Doctors of optometry can help stop troubling e-cigarette trends in youth

The government is stepping up its efforts to snuff out electronic cigarette use among young people, offering an opportunity for doctors of optometry to reiterate to their patients smoking's health hazards, including to their eyes.

On Sept. 12, Food and Drug Administration (FDA) Commissioner Scott Gottlieb, M.D., declared e-cigarettes a "clear and present danger" and called vaping among youth an "epidemic." The FDA head announced a crackdown on the illegal sales and marketing of e-cigarettes to young people; it sent 1,300 warning letters and complaints to retailers and manufacturers and challenged them to come up with less addictive options for consumers. And he hinted at more changes to come, as part of a new overall strategy to address troubling smoking trends among youth.

Not only is smoking an irritant to the eyes, but it also is a major risk factor for age-related macular degeneration (AMD) and cataracts, and the leading cause of preventable disease in the U.S.

"Given the explosive growth of e-cigarette use by kids, we're committed to taking whatever measures are appropriate to stem these troubling use trends," Dr. Gottlieb said.

In a June 8 article in Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention reported that while overall tobacco use declined non-linearly in the U.S. between 2011 and 2017, e-cigarette use in the past 30 days increased non-linearly among high school students (1.5% to 11.7%) and middle schoolers (0.6% to 3.3%) in the same period.

Grounds for concern

Advocates argue for the increased scrutiny of e-cigarette use by young people because:

• The majority of smokers start in their youth and young adulthood (9 out of 10 by age 18).
• A December 2017 Jama Network study linked vaping as a gateway to more vaping and combustible cigarettes.
• E-cigarettes surpassed combustible cigarettes as the most-used tobacco product among youth in schools.

E-cigarettes have a particular appeal to youth. They come flavored, are advertised in an enticing, youthful way, and give the impression they are healthier than combustible cigarettes—they do contain fewer toxins but they are still hazardous.

Patient education

The AOA Health Promotions Committee's own concerns about the vaping trend prompted it to produce new patient education, "Smoking, Vaping and Your Eyes," led by committee member Dan Bintz, O.D.

The fact sheet provides patients with information on the hazards of combustible cigarettes and e-cigarettes, beyond being an irritant to the eyes.

"It's a huge concern for our young people (teens and young adults) and optometrists," says Sue Lowe, O.D., chair of the Health Promotions Committee. "We are always concerned with oxygen flow to the retina, any type of carcinogen in the body—not to mention the lungs.

"I'll be revising my quality-of-life handout for patients to include vaping," Dr. Lowe says.

For more than a decade, Dr. Bintz has queried his patients about their consumption of combustible cigarettes. He asks them:

• Do you smoke?
• Are you a current or former smoker? Never smoked?
• How much do you smoke?

And now?

"I haven't singled out vaping in my questions, though I think we (doctors of optometry and paraoptometric staff) should be having that specific conversation," Dr. Bintz says. "The challenge is there is not a specific 'vape' question on our EHR, so it doesn't get asked. And if it were asked, it would have to be entered manually in comments. Updated patient education also should be utilized.

"Doctors and staff need to continue thinking beyond the eye," he adds. "Tobacco is the primary cause of death for 1,000 persons daily in the U.S. alone, and it's totally preventable. I am concerned that we are seeing just the beginning of the vaping issue, especially with the shift in marijuana laws and the continued downward use of conventional tobacco products."

AOA resources

"Contact Lenses, Smoking and Vaping" pamphlet.
"Smoking, Vaping and Your Eyes" fact sheet.