Deficiency Amblyopia

This disorder is most likely related to the depletion of one or more B vitamins, although none has been specifically implicated. Deficiency amblyopia occurs only after severe and prolonged nutritional deprivation. The strict dietary deficiencies required to produce amblyopia are known to occur mainly in mistreated prisoners of war and alcoholics. Smoking tobacco was once considered another risk factor (hence, the alias tobacco-alcohol amblyopia), but this is no longer believed to be true.

Patients with this disorder experience the subacute onset (over days to weeks) of symmetrical loss of visual acuity, and colors perceived appear to be washed out. On examination, the central portion of vision is especially impaired, and occasionally patients exhibit pallor of the optic discs. Patients often have evidence of other syndromes of nutritional deficiency, including a predominantly sensory polyneuropathy. The possible causes of optic neuropathy are legion, and most are much more common than deficiency amblyopia. The diagnosis should be suggested by the clinical setting.

The most valuable test in the evaluation of these patients is perimetry, which allows for the confirmation of the central or centrocecal distribution of the visual field defect. The diagnosis can be solidified, retrospectively, by a positive response to treatment. Because this disorder results from extreme nutritional deprivation, prevention is relatively easy. Any reasonably balanced diet should provide sufficient vitamin intake for this purpose. Substantial recovery is possible in most cases by eating a nutritious diet supplemented by multivitamins. The majority of patients recover if proper treatment is instituted and the degree of recovery is inversely proportional to the duration of nutritional deprivation.

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