BMJ  2003;326:1458-1459 (28 June), doi:10.1136/bmj.326.7404.1458-c

Letter

Age related macular degeneration

Smoking entails major risk of blindness

EDITOR—Chopdar et al's review of age related macular degeneration was timely,¹ but they paid insufficient attention to the association between smoking and age related macular degeneration.

Pooled results from three large population based cross sectional studies found an odds ratio for all types of age related macular degeneration of 3.12 (95% confidence interval 2.10 to 4.64) for current smokers compared with never smokers.² This increased risk was present for both atrophic age related macular degeneration and neovascular age related macular degeneration (odds ratios 2.54 (1.25 to 5.17) and 4.55 (2.74 to 7.54), respectively). Former smokers had only a slightly increased risk of age related macular degeneration compared with never smokers (odds ratio 1.36 (0.97 to 1.90)), which implies that stopping smoking may be an effective preventive approach.

Longer follow up further confirms the link between smoking and age related macular degeneration.^{3 4} The Australian Blue Mountains eye study also showed that smokers developed late age related macular degeneration 10 years earlier than non-smokers.⁴ Chopdar et al estimated smoking causes or contributes to up to 20% of blindness in people aged over 50.

Chopdar et al's article focused largely on high technology and new therapeutic interventions. Despite the strong evidence that smoking causes age related macular degeneration and stopping may reduce risk, only passing reference was made to smoking cessation.

Patients attending eye services are generally unaware of the link between smoking and eye disease. When warned of the risk, smokers often try to stop, which implies that the fear of blindness is a compelling reason to quit smoking. In Australia coordinated efforts on national television to raise public awareness that smoking causes blindness have been encouraging. Eye health practitioners give too little weight to smoking cessation and tobacco control and smoking cessation specialists insufficient attention to eye disease.⁵ The ocular hazards of smoking should be publicised more, and appropriate smoking cessation support should be offered in eye services.

Bolton Hospitals NHS Trust, Bolton BL4 OJR Simon.Kelly{at}boltonh-tr.nwest.nhs.uk

Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, Manchester M13 9PT

Bury Primary Care NHS Trust, Bury BL9 0EN

University of Sydney, Department of Ophthalmology Centre for Vision Research, Westmead Hospital, Westmead, NSW 2145, Australia

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Competing interests: None declared.

References

1. Chopdar A, Chakravarthy U, Verma D. Age related macular degeneration. BMJ 2003;326: 485-8. (1 March.)[Free Full Text]
2. Smith W, Assink J, Klein R, Mitchell P, Klaver CCW, Klein BEK, et al. Risk factors for age-related macular degeneration. Pooled findings from three continents. Ophthalmology 2001;108: 697-704.[CrossRef][ISI][Medline]
3. Klein R, Klein BEK, Tomany SC, Moss SE. Ten-year incidence of age-related maculopathy and smoking and drinking. The Beaver Dam Eye Study. Am J Epidemiol 2002;156: 589-98.[Abstract/Free Full Text]
4. Mitchell P, Wang JJ, Smith W, Leeder SR. Smoking and the 5-year incidence of age-related maculopathy: the Blue Mountains Eye Study. Arch Ophthalmol 2002;120: 1357-63.[Abstract/Free Full Text]
5. Mitchell P, Chapman S, Smith W. "Smoking is a major cause of blindness": a new cigarette pack warning? Med J Aust 1999;171: 173-4.[ISI][Medline]

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