Tobacco smoking can be linked to a plethora of ocular diseases, notably those that impact the vasculature, as well as early cataract development.1,2 While some studies report an association between smoking and glaucoma, the role of cigarette smoking as a risk factor is still unclear. However, a Malaysian research team says it found no significant association between cigarette smoking and severity of primary angle-closure glaucoma (PACG); however, the number of cigarettes smoked per day was associated with greater severity of PACG.

The study looked at 150 PACG patients over two years. Researchers took into account the patients’ ocular examinations, including Humphrey visual field (HVF) 24-2 analysis assessment to score PACG severity as mild, moderate or severe and a questionnaire to assess smoking status. Those with retinal diseases, neurological diseases, memory problem or severe myopia were excluded.

The study included a total of 13 (8.7%) active smokers, defined as a daily smoker or an occasional smoker, 25 (16.6%) ex-smokers, 90 (60.0%) passive smokers, defined as individuals who inhale second-hand cigarette smoke and 22 (14.7%) nonsmokers. No significant difference was identified in the smoking habits and severity of PACG. However, active smokers (61.5%) and ex-smokers (48.0%) tend to have severe visual field defects.

“It is important to encourage PACG patients to practice healthier lifestyles as a more holistic adjunct to IOP lowering agents,” the study concludes. “Cessation of cigarette smoking may provide beneficial effects in halting the acceleration of retinal nerve fiber damage in glaucoma.”

1. Klein BE, Klein R, Linton KL et al. Cigarette smoking and lens opacities: The Beaver Dam Eye Study. Am J Prev Med. 1993;9(1):27-30.

2. Cooke JP. New insights into tobacco-induced vascular disease: clinical ramifications. Methodist DeBakey Cardiovascular Journal. 2015;11(3):156-9. 

3. Niven T, Azhany Y, Rohana A, et al. Cigarette smoking on severity of primary angle closure glaucoma in Malay patients. J Glaucoma. 2019;28(1):7-13.