Tobacco-alcohol amblyopia: a proposed biochemical basis for pathogenesis.

Tobacco-alcohol or nutritional amblyopia is a rare disorder of decreased central vision associated with nutritional deficiencies and tobacco smoking. although folate deficiency is common in patients with tobacco-alcohol amblyopia, the role of folic acid in this disorder has been underplayed. The role of cyanide from tobacco smoke, folate and other dietary deficiencies will be reviewed. A new model of the pathogenesis of tobacco-alcohol amblyopia is proposed based on the presumptive alteration of methionine and S-adenosyl-L-methionine metabolism.