hit hard enough, or the head swivels quick enough around, it can detach from the wall of the eye,” said Dr. Jonathan Gelber, a member of the Association of Ringside Physicians and the author of the book Tiger Woods's Back and Tommy John's Elbow: Injuries and Tragedies That Transformed Careers, Sports, and Society. “Untreated it can lead to severe consequences, even blindness. Consider Michael Bisping in MMA. He suffered a detached retina in his fight against Vitor Belfort and fought again three months later. Eventually he became blind in the eye and says he secretly fought with a glass eye for years.”

Spence offered on social media that he had “come back from worse,” referencing the horrific car crash that placed him in critical condition in October of 2019. Despite the grisly images from the scene and the speculation that Spence might never be the same physically, he showed no appreciable decline in either skill or durability in a comeback win over Danny Garcia in December of 2020. 

Gelber speculates that following his surgery, Spence will be cleared for everyday activities in a couple of weeks. But in terms of a return to contact sport, the likely recovery period is several months. Provided a doctor clears him for combat once again, he’ll be able to make a full return. 

As Gelber points out, this kind of prognosis would have been unthinkable 40 years ago. 

“Sugar Ray Leonard listened to his doctors and had surgery. Fortunately, his retina wasn't completely detached, but he was starting to see spots and flashes of lights,” he said. “Before that, it was considered a career ending injury. Sugar Ray Leonard fought for another fifteen years.”

In 1982, Leonard was forced to back out of a scheduled world title defense against Roger Stafford after it was discovered he had a partially detached retina. Leonard sought out influential eye surgeon Dr. Ronald G. Michels for his operation. Although many believe Leonard is the first fighter to return to boxing after retinal surgery, he is actually only one of the first, but by far the most publicized and discussed. In fact, Leonard picked Michels because he operated on Ernie Shavers, who suffered a detached retina during a bout with Larry Holmes in 1979, enabling Shavers to fight another 21 times. A year later, then-WBC super welterweight champion Maurice Hope had retina surgery presumed to spell the end of his career, but returned to make two defenses of his title—the second of which was even paired with a closed circuit showing of Leonard-Roberto Duran in Wembley Arena. 

The success of Leonard’s operation and his continued success in the ring began to change the industry’s previous hard line on fighters returning from retinal surgeries. Marvin Camel, boxing’s first cruiserweight champion, underwent retinal surgery under an assumed name in order to avoid being denied a license, and fought for close to 13 years afterwards before the California State Athletic Commission, which previously did not allow fighters with retinal detachments in their medical history to fight, became aware of Camel’s past. 

These days, commissions provide much more leeway, even ones previously as strict as the CSAC. Abner Mares suffered a detached retina in 2008 and went on to fight in California many times. Unfortunately, Mares suffered another detachment in sparring in 2019 and while he has said he intends upon returning, he has been seen wearing sunglasses during his on-air duties for Showtime. 

The list of fighters who have had to hang up their gloves due to eye injuries is long, even after the advancement in optical surgical procedures. Notable fighters such as Oscar Negrete, Nicola Adams, John Murray, Lee Purdy, Anthony Ogogo and more have seen their careers cut short in recent years due to injuries ranging from detached retinas to torn pupils. 

In a study titled "A 16 year study of injuries to professional boxers in the state of Victoria, Australia," which documented injuries in boxing matches from 1985 to 2001 in Victoria, researchers found that 45.8% of all boxing injuries are to the eye region. It concluded that "a high rate (66%) of boxers suffer appreciable ocular trauma that may go unrecognized in injury surveillance studies,” which can perhaps explain the number of ex-fighters who have developed cataracts over the years. In 2003, the British Journal of Sports Medicine unsurprisingly concluded that a boxer is 10 times more likely to suffer an ocular lesion than the general public. 

It is important to distinguish between Spence’s injury, a retinal tear, and a retinal detachment. While both are severe on their own and can lead to blindness, a detachment would be considered more worrisome. In a general sense, one wants to repair retinal tears so that they don’t turn into detachments. However, that would have been a real possibility for Spence had his affliction gone undetected. 

"I would argue that the timing of this fight and his pre-fight physical might have saved (Spence’s) vision," said Dr. Brian Sutterer in a video posted to his YouTube channel on August 11. "Overall Spence is extremely fortunate that this is discovered. This is a perfect example of why we do these eye exams. We're trying to catch these things. Because if he wasn't checked, he went and fought, he gets another eye injury, now it can be a full-blown detachment that can threaten his vision, which goes beyond boxing."

The good news is that according to Dr. Gelber, retinal tear operations have high success rates in terms of sustaining the integrity of the eye moving forward.  

“Like any surgery there are re-tear rates but they are generally pretty low,” said Gelber, while offering that “it’s possible (the rates could be) higher with certain at-risk activities like fighting.”

For now, Spence can still plan on a future in the ring, but in his Instagram announcement seemed to put the situation in a healthy perspective.

“Being able to see my kids grow is the most important thing to me,” said Spence. 

Corey Erdman is a boxing writer and commentator based in Toronto, Ontario, Canada. Follow him on Twitter @corey_erdman