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 cataract^{w1 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 criteria^w4 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 …