Talk to patients about smoking habits

Excerpted from page 55 of the October 2014 edition of AOA Focus.

Today marks the American Cancer Society's Great American Smokeout, an annual observance day dedicated to encouraging smokers to quit or to use the day to make a quitting plan—and doctors of optometry can take the opportunity to start a conversation with patients about smoking habits.

Smoking is a major risk factor for development of age-related macular degeneration (AMD) and worsening of symptoms. In fact, studies have shown that smoking doubles an individual's risk for AMD, whereas smoking cessation decreases risk for AMD.

But smoking is also one of the risk factors that can be controlled and modified.

A 2014 study published in Optometry & Vision Science found that patients with AMD who smoke fail to self-report smoking more frequently than patients in the general American population.

Mark Swanson, O.D., associate professor of optometry at the University of Alabama at Birmingham and study author, found that 1 out of 20 patients seen by doctors of optometry who say, "I don't smoke," actually do.

Estimates of potential smoking deception—among adults over age 40 with macular degeneration and those at risk of late-stage disease—were calculated by comparing self-reported rates of cigarette use, any nicotine product use, and serum cotinine levels.

How to better communicate with AMD patients

It's important for doctors of optometry and other eye care professionals to be aware that some smokers may not be forthright about their habits.

"The take-home message is that people who are self-reported former smokers may not necessarily have stopped smoking," Dr. Swanson says.

Smokers may be deceptive because smoking is not as socially acceptable as it used to be—and because of how difficult it can be to quit.

"On average, studies have found that it takes around 7 times to try to quit smoking before someone is successful. If someone reports being a former smoker, it's easy for them to fall back into the habit," he notes.

For doctors dealing with AMD patients who self-report as former smokers, Dr. Swanson suggests having a discussion with them about the difficulties of sticking with cessation—whether it's cigarettes or other forms of tobacco, including cigars.