Tobacco-alcohol amblyopia neuro-ophthalmological findings and clinical course

The clinical picture of 40 patients with tobacco-alcohol amblyopia (TAA) is described. In 15 patients the course of the disease was studied longitudinally over a period of 31 months. In addition in six patients the acute development of the disease was studied during a period of four weeks in-patient treatment. TAA is characterised by distinct bilateral visual disturbances, symmetric scotomas, acquired disturbances of colour vision and mostly normal fundi. Visual acuity is usually grossly diminished. Central scotomas were present in 80% of the cases while the centrocecal from prevailed in the rest. The acquired disturbances of colour vision usually concerned the red-green sense (84%). The amplitudes of the visual evoked potentials were always reduced and deformed. In 33% we could not detect a P-100. In 5% the latency of the P-100 was prolonged. Full field stimulation was the best method of defining the P-100. By foveal stimulation the deformations of the amplitudes were more evident. The prognosis of the visual disturbances was unpredictable. The abnormalities improved in one half of the patients, but complete recovery was never reached despite substitution with vitamins.