Editorials

Smoking and blindness

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7439.537 (Published 04 March 2004) Cite this as: BMJ 2004;328:537
  1. Simon P Kelly (simon.kelly@boltonh-tr.nwest.nhs.uk), consultant ophthalmic surgeon,
  2. Judith Thornton, honorary research fellow,
  3. Georgios Lyratzopoulos, lecturer in public health,
  4. Richard Edwards, senior lecturer in public health,
  5. Paul Mitchell, professor of clinical ophthalmology
  1. Bolton Hospitals NHS Trust, Bolton BL4 0JR
  2. Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT
  3. University of Sydney Department of Ophthalmology, Centre for Vision Research, Westmead Hospital, Westmead, NSW 2145, Australia

    Strong evidence for the link, but public awareness lags

    While most people and many patients attending eye clinics recognise many adverse health hazards of tobacco smoking, they remain largely unaware of its link with blindness. Although smoking is associated with several eye diseases, including nuclear cataractw1 w2 and thyroid eye disease,w3 the most common cause of smoking related blindness is age related macular degeneration, which results in severe irreversible loss of central vision. Current treatment options are of only partial benefit to selected patients. Identifying modifiable risk factors to inform efforts for prevention is a priority.

    A risk factor is generally judged to be a cause of disease if certain causality criteria are fulfilled.w4 Applying commonly used criteriaw4 to available evidence provides strong evidence of a causal link between tobacco smoking and age related macular degeneration. The strength of association is confirmed in a pooled analysis of data from three cross sectional studies, totalling 12 468 participants, in which current smokers had a significant threefold to fourfold increased age adjusted risk of age related macular degeneration compared with never smokers.1 By way of comparison, although the relative risks associated …

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