February 2012

Last year a study published in the journal Optometry reported that Australian smokers are far more likely to know that smoking causes blindness than smokers in the US, UK or Canada. The investigators, who measured the health knowledge of smokers through telephone surveys, found that less than 10% of smokers in the US and the UK were aware of the link between smoking and blindness, but that in Australia, the only country of the 4 with a national awareness campaign about smoking and eye health, almost half of smokers were aware of the effects of smoking on vision.

The Australian campaign has obviously been very effective. The graphic photo of an eye with lids held apart with a speculum brings the message home, although the damage smoking does lies deeper, unseen in the photo, and half of Australia’s smokers still haven’t got the message.

Smoking is associated with a wide variety of eye diseases, both directly and through increasing the effects of a patient’s genetic susceptibility. The most important of these is macular degeneration (AMD). Smokers have 4 times the risk of non-smokers of developing the disease, and a smoker’s “second-hand” smoke increases the risk of family members developing AMD. There are a number of reasons for the increase in risk. Nicotine itself has been shown to cause over-expression of VEGF, a protein that stimulates new blood vessel proliferation, and has been shown to block PEDF, a protein that suppresses abnormal blood vessel proliferation. The proliferation of abnormal “new” blood vessels is what leads to the aggressive “wet” form of AMD. Tobacco smoke also reduces anti-oxidants, reducing the capacity of the macula to respond to toxic and other damage.

Cigarette smoke increases the risk of cataract development, dry eye syndrome, visual loss from thyroid eye disease, and recent studies have shown that it increases the risk and severity of ocular inflammation.

We need to encourage our smoking patients to quit for the sake of their eyesight, and support them when they try. The Federal government is currently fighting “big tobacco” in the high court, trying to get plain packaging through. Tobacco companies are worried about the loss of their brand identity. But to your eye, all cigarettes are branded the same.