Impact of smoking on eye health

A summary published by the World Health Organization (WHO) takes stock of the impact of smoking, but also of passive smoking and the use of electronic cigarettes, on eye health (cataracts, glaucoma and age-related macular degeneration). Another encouragement to stop smoking as soon as possible and to adopt a healthy lifestyle.

Loss of vision is one of the most disabling disabilities. It has been ranked as the second most feared condition in the United States, behind mental disability.[1]. It is also one of the many health consequences of smoking, although it is rarely thought of. In a policy brief, the WHO summarizes the various points linking smoking to eye diseases[2].

Direct or indirect effects of smoking on eye disorders

Three types of eye conditions are reviewed: cataracts, age-related macular degeneration, and glaucoma.

Most cataracts develop with age, but diabetes, tobacco use, and steroid use are among the risk factors that can influence their development. Smoking is particularly linked to the development of nuclear cataract, the most common form, because it releases free radicals that increase oxidative stress in the lens. The intensity of smoking and the cumulative doses of toxins increase the need for surgical intervention, which in turn can be complicated by smoking. A daily consumption of 15 cigarettes per day increases the risk of cataract surgery by 42% compared with people who have never smoked.[3]An Indian study also showed that the use of smokeless forms of tobacco, such as chewing tobacco, was also significantly associated with the development of nuclear cataracts.[4].

Smoking is also identified as one of the first modifiable risk factors in the onset and development of age-related macular degeneration (AMD), again for its action on oxidative stress. A meta-analysis has highlighted, in particular, a four times higher risk of neovascular AMD and two to three times higher risk of atrophic AMD in smokers.[5]. A dose-response relationship was also highlighted in another study, between the number of pack-years and the appearance of AMD.[6]Smokers are also more likely to develop AMD at a younger age, 5.5 years earlier than never smokers, with the gap narrowing to 4.4 years for ex-smokers.[7]. Passive smoking is also a risk factor, with exposure to passive smoking for 5 years being enough to double the probability of developing AMD. Children exposed to their mother's smoking during pregnancy are also five times more likely to develop AMD. meningitis bacterial, which can cause serious vision problems.

A cohort study has shown that smoking could increase the incidence of glaucoma. In particular, it pointed out a dose-response relationship between the number of pack-years and the incidence of glaucoma, which is not found in ex-smokers or in people exposed to passive smoking.[8]. Smoking also increases dry eyes, which can lead to glaucoma. Dry eyes can also result from using an e-cigarette, especially when using a high voltage, which results in the release of free radicals and aldehydes.

The use of an e-cigarette can also expose one to adverse effects such as blurred vision or loss of vision that may require surgery. In cases of accidents where the e-cigarette battery explodes in the user's mouth, significant eye trauma, such as a laceration of the cornea or damage to the eye tissues, can impair visual acuity.[9].

Individual and collective prevention avenues

Preventive actions for these pathologies can be at two levels, individual or collective. Individual actions focus on quitting smoking, whose beneficial effect on the respiratory and cardiovascular systems can significantly reduce the risk of AMD. However, the increased risk of AMD only completely disappears after twenty years of quitting smoking, knowing that there is no known treatment for AMD. Avoiding exposure to second-hand and third-hand smoke is also an area of prevention for AMD, as is adopting a healthy lifestyle (doing physical activities, adopting a balanced diet with a large place for green vegetables and fruits, protecting yourself from ultraviolet rays, etc.). For the prevention of various eye disorders, regular eye examinations are recommended. Finally, to prevent accidents related to the use of electronic cigarettes, training in the correct handling of these devices is strongly recommended.

In terms of collective actions, WHO recommends implementing the main measures set out in the Framework Convention on Tobacco Control (CCLAT) and that may affect demand, in particular increases in taxes and excise duties, as well as bans on advertising, promotion and sponsorship of tobacco products. WHO also recommends an emphasis on smoke-free spaces and environments, graphic health warnings and the widespread use of standardised plain packaging for different tobacco products.

Keywords: Vision, eye disorders, AMD, eye health, cataract, glaucoma, WHO.

©Generation Without Tobacco

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[1] United States Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, GA: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004. [2] WHO, Tobacco and vision loss, published October 12, 2022, accessed October 14, 2022. [3] Lindblad BE, Håkansson N, Wolk A. Smoking cessation and the risk of cataract. JAMA Ophthalmol. 2014;132(3):253–7. [4] Raju P, George R, Ramesh SV, Arvind H, Baskaran M, Vijaya L. Influence of tobacco use on cataract development. Br J Ophthalmol. 2006;90(11):1374–7. [5] Age-related macular degeneration (AMD). In: National Eye Institute. Bethesda, MD: National Eye Institute; 2021. [6] United States Department of Health and Human Services. The health consequences of smoking: 50 years of progress. A report of the Surgeon General. Atlanta, GA: United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. [7] Vittorio AF, Nguyen V, Barthelmes D, Arnold JJ, Cheung CMG. Murray N et al. Smoking status and treatment outcomes of vascular endothelial growth factor inhibitors for neovascular age-related macular degeneration. Retina. 2020;40(9):1696–1703. [8] Pérez-De-Arcelus M, Toledo E, Martinez-González MÁ, Martin-Calvo N, Fernández-Montero A, Moreno-Montañés J. Smoking and incidence of glaucoma: the SUN cohort. Medicine. 2017;96(1):e5761. [9] Chen IL. FDA summary of adverse events on electronic cigarettes. Nicotine Tob Res. 2013;15(2):615–6. National Committee Against Smoking |