Are you asking your patients about their e-cigarette use?

Brad Lane, O.D., who practices in West Virginia, always asks his patients if they smoke. Dr. Lane has been posing that question for a long time in an effort to educate them on the health hazards of their smoking habit, including to their eyes.

However, as of late, he's tweaked the query.

"Now I might ask, 'do you smoke or vape?'" Dr. Lane says. "The popularity of vaping and e-cigarettes [electronic cigarettes] has caused me to change the way I approach some patients.

"All the news about vaping has made me think differently about how I asked my questions."

The government is stepping up its efforts to snuff out e-cigarette use among young people, providing an opportunity for doctors of optometry to reiterate to their patients the health hazards of combustible and e-cigarettes. That includes harm to their eyes.

Dr. Lane says doctors of optometry can call patients' attention to harmful smoking trends and help prevent some young patients from experiencing serious consequences.

"The majority of ocular side effects of smoking and vaping are not immediate, but they can occur," Dr. Lane says. "Both smoking combustible cigarettes and vaping can cause dry and irritated eyes, but the main concerns are the toxins in e-cigarettes and a decrease in oxygen to the eye that results in damage seen later in life. Anytime there is a decreased amount of oxygen getting to the ocular structures, those structures do not properly function, and permanent damage can occur."

E-cigarette use on the rise

According to a Feb. 11 report by the Centers for Disease Control and Prevention (CDC), 4.9 million middle and high school students used tobacco products in 2018. That's 3.6 million more young people than the year before, meaning 1 in 4 high schoolers and 1 in 14 middle schoolers used a tobacco product last year, the CDC says. Tobacco products include cigarettes, e-cigarettes, smokeless tobacco, hookahs, pipe tobacco and cigars. All tobacco products, including e-cigarettes, contain nicotine.

Driving the jump was the use of e-cigarettes, also called vaping because of the vapor produced by an e-cigarette. The CDC is concerned that e-cigarettes may have a particular appeal to young people. They come in flavored aerosols, are advertised in an enticing way, and give the impression they are healthier than combustible cigarettes. While they do contain fewer toxins, they are still hazardous.

"Let me be clear that any use of any tobacco product is unsafe for teens," said Anne Schuchat, CDC principal deputy director, during a conference call upon the study's release. "Our report finds many are using multiple products; these products typically contain nicotine and several other harmful ingredients. We want everyone, particularly parents and teachers, to know how dangerous use of nicotine in any form is for kids. Nicotine is highly addictive and can harm brain development, including harmful effects on learning, memory and attention."

What can doctors of optometry do?

Depending on patients' answers to his question, Dr. Lane takes the opportunity to engage them in conversation. His response might vary.

"It's dependent on the patient and their reasoning for vaping," he says. "If a patient is using vape pens or e-cigarettes to help them slowly decrease and eliminate their dependency on nicotine and/or combustible cigarettes, I will encourage them to continue moving forward on their journey.

"However, if the patient has recently started to vape and has no intentions of stopping, I suggest they quit and then discuss the ocular side effects of having a decrease in oxygen to the retina caused by e-cigarettes," he says. "I also discuss the long-term effects on their overall health. There seems to be a misconception that vaping is safe and doesn't cause side effects, such as cancer. When faced with that sort of conversation, I take extra time to educate the patient on some ingredients in vape juice and the side effects they may have on them later in life."

Resources for patient education

• Access the patient education pamphlet "Contact Lenses, Smoking and Vaping."
• Access the "Smoking, Vaping and Your Eyes" fact sheet produced by the AOA's Health Promotions Committee in 2018.
• Access CDC resources.