Glaucoma Progression May Result From Frequent Cigarette Use

stop smoking concept.
stop smoking concept.
Modifying smoking behavior may lower the risk of developing severe glaucoma or losing vision.

Patients with primary open-angle glaucoma (POAG) who are heavy smokers are more susceptible to visual field (VF) loss than individuals who do not smoke, according to research published in Ophthalmology. 

Researchers enrolled 511 eyes of 354 patients with POAG from the Diagnostic Innovations in Glaucoma Study (DIGS) ( Identifier: NCT00221897) and African Descent and Glaucoma Evaluation Study (ADAGES) ( Identifier: NCT00221923) in the analysis. Participants were aged a mean 64.8 years at baseline, with 35% reporting African ethnicity and 59.8% identifying as smokers. The team performed comprehensive eye evaluations, dilated fundus exams, and stereoscopic optic disc photography on all members of the cohort. 

Overall, the team noted that 149 participants (42.1%) reported smoking at some point in their lives and 39 (11%) were heavy smokers at baseline. Median smoking intensity among smokers was 7.8 pack-years with 83, 27, 24, and 15 participants reporting 0-10, 10-20, 20-30, and more than 30 pack-years, respectively. Median VF mean deviation was -2.5 dB among the cohort. 

The investigators determined that higher smoking intensity correlated with a more rapid VF deterioration (P =.010). Participants who smoked heavily more than doubled their risk of VF progression compared with those reporting no smoking history (OR=2.21; 95% CI, 1.02-4.76; P =.044). The team also noted that older age was associated with faster VF worsening (P <.001). With the exception of body mass index (BMI), the team did not report any associations between VF progression and alcohol consumption (P =.630), African ethnicity (P =.114), or any other demographic factors.  

“This study demonstrated that heavy smoking significantly increases the risk and incidence of progression in POAG, and smoking intensity may be an independent prognostic factor of POAG progression,” according to the researchers. “This has important health care implications, as modifying smoking behavior may reduce the risk of developing severe glaucoma and eventual blindness.”

Study limitations include a failure to consider potential confounding factors from second hand, environmental cigarette exposure and a questionnaire that only reflected baseline conditions. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mahmoudinezhad G, Nishida T, Weinreb RN, et al. Impact of smoking on visual field progression in a long-term clinical follow-up. Ophthalmol. Published online June 22, 2022. doi:10.1016/j.ophtha.2022.06.017