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Curr Treat Options Neurol 2019 Feb 7;21(1). Epub 2019 Feb 7.

Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.

Purpose Of Review: Nutritional optic neuropathy is a potential cause of severe visual loss; however, appropriate and timely management can result in excellent visual outcomes. The purpose of this review is to outline our current understanding of the treatment and outcomes for nutritional optic neuropathy.

Recent Findings: Current understanding of nutritional optic neuropathy has been greatly aided by some well-reported and investigated epidemics of the condition, most notably the Cuban epidemic optic neuropathy of the early 1990s. Read More

Exp Eye Res 2019 01 24;178:255-262. Epub 2018 Aug 24.

Laboratory for Nutrition and Vision Research, USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA, 02111, USA. Electronic address:

Laboratory and epidemiological data indicate that high blood sugar levels and/or consuming high glycemia diets are linked to multiple age-related diseases, including age-related macular degeneration, cataract, Parkinson's disease, Alzheimer's disease, diabetic retinopathy, and, apparently glaucoma. High concentrations of blood sugar and perturbations of the systems that regulate blood sugar lead to the accumulation of advanced-glycation end products (AGEs). AGEs are toxic compounds that are formed from the combination of sugars and their metabolites with biomolecules in a non-enzymatic biochemical reaction called glycation. Read More

MEDICC Rev 2018 Apr;20(2):27-31

Neurology and Neurosurgery Institute, Havana, Cuba.

From 1991 to 1993, an epidemic of optic and peripheral neuropathy-the largest of the century-broke out in Cuba, affecting more than 50,000 people. Initially the main clinical features were decreased visual acuity, central and cecocentral scotomas, impaired color vision and absence of the papillomacular bundle. Later, peripheral and mixed optic-peripheral forms began to appear. Read More

Medicine (Baltimore) 2017 Dec;96(50):e9200

Laboratory of Pharmacology, National Institute of Pediatrics, and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.

Background: Toxic optic neuropathies are alterations of the optic nerve and can be caused by environmental, pharmacological, or nutritional agents.

Case: It is about a 7-year-old male patient, a native of the State of Mexico, Mexico who was diagnosed with cervical mycobacterial lymphadenitis that required management with linezolid.

Observations: After 7 months of treatment, visual acuity of the left eye decreased and was accompanied by headache. Read More

Ir J Med Sci 2017 Aug 30;186(3):565-570. Epub 2016 Dec 30.

Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.

Background: Optic neuropathy is a disorder characterised by dysfunction or destruction of the optic nerve tissues. Acquired causes include interruption in the blood supply, nutritional deficiency, compression by a tumour or aneurysm, trauma, and toxic types (Ambizas and Patel In US Pharm 36(4):HS2-HS6, 1). Drug-induced optic neuropathy is of the toxic type and can be defined as a clinical syndrome characterised by papillomacular bundle damage, central, or cecocentral scotoma, and reduced colour vision (Ambizas and Patel In US Pharm 36(4):HS2-HS6, 2011; Sharma and Sharma In Indian J Ophthalmol 59(2):137-141, 2). Read More

Case Rep Neurol Med 2016 19;2016:5419432. Epub 2016 Jan 19.

Neurology Clinic, Dasman Diabetes Institute, P.O. Box 1180, 15462 Dasman, Kuwait; Al-Bahar Ophthalmology Center, Ibn Sina Hospital, P.O. Box 25427, 13115 Safat, Kuwait.

Optic neuritis is a common presentation of demyelinating disorders such as multiple sclerosis. It typically presents with acute painful monocular vision loss, whereas chronic optic neuropathy can be caused by compressive lesions along the anterior visual pathway, genetic, toxic, or nutritional causes. We report an unusual presentation mimicking optic neuritis, which was subsequently diagnosed as optic nerve sheath meningioma (ONSM). Read More

J Neuroophthalmol 2015 Sep;35(3):242-5

Department of Ophthalmology (LMCV, NFAS, AMDdS, RSdA, LAPAP, ARV, BICCJB, JPTF, DMA, JPPBdC), Central Lisbon Hospital Center, Lisbon, Portugal; Faculty of Medicine (LAPAP), Institute of Pharmacology and Neurosciences, University of Lisbon, Lisbon, Portugal; and Faculty of Medical Sciences (JPPBdC), New University of Lisbon, Lisbon, Portugal.

Objective: To analyze the retinal ganglion cell layer (RGL) by optical coherence tomography (OCT) in toxic and nutritional optic neuropathy and to correlate its thickness and volume with functional damage.

Methods: We conducted an observational cross-sectional study in healthy subjects and in patients with toxic optic neuropathy observed in the Neuro-Ophthalmology Department of Central Lisbon Hospital Center. Complete ophthalmologic examination, OCT (Heidelberg Spectralis), and automated static perimetry were performed. Read More

J Med Life 2014 Oct-Dec;7(4):472-6

"Carol Davila" University of Medicine and Pharmacy, Bucharest.

Part of the large group of nutritional and toxic optic neuropathies, tobacco-alcohol optic neuropathy is a disease often underdiagnosed or detected at a stage when the full recovery of vision is not possible. This article summarizes its signs and symptoms, describes the pathophysiological processes involved and provides the necessary information for diagnosis and treatment of the entity previously known as tobacco-alcohol amblyopia, reporting in the end, a challenging case along with its findings. Read More

Ann Afr Med 2015 Apr-Jun;14(2):109-13

Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.

Context: Optic atrophy is a clinical sign and not a disease. The etiology of optic atrophy is diverse, some of which may be life threatening.

Patients And Methods: A retrospective review of the medical records of all adult patients aged 16 years and above with nonglaucomatous optic atrophy at the eye clinic of the University of Benin Teaching Hospital over a 4-year period was conducted. Read More

Neurol India 2014 Nov-Dec;62(6):599-605

Department of Neurology, K. S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India.

Visual loss consequent to anterior visual pathway involvement can occur in a variety of clinical settings. In a tropical country like India, apart from the usual suspects, nutritional, infective, and toxic amblyopia have to be considered in the differential diagnosis. The mode of onset (acute/chronic), unilateral versus bilateral involvement, accompanying occular pain or the lack of it, and pattern of visual loss are some of the pointers which help to differentiate optic neuropathy clinically. Read More

Acta Ophthalmol 2015 Aug 27;93(5):402-10. Epub 2014 Aug 27.

Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany.

Toxic optic neuropathy (TON) is caused by the damage to the optic nerve through different toxins, including drugs, metals, organic solvents, methanol and carbon dioxide. A similar clinical picture may also be caused by nutritional deficits, including B vitamins, folic acid and proteins with sulphur-containing amino acids. This review summarizes the present knowledge on disease-causing factors, clinical presentation, diagnostics and treatment in TON. Read More

Continuum (Minneap Minn) 2014 Aug;20(4 Neuro-ophthalmology):877-906

Purpose Of Review: Toxic, nutritional, hereditary, traumatic, and neoplastic optic neuropathies result in significant disability due to visual dysfunction. Many of these conditions are treatable. Early diagnosis may allow for intervention to stabilize or improve vision and prevent unnecessary testing. Read More

Handb Clin Neurol 2014 ;121:1521-48

Department of Neurology, Weill Cornell Medical College, Methodist Neurological Institute, Houston, TX, USA. Electronic address:

A large number of causal agents produce spinal cord lesions in the tropics. Most etiologies found in temperate regions also occur in the tropics including trauma, herniated discs, tumors, epidural abscess, and congenital malformations. However, infectious and nutritional disorders occur with higher prevalence in tropical regions. Read More

J Neurol Sci 2013 Apr 7;327(1-2):41-5. Epub 2013 Mar 7.

Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, KS211, Boston, MA 02215, United States.

Introduction: Tobacco alcohol amblyopia is an outdated term for a rare condition characterized by visual impairment due to tobacco and alcohol abuse usually associated with nutritional deficiencies. The more accurate term used now is Nutritional Optic Neuropathy. The visual impairment generally presents as a centrocecal scotoma. Read More

Clin Neurol Neurosurg 2013 Aug 4;115(8):1389-93. Epub 2013 Feb 4.

Department of Clinical Neurophysiology, King's College Hospital, London, UK.

Background: The syndrome of subacute simultaneous peripheral neuropathy and bilateral optic neuropathy is known to occur in tropical countries, probably due to malnutrition or toxicity, but not often seen in developed countries. We report seven patients in London who were not malnourished or alcoholic, and in whom no clear cause was found.

Methods: We retrospectively reviewed the case notes and arranged some further investigations. Read More

Semin Ophthalmol 2010 Jul;25(4):112-22

Department of Neuro-ophthalmology, The Institute of Neurology and Neurosurgery, Havana, Cuba.

The similarities and differences between toxic/nutritional and hereditary optic neuropathy and the pathophysiologic mechanisms that they have in common are described. This is based on data from the epidemic suffered in Cuba in 1992, which affected the optic nerves of many individuals and the experience of the authors in dealing with various toxic optic neuropathies, as well as Leber's hereditary optic neuropathy. Read More

Eur J Radiol 2010 May 21;74(2):299-313. Epub 2010 Apr 21.

Head and Neck and Maxillofacial Radiology, Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH - 1211 Geneva 14, Switzerland.

This article provides an overview of the imaging findings of diseases affecting the optic nerve with special emphasis on clinical-radiological correlation and on the latest technical developments in MR imaging and CT. The review deals with congenital malformations, tumors, toxic/nutritional and degenerative entities, inflammatory and infectious diseases, compressive neuropathy, vascular conditions and trauma involving the optic nerve from its ocular segment to the chiasm. The implications of imaging findings on patient management and outcome and the importance of performing high-resolution tailored examinations adapted to the clinical situation are discussed. Read More

Acta Ophthalmol 2011 Aug 16;89(5):495-9. Epub 2010 Mar 16.

Department of Ophthalmology, Poznan City Hospital, Poland.

This article reviews the historical and current concepts of 'tobacco optic neuropathy' (TON) a rare disorder of optic nerve function related to the toxic effects of an unidentified constituent of tobacco. It is considered to be an entity distinct from that often described as 'tobacco-alcohol amblyopia', a disorder better described as a nutritional optic neuropathy. It is suggested that 'tobacco-alcohol amblyopia' is an inappropriate term, because the condition to which it refers is not an amblyopia, and there is little evidence to implicate a toxic effect of either tobacco or alcohol in the pathogenesis of that disorder. Read More

Drugs Today (Barc) 2007 Nov;43(11):827-36

Casey Eye Institute, Portland, Oregon, USA.

The term optic neuropathy is used to describe optic nerve damage caused by any of four main etiologies: ischemic, hereditary, nutritional and toxic. Ischemic and hereditary optic neuropathies produce profound and often irreversible vision loss. Proper diagnosis of nutritional or toxic optic neuropathies provides the opportunity for potential treatment and hope of restored visual function. Read More

Clin Ophthalmol 2007 Sep;1(3):233-46

Neuro-Ophthalmology Service, Department of Ophthalmology, Ibn Sina Hospital, PO Box 1262, Kuwait City, Kuwait.

Optic neuropathy is a frequent cause of vision loss encountered by ophthalmologist. The diagnosis is made on clinical grounds. The history often points to the possible etiology of the optic neuropathy. Read More

J Neurol Sci 2007 Nov 17;262(1-2):158-64. Epub 2007 Aug 17.

Department of Ophthalmology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20, Rue Leblanc, 75015, Paris, France.

Nutritional deficiency may be the cause of a genuine optic neuropathy, sometimes associated with involvement of the peripheral nervous system. Nutritional optic neuropathies are usually bilateral, painless, chronic, insidious and slowly progressive. Most often, they present as a non-specific retrobulbar optic neuropathy. Read More

Semin Ophthalmol 2002 Mar;17(1):29-32

Department of Ophthalmology, Doheny Eye Institute, University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, USA.

Metabolic optic neuropathies form a rubric of disease characterized by bilaterally symmetrical visual impairment with loss of central visual acuity, dyschromatopsia, centrocecal visual field defects, temporal optic disc atrophy, and specific loss of the nerve fiber layer in the papillomacular bundle. The three subcategories of metabolic optic neuropathies are heredodegenerative (such as Leber's hereditary optic neuropathy), nutritional deficiencies (such as vitamins B12 or folic acid), or toxicities (such as ethambutol or cyanide). It's interesting to note that the first of these three is a congenital cause of mitochondrial impairment, whereas the latter two are acquired injuries to mitochondria. Read More

Rev Neurol 2003 Oct 16-31;37(8):726-9

Servicio de Neurología, Hospital General Universitario de Alicante, Alicante, España.

Introduction: In Western countries, neurological disorders secondary to toxic nutritional problems usually present as isolated cases that are generally associated to identifiable causes (alcoholism, eating disorders, absorption disorders, use of medicines) that reduce the availability of basic nutrients, especially B group vitamins, but also folic acid (FA). The optic nerves and the peripheral axons are frequent target organs in this type of pathology, but leukoencephalopathy and spinal cord involvement may also appear, often in combination.

Case Report: We describe the case of a 38-year-old female smoker with a heavy alcohol habit, who developed a subacute clinical pattern of, predominantly axonal, sensitive peripheral polyneuropathy, with vegetative fibre involvement. Read More

Curr Neurol Neurosci Rep 2003 Sep;3(5):410-4

Neuro-Ophthalmology Unit, Department of Ophthalmology, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel.

Toxic optic neuropathy is a complex, multifactorial disease potentially affecting individuals of all ages, races, places, and economic strata. Etiology includes nutritional, environmental, toxicologic, and genetic factors. Most cases of nutritional amblyopia are encountered in disadvantaged countries. Read More

Dev Ophthalmol 2003 ;37:94-108

MitoKor, San Diego, Calif., USA.

The clinical, biochemical and genetic features of Leber's hereditary optic neuropathy (LHON) are reviewed. The etiology of LHON is complex, but the primary risk factor is a mutation in one of the seven mitochondrial genes that encode subunits of respiratory chain complex I. The pathogenesis of LHON is not yet understood, but one plausible model is that increased or altered mitochondrial ROS production renders the retinal ganglion cells vulnerable to apoptotic cell death. Read More

Rev Prat 2001 Dec;51(20):2215-9

Service d'ophtalmologie Hôpital de La Pitié-La Salpêtrière 75651 Paris.

Painless, bilateral, insidious loss of central vision associated with dyschromatopsia should alert the physician to the possibility of a nutritional, toxic or iatrogenic optic neuropathy, sharing similar clinical features. Given the increasing number of available drugs for systemic disorders, a variety of newly introduced medications have been related to toxicity on the optic nerve. Detecting the cause in the early stages of the disease is mandatory, as withdrawal of the toxic agent may result in vision recovery. Read More

J Neuroophthalmol 2001 Dec;21(4):302-9

Department of Ophthalmology and Neurology, Scheie Eye Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

Optic nerve disorders were not reliably diagnosed until the late nineteenth century when ophthalmoscopy became part of the ophthalmic examination. By the early 1900's, all of the salient clinical features of optic neuritis and its relationship to "systemic sclerosis" were recognized, but there was much controversy and misunderstanding about its differential diagnosis, pathogenesis, and possible treatment. During the twentieth century, physicians began to distinguish optic neuritis from infectious, hereditary, toxic, nutritional, and ischemic optic neuropathies. Read More

Arch Soc Esp Oftalmol 2001 Aug;76(8):493-8

Departamento de Oftalmología del Hospital Hermanos Ameijeiras, La Habana, Cuba.

Unlabelled: The Epidemic Optic Neuropathy (EON) that occurred in Cuba in 1993 affected more than 50,000 people. With the purpose of characterizing it from the clinical and neurophysiological points of view, and of determining the etiology of this illness, we studied 85 of this patients who were treated in the Ophthalmology Department of the Hermanos Ameijeiras Clinical Surgical Hospital, located in Centro Havana, Havana city. Cuba. Read More

Ophthalmol Clin North Am 2001 Mar;14(1):61-71, viii

Neuro-Ophthalmology Unit, Department of Ophthalmology, Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia, USA.

A diverse group of pathologic processes may affect the optic nerve. Clinical manifestations allow localization of pathology to the optic nerve and suggest possible etiologies. Optic disc edema and optic atrophy are fundoscopically visible signs of optic nerve pathology and may provide clues to the underlying process. Read More

Med Hypotheses 2001 Mar;56(3):339-47

Pedro Kouri Institute of Tropical Medicine (IPK), Havana, Cuba; Autopista Novia del Mediodia, Km 6, PO Box 601, La Lisa, Cuba.

During the epidemic of optic and peripheral neuropathy which occurred in Cuba in 1992-1993, viruses antigenically related to the Coxsackie viruses were isolated from cerebrospinal fluid of patients. Concurrently with the virologic studies, epidemiologic, toxicologic, nutritional, immunologic, and histopathologic investigations were also carried out. Although it was demonstrated that the illness was associated with toxic and nutritional risk factors, it has not been possible to identify a specific etiology for the symptoms observed. Read More

Rev Neurol 2000 Sep 16-30;31(6):549-66

Oftamología y Jefa del Departamento de Neuroftalmología, Ministerio de Salud Publica, Ciudad de la Habana, Cuba.

Introduction: The authors describes the past eight years, since an epidemic started in Cuba which mainly affected the nervous system, particularly the optic nerve and the peripheral nerves. It is thought to have been the biggest epidemic involving the nervous system this century, although there may be over-diagnosis. The cause is controversial but is probably nutritional imbalance with additional toxic elements also in some cases. Read More

Semin Neurol 2000 ;20(1):97-110

Neuro-ophthalmology Section, Midwest Eye Institute, Indiana University Medical Center, Indianapolis, USA.

Before embarking on expensive ancillary testing, it is crucial for the neurologist to distinguish visual loss due to optic nerve dysfunction from other causes of visual loss. This can usually be accomplished based on specific features of the history and bedside examination. Once it has been established that a patient has some form of optic neuropathy, several clinical features are helpful in determining the etiology. Read More

Rev Neurol 1999 Aug 16-31;29(4):289-96

Servicio de Neuroftalmología, Instituto de Neurología y Neurocirugía (INN), La Habana, Cuba.

Introduction: This century, the greatest epidemic affecting the nervous system was notified in Cuba seven years ago. At the present time the epidemic continues although to a lesser extent. The clinical findings of the illness were mainly bilateral optic neuropathy sometimes accompanied by other symptoms and peripheral neuropathy. Read More

Trans Am Ophthalmol Soc 1998 ;96:881-923

Doheny Eye Institute, Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles, USA.

Background: Blindness from an optic neuropathy recently occurred as an epidemic affecting 50,000 patients in Cuba (CEON) and had clinical features reminiscent of both tobacco-alcohol amblyopia (TAA) and Leber's hereditary optic neuropathy (Leber's; LHON). Selective damage to the papillomacular bundle was characteristic, and many patients also developed a peripheral neuropathy. Identified risk factors included vitamin deficiencies as well as exposure to methanol and cyanide. Read More

Rev Neurol 1997 Dec;25(148):1852-8

Departamento de Neurología, hospitales Clínico-Quirúrgico Dr. Gustavo Aldereguía Lima.

Introduction: From October 1992 to September 1993 clinical observations of the civil population of Cienfuegos revealed the presence of epidemic neuropathy (EN) reaching about 2,000 patients. The clinical manifestations were not uniform. Although numerous studies have been carried out in our country, none have established the characteristics of EN 'the peripheral form'. Read More

Rev Neurol 1997 Dec;25(148):1848-52

Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba.

Introduction: At the beginning of 1992 an epidemic neuropathy was seen in Cuba.

Material And Methods: To determine the clinical characteristics we studied the clinical and neurological features, cerebrospinal fluid, and did neurophysiological investigations and sural nerve biopsies.

Results: Sixty patients were studied. Read More

Rev Cubana Med Trop 1997 ;49(3):186-95

Instituto de Medicina Tropical Pedro Kourí, Ciudad de La Habana, Cuba.

During the epidemic neuropathy occurred in Cuba from 1992 to 1993, viral isolations antigenically connected with Coxsackie viruses were obtained from the cerebrospinal fluid of patients. Virological, epidemiological, toxicologic, nutritional, immunological and histopathological investigations were made. Though the disease was related to toxic and nutritional factors, it has been impossible to identify the cause of the epidemic. Read More

Surv Ophthalmol 1997 Jan-Feb;41(4):341-53

Department of Ophthalmology, New England Eye Center, New England Medical Center, Tufts University, Boston, Massachusetts, USA.

During 1992 and 1993 an epidemic of optic and peripheral neuropathy affected over 50,000 Cubans. This occurred in the unique setting of a communist country which had a widespread health care network and wherein sudden changes in the economy affected most of the population. Although nutritional factors appeared to play a key role in the pathogenesis of the epidemic neuropathy, viral, toxic, and genetic factors were investigated by Cuban and North American scientists. Read More

Am J Public Health 1996 May;86(5):738-43

Hospital Gustavo Aldereguía, Cienfuegos, Cuba.

The 1991 to 1994 epidemic of neuropathy in Cuba has been one of the more devastating in recent history, affecting more than 50,000 people throughout the entire country with clinical manifestations of optic and peripheral neuropathy. Although the causes are not entirely clear, it seems that a combination of acute nutritional deficiency and the toxic effects of tobacco and possibly other unidentified toxic substances is involved. The epidemic coincided with the acute worsening of the economic situation on the island following political changes in Eastern European countries and a tightening of the US economic embargo. Read More

Curr Opin Neurol 1996 Feb;9(1):5-15

Johns Hopkins Hospital, Baltimore, MD 21287, USA.

Recent articles in the scientific literature have described major advances in our understanding of the anatomy and vascular relationships of the optic nerve (cranial nerve II) and of the diagnosis and treatment of a variety of disorders affecting this nerve, including congenital anomalies of the optic disc, dominant hereditary optic neuropathy, anterior and retrobulbar arteritic and nonarteritic ischemic optic neuropathy, optic neuritis, Cuban epidemic optic neuropathy, toxic and nutritional optic neuropathies, radiation-induced optic neuropathy, AIDS-related optic neuropathy, optic neuropathies caused by tumors, and papilledema. Read More

Semin Ophthalmol 1995 Sep;10(3):195-202

Neuro-Ophthalmology Department, University of Texas Medical Branch, Galveston, USA.

The syndrome characterized by papillomacular bundle damage, central or cecocentral scotoma, and reduction of color vision can be produced by toxic, nutritional, or hereditary causes. Patients who present with such a picture should be evaluated for toxic sources such as tobacco or alcohol use. Nutritional deficiencies must be considered and a good family history should be obtained to explore hereditary factors. Read More

Bol Oficina Sanit Panam 1995 Feb;118(2):115-26

Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), La Habana, Cuba.

The purpose of this study was to identify the risk factors for epidemic optic neuropathy, which occurred in Cuba in 1992 and 1993, as well as to formulate a hypothesis about its etiology. The study sample consisted of 551 pairs of cases and controls matched for age, sex, and area of residence. The cases were patients aged 15 years and over who were diagnosed in April 1993. Read More

J Neurol Sci 1994 Dec;127(1):68-76

National Reference Center for Pathologic Anatomy, Laboratory of Pathology, Havana, Cuba.

More than 50,000 patients were affected in Cuba during an epidemic outbreak of peripheral neuropathy from January 1992 until September 1993. The disease presented as either a retrobulbar optic neuropathy, a predominantly sensory peripheral neuropathy, a dorsolateral myeloneuropathy, or as mixed forms. The morphological findings in sural nerve biopsies from 34 patients with various forms of the disease are presented here. Read More

Arch Ophthalmol 1994 May;112(5):691-9

ORBIS International, New York, NY.

Objective: To characterize and establish a clinical definition of the optic neuropathy that appeared in epidemic form in Cuba in 1992 and 1993.

Methods: At the invitation of the Cuban Ministry of Health, Havana, members of ORBIS International and the Pan American Health Organization, assembled teams that traveled to Cuba in May 1993. We were initially briefed by Cuban national experts in the areas of virology, nutrition, toxicology, ophthalmology, neurology, and public health. Read More

Nutr Rev 1993 Dec;51(12):349-57

School of Nutrition and a Research Scientist, USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111.

From late 1991 to mid-1993, cases of optic neuropathy of unknown etiology, which first appeared in unusual numbers in a western province of Cuba, spread and multiplied throughout the island. The dominant symptoms changed, becoming increasingly those of peripheral neuropathy. Incidence rates peaked in April 1993. Read More

Br J Ophthalmol 1984 Jul;68(7):449-57

Bilateral centrocaecal scotomata have been recognised as a sign of intrinsic optic nerve disease, usually associated with hereditary optic neuropathy, and nutritional or toxic amblyopias. This report describes four patients with central scotomata due to intracranial masses, three of whom recovered after surgical intervention. The clinician should be alerted to the association in patients with headaches, other neurological signs, and central visual loss. Read More

Br J Ophthalmol 1984 May;68(5):336-42

Unilateral central or centrocaecal scotoma may result from optic nerve compression. However, such defects bilaterally usually indicate non-compressive optic neuropathy of toxic or nutritional, hereditary, or demyelinating origin. Three cases are reported of patients who presented with somewhat atypical bilateral central or centrocaecal scotomata and were found to have suprasellar mass lesions demonstrated by CT scan and confirmed neurosurgically. Read More

Adv Neurol 1982 ;32:11-9

Bull Mem Soc Fr Ophtalmol 1981 ;93:230-7