Literature DB >> 23766587

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Jyoti Prakash1.   

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Year:  2012        PMID: 23766587      PMCID: PMC3678188          DOI: 10.4103/0972-6748.110962

Source DB:  PubMed          Journal:  Ind Psychiatry J        ISSN: 0972-6748


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I am thankful to the reader for going through my paper and critically appreciating the same. I thank the journal for providing me such podium. The questions are pertinent and concerns genuine. However, we would like to justify our standpoint and put things in right perspective. Our case presented with bilateral painless loss of vision in the background of prolonged alcohol abuse and tobacco smoking. The presentation was similar to tobacco-alcohol amblyopia discussed in the literature. Management of similar line did yield satisfactory result. Tobacco alcohol amblyopia is also called toxic-nutritional optic neuropathy.[12] This suggest the disorder to be either due to toxic effects of alcohol and tobacco and/or due to nutritional deficiency arising due to abuse of both.[3-6] Though some literature do give primacy to nutritional aspect, most do emphasizes the causation to be multifactorial. The authors nowhere implicate tobacco or alcohol as sole etiological basis for tobacco alcohol amblyopia. In fact tobacco or alcohol mostly mediate or contribute by their toxic and adverse nutritional effects.[7-9] Tobacco alcohol amblyopia improves with removal of toxin/toxic effects and provision of nutritional/vitamin supplements.[9] Our patient also improved adequately with abstinence from tobacco and alcohol and vitamin B supplements. Though the symptom profile in toxic alcohol amblyopia is similar to those seen in Leber's hereditary optic neuropathy; the nature of onset, adequate symptom resolution with abstinence and primarily vitamin supplements and absence of similar illness in family suggested it would be mainly due to tobacco and alcohol; preventing our clinical judgment to err in other direction. To sum up; the nomenclature and the etiological basis of such entity can at the most be debatable; but to call it nonexistent; would be premature an opinion.
  8 in total

1.  Tobacco-alcohol amblyopia: a maculopathy?

Authors:  R Behbehani; R C Sergott; P J Savino
Journal:  Br J Ophthalmol       Date:  2005-11       Impact factor: 4.638

2.  Absorption of vitamin B12 in tobacco amblyopia.

Authors:  E J Watson-Williams; A C Bottomley; R G Ainley; C I Phillips
Journal:  Br J Ophthalmol       Date:  1969-08       Impact factor: 4.638

3.  Optical coherence tomography in a patient with tobacco-alcohol amblyopia.

Authors:  C Kee; J-M Hwang
Journal:  Eye (Lond)       Date:  2007-04-13       Impact factor: 3.775

4.  Multidimensional scaling of D15 caps: color-vision defects among tobacco smokers?

Authors:  David Bimler; John Kirkland
Journal:  Vis Neurosci       Date:  2004 May-Jun       Impact factor: 3.241

Review 5.  Metabolic optic neuropathies.

Authors:  Alfredo A Sadun
Journal:  Semin Ophthalmol       Date:  2002-03       Impact factor: 1.975

6.  Whole blood cyanide levels in patients with tobacco amblyopia.

Authors:  J V Jestico; M D O'Brien; R Teoh; P A Toseland; H C Wong
Journal:  J Neurol Neurosurg Psychiatry       Date:  1984-06       Impact factor: 10.154

Review 7.  Cyanide in human disease: a review of clinical and laboratory evidence.

Authors:  J Wilson
Journal:  Fundam Appl Toxicol       Date:  1983 Sep-Oct

8.  Toxic optic neuropathy.

Authors:  Pradeep Sharma; Reena Sharma
Journal:  Indian J Ophthalmol       Date:  2011 Mar-Apr       Impact factor: 1.848

  8 in total

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