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Previous Volume 333:1176-1182 November 2, 1995 Number 18 Next

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ABSTRACT

Background From 1991 to 1993, epidemic optic and peripheral neuropathy affected more than 50,000 people in Cuba. The number of new cases decreased after the initiation of vitamin supplementation in the population. In September 1993, Cuban and U.S. investigators conducted a study to characterize and identify risk factors for the optic form of the syndrome.

Methods We conducted ophthalmologic and neurologic examinations, assessed exposure to potential toxins, administered a semiquantitative food-frequency questionnaire, and assessed serum measures of nutritional status in 123 patients with severe optic neuropathy, matched for sex and age to randomly chosen normal subjects.

Results In the case patients, prominent clinical features were subacute loss of visual acuity with field defects, diminished color vision, optic-nerve pallor, and decreased sensitivity to vibration and temperature in the legs. Tobacco use, particularly cigar smoking, was associated with an increased risk of optic neuropathy. The risk was reduced among subjects with higher dietary intakes of methionine, vitamin B₁₂, riboflavin, and niacin and higher serum concentrations of antioxidant carotenoids. The risk was also reduced among subjects who raised chickens at home or had relatives living overseas — factors that may be indirect measures of increased food availability.

Conclusions The epidemic of optic and peripheral neuropathy in Cuba between 1991 and 1993 appears to be linked to reduced nutrient intake caused by the country's deteriorating economic situation and the high prevalence of tobacco use.

Source Information

Address reprint requests to Dr. Rossanne M. Philen, Centers for Disease Control and Prevention, 4770 Buford Hwy., Mailstop F-46, Atlanta, GA 30341.

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Epidemic Optic Neuropathy in Cuba
Garfield R., Kirkpatrick A. F., Philen R. M., The CDC Members of the Cuba Neuropathy Field Investigation Team
Extract | Full Text  
N Engl J Med 1996; 334:1063-1064, Apr 18, 1996. Correspondence

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