Comment on: ‘Patients with unexplained neurological symptoms and signs should be screened for vitamin B12 deficiency regardless of haemoglobin levels’

To the Editor:

We read with interest the recently published Eye correspondence that patients with unexplained neurological symptoms should be screened for vitamin B12 deficiency, regardless of haemoglobin levels [1].

Vitamins are essential for normal metabolic function and deficiencies can cause a range of ophthalmic and neuro-ophthalmic pathology. Identifying a vitamin deficiency should always prompt investigation to exclude concurrent deficiencies. The current socioeconomic challenge and food insecurity may result in a rise in reversible, nutritional visual loss and disease.

Recognising the key ophthalmic features of vitamin deficiencies is a requirement of the Royal College of Ophthalmologists’ Ophthalmic Specialist Training [2]. Table 1 addresses this knowledge. We hope that it will act as a useful aide memoir in the coming months, when the socioeconomic challenge may increasingly affect our patients’ food choices and visual health.

Table 1 Vitamin deficiencies with ophthalmic and neurological manifestations.