Smoking Increases Risk of Vision-Threatening Eye Diseases: Study
USA: A large-scale international analysis has found that tobacco use is strongly linked with a higher likelihood of developing several serious eye disorders, including cataracts, glaucoma, macular degeneration, and retinal vascular diseases. Across all conditions evaluated, individuals who smoked consistently demonstrated a greater risk than those who did not. The findings reinforce smoking as a major modifiable contributor to vision impairment and underscore the importance of cessation efforts in protecting eye health and guiding public health interventions.
The study, published in Clinical Ophthalmology, examined the relationship between smoking and a broad range of vision-threatening conditions using real-world data. Researchers aimed to quantify the risk of diseases such as cataract, glaucoma, diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vascular occlusion, uveitis, and ischemic optic neuropathy (ION). The analysis drew on the TriNetX electronic health records database, encompassing over 12 million patients.
Participants were divided into smokers (304,823 individuals) and non-smokers (over 11.8 million individuals). To ensure comparability, the researchers used propensity score matching to balance both groups for demographic characteristics and key vascular risk factors. This resulted in two matched cohorts of 300,867 patients each. Over a follow-up period of ten years, the incidence of various ocular conditions was compared using risk ratios.
The following were the key findings:
• Smokers had a significantly higher risk for all studied eye diseases, with statistically significant differences across outcomes
• Risk of posterior subcapsular cataracts was more than doubled in smokers (RR 2.60)
• Uveitis risk was markedly increased among smokers (RR 2.43)
• Higher risk of retinal vascular occlusions was observed, including:
• Central retinal artery occlusion (RR 2.35)
• Central retinal vein occlusion (RR 2.16)
• Increased risk across various glaucoma subtypes (RR 1.57–2.47)
• Elevated risk of age-related macular degeneration (RR 1.85)
• Increased risk of diabetic retinopathy (RR 1.21)
The study’s strength is its large real-world dataset, but its retrospective design and reliance on medical records may have led to underreporting of smoking. It also lacked details on smoking patterns and could not fully account for confounding factors like lifestyle and socioeconomic status.
Despite this, smoking showed a clear link with multiple vision-threatening conditions. The authors recommend including smoking history in eye risk assessment and reinforcing ocular risks during cessation counseling.
Overall, the findings add to the growing body of evidence supporting tobacco control as a critical component of strategies aimed at reducing preventable vision loss worldwide.
Reference:
Gad El Sayed M, Vu Pham N, Bandaru D, Abboud I, Zakhary MB, Zakhary M, Bishay RGE, Rezaei K, Khaksar P, Enciso J, Tran K, Martinez SJ, Mikhail K, Glendrange RR, Fouad Y. Smoking and Risk of Vision Threatening Complications: A Global Database Analysis. Clin Ophthalmol. 2026;20:596936. https://doi.org/10.2147/OPTH.S596936
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