Smoking and Risk of Vision Threatening Complications: A Global Database Analysis

Purpose: To investigate the association between smoking and the incidence of vision-threatening conditions, including cataract, glaucoma, diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vascular occlusion, uveitis, and ischemic optic neuropathy (ION) in a large real-world database to provide quantitative risk estimates to inform smoking cessation counseling. Methods: A retrospective cohort study was conducted using the TriNetX electronic health records platform, analyzing 12,183,254 patients. Patients were categorized into smokers (n = 304,823) and non-smokers (n = 11,878,431), and then a propensity score matching was utilized to balance both groups for demographic features and vascular risk factors. The incidence rates of the studied ocular conditions were then compared over a ten-year period using risk ratios (RR). Results: Matched cohorts included 300,867 patients per group. Smokers exhibited a significantly higher 10-year risk for all studied ophthalmic outcomes (p < 0.0001). The strongest associations were observed for posterior subcapsular cataract (RR 2.60; 95% CI, 2.41-2.82), uveitis (RR 2.43 [2.25-2.63]), and retinal vascular occlusions (CRAO: RR 2.35; CRVO: RR 2.16). Increased risks were also consistent across glaucoma subtypes (RR 1.57-2.47), AMD (RR 1.85), and diabetic retinopathy (RR 1.21). Conclusion: Smoking is significantly associated with an increased risk of multiple vision-threatening ocular diseases. These findings highlight the need for ophthalmologists and public health professionals to incorporate smoking history into risk stratification and screening programs and to emphasize ocular health during smoking cessation counseling.