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But, during the past 40 years, abundant evidence has been published indicating that high-dose oral cobalamin is as efficacious as the parenteral form.7 Vitamin B12 deficiency causes anemia, fatigue, loss of appetite, mood disturbances, paresthesias, ataxia, and memory loss.8 The process of vitamin B12 absorption can be impaired at the level of the stomach, where intrinsic factor is produced, or at the level of the terminal ileum, where intrinsic factor bound to vitamin B12 is absorbed.8 Medications, such as metformin or antacids, also can impair absorption.8 But, a small amount of vitamin B12 is absorbed by passive diffusion without intrinsic factor.8 Vitamin B12 is available over the counter in the form of tablets (100, 500, 1,000, or 5,000mg) and lozenges (50, 100, 250, or 500mg).8 Vitamin B12 (cobalamin) deficiency should be considered in the differential diagnosis of any patient with optic nerve cupping, normal IOP and bitemporal visual field loss