Quitting Smoking Saves Your Eyes!

Nga Sze Wong

Background: Anecdotal evidence demonstrated that smoking could cause various permanently irreversible eye diseases. It was suggested that the oxidants in smoke damaged the retinal pigment epithelium and accelerated degenerative changes in the macula.

Purposes: (1) To evaluate the association between cigarette smoking and Age-Related Macular Degeneration (AMD) in the recent five years. (2) To propose a timely smoking cessation guideline in eye care settings.

Methods: A literature review was performed using databases including CINAHL (EbscoHost), Medline (OvidSP) and PubMed, with the combinations of keywords "smoking" and "Age-related Macular Degeneration". Relevant studies were manually searched and expert opinions were collected.

Results: Twelve eligible studies (Jan 2005 to Sep 2010) were extracted. Eleven studies out of the twelve (one systematic Review, one meta-analysis, two cohort studies, two case-control studies, four cross-sectional studies, and one literature review) affirmed a significant association and a dose-response effect between current smoking and AMD. However, the awareness of nurses and patients about the risk was low.

Action plan: A guideline "AWARD" developed by Chan & Lam (2008) was proposed in the eye hospital. AWARD has been currently implemented: (1) Ask about smoking status; (2) Warn the patient about the harmful impacts of smoking on their eyes; (3) Advise smokers to quit smoking; (4) Refer smokers to smoking cessation services; (5) Do it again (step 1 to 4) during the next follow-up.

Conclusion: Since smoking is a modifiable predictor for progression of AMD. Every ophthalmic nurse had an important role in helping AMD patients to quit smoking.