On World No Tobacco Day, don’t let smoke cloud your vision

Today is World No Tobacco Day, and doctors of optometry can smoke out opportunities to talk with their patients about the hazards smoking cigarettes poses to their eye health.

More than half a century has passed since the landmark 1964 U.S. Surgeon General's report on the hazards of smoking, yet tobacco use is still the leading cause of preventable disease and death in the U.S. with cigarettes the most commonly used tobacco product. According to the World Health Organization (WHO), 7 million people die each year from inhaling smoke and exposure to secondhand smoke. The focus of its 2018 campaign is cardiovascular disease—tobacco use is a risk factor for coronary heart disease. And though public awareness of its hazards has grown, the public's understanding of its impact on eye health has lagged.

As few as 9.5 percent of U.S. smokers believed that smoking could cause blindness

In fact, as few as 9.5 percent of U.S. smokers believed that smoking could cause blindness. A 2011 Optometry study concluded it's not only an American problem; 9.7 percent of British and 13 percent of Canadian smokers fell in the same category. However, contrast that with Australia, where a full 47 percent of smokers know the harm. So, what gives? 

It wasn't until the past dozen years that smoking-related eye conditions were noted in the Surgeon General's report, and only within the past few years has the report outlined a causal relationship between smoking and the leading cause of blindness and central vision loss in the U.S., age-related macular degeneration (AMD). Although AMD is one of the more serious eye conditions aggravated by smoking, it's not the only condition—there's Graves ophthalmology, diabetic retinopathy, dry eye and contact-lens related keratitis. 

The good news is that, due to greater awareness, smoking rates are dropping in the U.S. Still it remains a major health hazard. So much so that the U.S. Food and Drug Administration gave notice in March 2018 that it would be seeking a rule change "to lower nicotine in combustible cigarettes to minimal or non-addictive levels."
And there's a new wrinkle: electronic cigarettes (e-cigarettes) or electronic nicotine delivery systems.

Quit-smoking alternative?
Since e-cigarettes first burst on the scene a decade ago, they have been touted by marketers as a safer alternative to conventional cigarettes. But studies have been a mixed bag of findings. The National Academies of Sciences, Engineering and Medicine report, "Public Health Consequences of E-Cigarettes," published in January 2018 found:

  • For teenagers and young adults, e-cigarettes are often a "gateway" device to conventional cigarette smoking.
  • For adult smokers, there was insufficient evidence based on a small number of randomized controlled trials to conclude that e-cigarettes were a reliable smoking cessation tool. Among observational studies, there was "moderate evidence" that e-cigarettes aided in quitting smoking. "Maximizing the potential health benefits associated with e-cigarettes, the report says, will require determining with more precision whether and under what conditions e-cigarettes help people quit smoking; discouraging e-cigarette use among youth through education and access restrictions; and increasing the devices' safety through data-driven engineering and design," NASEM reported.
    WHO also has taken a cautious stance regarding its effectiveness for cessation.

"If used for the purpose of quitting, e-cigarettes may be beneficial as part of a comprehensive cessation program," says Daniel Bintz, O.D., who has been educating his patients on the hazards of smoking for years at his practices in Elk City, Oklahoma. Dr. Bintz also is a member of the AOA Health Promotions Committee.

"E-cigarettes also can reduce the amount of toxins in the air that typical secondhand smoke contains," Dr. Bintz says, "although they are finding that the risks are getting closer and closer between e-cigarettes and tobacco cigarettes (both contain toxic substances). On the downside, they tend to be attractive to youth, which may lead to tobacco use later."
Until the evidence is settled, Dr. Bintz will continue to ask his patients:

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

The AOA offers a number of smoking resources:

  • AOA Marketplace products, such as the "Eye See Tobacco Free" fact sheet.
  • The "Smoking, Vaping and Your Eyes" fact sheet is available here (member login required).

Other resources:

May 31, 2018

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