Help patients understand the hazards of vaping to the eyes

June 12, 2024
The use of tobacco products is on the decline but not so for e-cigarette (e-cig) use. A recent literature review on vaping underscores its potential hazards to the ocular surface.
e-cigarettes and vaping: Person vaping with glasses on

It seems like ever since vaping was introduced in the U.S. market almost two decades ago, health care providers and researchers have been trying to smoke out whether vaping is indeed a “safe” alternative to combustible cigarettes.

In “The Impact of Vaping on the Ocular Surface: A Systematic Review of the Literature,” published April 28, 2024, in the Journal of Clinical Medicine, researchers found “significant risks”—from non-intended and intended exposures, though they note that more research is needed.

“The impact of vaping on the ocular surface is not benign,” the review’s authors say. “There are significant risks that vaping can pose to the ocular surface.

“Hence, it is necessary to develop appropriate risk communication tools given the increasing popularity of this activity.”

Among the conclusions, from intended and non-intended exposure to vapes’ aerosol mist, in the review:

  • E-cigs may reduce the quality and stability of the tear film, thereby impacting the ocular surface. The tear film acts as protection, lubricant and refraction for the cornea.
  • E-cigs/vaping products may contribute potentially to dry eye, a multifactorial disease.
  • E-cig users should be educated on the potential effects that vaping can have on their ocular surface, as well as potential dangers from non-intended exposure.
  • Policymakers should consider passing legislation that reduces the potential for ocular harm caused by e-cigs/vaping products, such as restricting e-liquid containers.

AOA members Pamela Lowe, O.D., FAAO, Dipl. ABO, who practices in Illinois, and Daniel Bintz, O.D., who practices in Oklahoma, comment on the literature review and about the role of doctors of optometry in protecting patients’ eye health from vaping.

What is your view on the conclusions in the literature review?

Dr. Lowe: Continued studies, along with a review of current studies, on the side effects of vaping are important to shed light on the potential ocular and physical complications optometrists need to be aware of to properly educate patients. This review of the current literature outlines the implications vaping has on tear film stability, which directly impacts visual and ocular comfort. The review of literature also addresses the well-known addictive nature of tobacco use and its long-term potential for systemic disease.

Dr. Bintz: It’s a good starting place. We know that any additive to the air we are exposed to may have a negative effect on the ocular surface and other external and internal tissues. So, it makes sense to study this new form of smoking. They keep repeating that studies are in their infancy and that more research is needed, but that initial studies are having mixed results, with most pointing to e-cig use as being an ocular surface irritant and possibly long-term effects of damaging the anatomy of the lids that helps produce tear film.

Do you converse with your patients about their vaping and/or tobacco use and potential harm to their eye health and vision?

Dr. Lowe: In many cases, the only health care provider patients see is their optometrist; this puts the responsibility on doctors of optometry to address the potential ocular and systemic diseases for which a patient is at risk. Addressing strategies to reduce these risks is essential for every patient’s follow-up and treatment plan.

Dr. Bintz: Yes, we all try to keep pushing the message, but with having to increase patient loads due to low reimbursement from vision care plans, our conversations sometimes do not happen or are quite brief.

How are you communicating with your patients on the subject?

Dr. Lowe: Along with giving patients information and resources on smoking cessation and the risks of topical tobacco use with popular products like Zyn, our office refers patients back to their primary care general physician to coordinate care. Especially due to the increased systemic risks of cancer, heart disease, stroke and cardiovascular disease.

Dr. Bintz: It’s part of the social history the techs take during pretesting and health history review, which I review during the exam. In our practice, we also have a poster in each pre-test room, one about vaping and the other about tobacco use. We also have materials from 1-800-QUIT NOW.

What role does patient education have in discouraging e-cigs/tobacco use?

Dr. Lowe: We are most certainly educating ALL patients who use tobacco products on the potential health risks and the direct relationship to tear film stability and increased risks for sight-threatening conditions such as glaucoma and age-related macular degeneration.

Dr. Bintz: I think most patients know they would be better off not using e-cigs but many think of it as the lesser of two evils, compared to tobacco use. Again, we try to educate them as to the risks of tobacco use, starting with contact lens training, as many new contact lens wearers are at the age where experimenting with vaping and tobacco use occurs. Scaring them with talk of blindness and lung cancer may not be as effective as telling them the immediate downsides such as bad smelling breath, hair, clothing, yellow teeth, reduced athletic performance. etc.

Go to AOA Marketplace to view the patient education pamphlet, "Contact Lenses, Smoking and Vaping."



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Find resources such as fact sheets, a press release, social media posts and more on vaping, smoking and the eyes.
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