Smoke signals: Links between smoking and eye disease

Fifty years, half a century or 20 million—all three describe a milestone moment in the nation’s public health history that put tobacco use under the spotlight.
Since the first Surgeon General’s Report on Smoking and Health was issued in 1964, more than 20 million Americans have died from smoking-related complications. To mark observance of the occasion, the nation’s top public health office issued a 978-page report that, in part, gives teeth to optometrists’ warnings for ocular complications from cigarette smoking.

Smoking and eye disease
Long has optometry known that smoking not only exposes the eyes to major irritants in the form of noxious chemicals, but also correlates closely with the development of eye diseases, such as cataract and age-related macular degeneration (AMD). Public knowledge of the link, on the other hand, remains fairly limited.

Chemicals in cigarette smoke cause blood vessels to constrict, limiting blood flow and the amount of oxygen to the eye. Over time, cigarette smoke can damage ocular cells and prolonged exposure leaves little chance for the cells to heal, according to the surgeon general’s report.

Studies have estimated smokers at least double their risk of developing AMD, while also exacerbating the risk of cataract development.

The 50th anniversary Surgeon General’s report, The Health Consequences of Smoking: 50 Years of Progress, states findings since the 2004 Surgeon General’s report on smoking have strengthened evidence of a relationship between smoking and AMD. While smoking cessation appears to decrease AMD risk, it still remains higher than those who have never smoked, even decades after quitting.

The report states: “The role of smoking in causing advanced AMD, which results in loss of vision, is a significant public health concern and a major clinical issue in the United States … because smoking causes both nuclear cataracts and AMD, it is important for ophthalmologists, optometrists and other health care providers to assess and address the smoking status of their patients.”

Sending the message home
Health reports help set the stage for public understanding of how lifestyle choices influence their overall well-being, but health care providers—interacting on a personal level—are the ones who truly hone a message of patient action.

Daniel Bintz, O.D., AOA Health Promotions Committee member, says changes in health care require optometrists to ask the lifestyle question, “Do you use tobacco products?” and provide referral options for people desiring to quit.

This being an area he’s strongly advocated, Dr. Bintz developed several programs to help ODs further the conversation on smoking. One such program encouraged paraoptometrics to stress implications of smoking to teens—the age group starts using contact lenses about the same time they consider tobacco use.

“We stressed shortness of breath resulting in poor athletic ability, stinky breath, stinky clothes, eye irritation from smoke, and contact lens contamination from nicotine and smoke residue on fingers,” Dr. Bintz states. “We did pre- and post-testing and found that over 90 percent of new contact lens wearers were not aware that tobacco use could lead to blindness.”

Eventually, this success would lead to creation of the “Eye See Tobacco Free” brochure, available alongside other resources in the AOA Marketplace.

Referencing the surgeon general’s report, Dr. Bintz says he would like to see more information about the relationship between tobacco use and blindness. But ODs can use this information as an opportunity to further tobacco cessation conversations.

“By discussing cessation with adults and prevention in pre-teens and teens, the doctor and staff show concern for not only ocular health, but also general health,” he states.

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