an objective sign was noted: a wedge defect of the temporal optic disc and the loss of the corresponding Papillomacular bundle. Most of the patients reported high consumption of alcohol particularly homemade rum and smoking cigarettes. This was associated with severe deficiencies of protein and vitamin intake, in particular of vitamin B12 and folate. This picture of vitamin deficiencies was exacerbated by low levels of methanol present in homemade rum. It was thought that the Cuban epidemic may have been caused by the chronic accumulation of formate from methanol metabolism in a population with severe folic acid depletion and the accumulation of cyanide from cigarette smoke. This conclusion was supported by evidence of improvement in visual acuity on prompt and daily administration of cyanocobalamin (3 mg) and folate (250 mg) along with dietary supplementation. Hereditary Optic Neuropathies The inherited optic neuropathies typically manifest as symmetric bilateral central visual loss. Optic nerve damage in most inherited optic neuropathies is permanent and progressive. Leber's Hereditary Optic Neuropathy (LHON) LHON, as the name suggests, is an inherited mutation that results in acute or subacute vision loss, displays incomplete penetrance and predominantly affects young males. Onset is usually between the 2nd and 4th decade of life, and usually presents with rapid vision loss in one eye followed by involvement of the second eye (usually within months). Visual acuity often remains stable and poor (below 20/200) with a residual central visual field defect. Patients with the m.14484/ND6 mutation are most likely to have visual recovery. Autosomal Dominant Optic Atrophy (DOA) DOA is an autosomal dominant disease caused by a defect in the nuclear gene OPA1. A slowly progressive optic neuropathy, usually presents in the first decade of life and is bilaterally symmetrical. Examination of these patients shows loss of visual acuity, temporal pallor of the optic discs, centrocecal scotomas with peripheral sparing, and subtle impairments in color vision. Behr’s syndrome This is a rare autosomal recessive disorder characterized by early-onset optic atrophy, ataxia, and spasticity. Charcot Marie Tooth disease (CMT) This disease is a heterogenous group of inherited neuropathies, stemming from a MFN2 mutation, in which both motor and sensory nerves are affected, resulting in distal limb weakness, sensory loss, decreased deep tendon reflexes, and foot deformities. Affected individuals develop progressive optic nerve dysfunction starting later in childhood. Hereditary spastic paraplegia (HSP) HSP is marked by slowly progressive lower limb spasticity and weakness. HSP can