We thank Dr. Grzybowski for his thoughtful comments(1) in response to our recent paper.(2) He makes several points: 1) We acknowledge that the seminal work of Carroll(3) set the stage for considering tobacco-alcohol amblyopia (TAA) as a nutritional optic neuropathy and that vitamin B treatment can ameliorate the condition even when patients continue to consume tobacco and alcohol. The studies of Rizzo and Lessell(4) also support the point that B-12 supplementation can help, despite continuation of smoking and drinking. Golnik and Schaible(5) demonstrated, in six patients, that oral folic acid alone led to improvements in such patients as well. TAA is probably in part a nutritional deficiency, and in light of the success for different modalities of nutritional supplementation, at minimum, it should be considered a multi-factorial condition. We agree that TAA is a bad term.