Smoking and ocular conditions

Muriel Schornack, OD, FAAO, discussed the correlation between cigarette smoking and ocular conditions and diseases during the 90th annual SECO International meeting in Atlanta.

Although the number of cigarette smokers has been declining, numbers are still high, said Dr. Schornack, who is part of the Department of Ophthalmology at the Mayo Clinic in Rochester, MN. The Centers for Disease Control’s (CDC) original goal was to reduce the prevalence of smoking to 12% or less by 2010. An updated goal is to reduce the prevalence to 16% in youth and 12% in adults by 2020. However, the current rate of decline will not allow us to achieve this goal.

Smokers are at increased risk for dry eye. Smoking affects the surface of the eye with:

• Direct surface irritation

• Decreased tear lipid quality

• Decreased lysozyme concentration

• Increased inflammatory stimuli

Smokers are at increased risk of thyroid-associated ophthalmology. Smokers were more likely to have a delayed and decreased response to treatment. Smoking affects thyroid function with:

• Inhibition of iodine uptake and hormone synthesis

• Decreased thyroid function

• Decreased serum levels of TSH and thyroglobulin

• Hypoxic effects on muscular tissue

Cataract development is now included in the Surgeon General’s warning about cigarettes. There is a very well-established association between smoking and cataracts. It affects the lens with oxidative damage to lens fibers and deposition of heavy metals within the lens.

Smoking affects ocular ischemia through:

• Increased blood viscosity

• Vasoconstriction

• Decreased oxygen capacity of hemoglobin

• Increased severity of atherosclerosis

The association between smoking and age-related macular degeneration (AMD) is approaching causation. Smoking affects macular changes through:

• Retinal ischemia, hypoxia, and microinfarctions

• Reduced plasma concentration of antioxidants

• Lipid peroxidation

Currently studies are mixed on the relationship between smoking and glaucoma. Hoehn (2012) showed that although male smokers exhibited an increase in intraocular pressure (IOP), the same association was not found in women smokers.

Print advertisements for cigarettes now include graphic images of smokers receiving treatment instead of a small black-and-white “Surgeon General’s Warning” box. Eye-tracking studies have shown that patients are looking at the graphic images and are more likely to remember the message.

Encourage your patients who smoke to quit by discussing the Five A’s, developed by the Mayo Clinic in 2009:

• Ask your patients if they smoke

• Advise them to quit

• Assess willingness to make a quit attempt

• Assist in the attempt

• Arrange for follow-up