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LETTER TO EDITOR
Year : 2012  |  Volume : 21  |  Issue : 1  |  Page : 79-80  Table of Contents     

Author reply


Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication22-Apr-2013

Correspondence Address:
Jyoti Prakash
Department of Psychiatry, Armed Forces Medical College, Pune 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


PMID: 23766587

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How to cite this article:
Prakash J. Author reply. Ind Psychiatry J 2012;21:79-80

How to cite this URL:
Prakash J. Author reply. Ind Psychiatry J [serial online] 2012 [cited 2019 Sep 16];21:79-80. Available from: http://www.industrialpsychiatry.org/text.asp?2012/21/1/79/110962

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. [1],[2] 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],[4],[5],[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],[8],[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.

 
   References Top

1.Kee C, Hwang JM. Optical coherence tomography in a patient with tobacco-alcohol amblyopia. Eye 2008;22:469-70.  Back to cited text no. 1
    
2.Behbehani R, Sergott RC, Savino PJ. Tobacco-alcohol amblyopia: A maculopathy? Br J Ophthalmol 2005;89:1543-44.  Back to cited text no. 2
    
3.Bimler D, Kirkland J. Multidimensional scaling of D15 caps: Color-vision defects among tobacco smokers? Vis Neurosci 2004;21:445-8.  Back to cited text no. 3
    
4.Wilson J. Cyanide in human disease: A review of clinical and laboratory evidence. Fundam Appl Toxicol 1983;3:397-9.  Back to cited text no. 4
    
5.Jestico JV, O'Brien MD, Teoh R, Toseland PA, Wong HC. Whole blood cyanide levels in patients with tobacco amblyopia. J Neurol Neurosurg Psychiatry 1984;47:573-8.  Back to cited text no. 5
    
6.Watson-Wiliams EJ, Bottomley AC, Ainley RG, Philips CI. Absorption of vitamin B12 in tobacco amblyopia. Br J Ophthalmol 1969;53:549-50.  Back to cited text no. 6
    
7.Sadun AA. Metabolic optic neuropathies. Semin Ophthalmol 2002;17:29-32.  Back to cited text no. 7
    
8.Kee C, Hwang JM. Authors' reply: Optical coherence tomography in a patient with tobacco-alcohol amblyopia. Eye 2007;21:1448.  Back to cited text no. 8
    
9.Sharma P, Sharma R. Toxic optic neuropathy. Indian J Ophthalmol 2011;59:137-41.  Back to cited text no. 9
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