To the Editor.
—With regard to Dr. Knox's comments on "tobacco amblyopia" in his most excellent annual review in the January ARCHIVES (83:103-127, 1970), I would like to add the following observations.
In the United Kingdom tobacco amblyopia is a well recognized and not uncommon complaint. It occurs in elderly men who smoke large quantities of pipe tobacco. This pipe tobacco is of the cheaper, stronger variety, commonly known by the patient as "Shag tobacco." The alcohol intake of these men need not be above average.
One gets gratifying results from treatment, which consists of discontinuing their pipe smoking habit. On more than one occasion in my experience, the patient has been very agreeably surprised at the visual improvement, and has vowed never to touch his pipe again.
We do not seem to see this condition in cigarette or cigar smokers. I hazard a guess that in the United
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