Running Head: SMOKING AND BLINDNESS 1

Smoking and Blindness:

Increased Awareness Could Encourage Cessation
Michelle Hodgson-Smith
Salt Lake Community College











SMOKING AND BLINDNESS 2

Abstract
Smoking tobacco is ridiculously dangerous. It can cause many devastating health problems
including heart disease, stroke, and lung cancer. The risk of these conditions is very well known.
What many people do not know is that smoking tobacco can also lead to blindness. Ocular
diseases that are attributed to smoking include macular degeneration, cataracts, glaucoma, and
ophthamopathy. Age-related macular degeneration (AMD) is the leading cause of blindness.
Research has shown that tobacco related blindness awareness is low, including in the
optometrists office. Studies show that blindness can be a motivating factor for smoking
abstinence and/or cessation.
Keywords: Awareness, Blindness, Age-related Macular Degeneration, Ocular Disease,
Smoking, Smoking Cessation, Tobacco












SMOKING AND BLINDNESS 3

Smoking and Blindness:
Increased Awareness Could Encourage Cessation
The health hazards associated with tobacco smoking are enormous. The more commonly
known health issues include cardiovascular disease, cancer and respiratory disease.
Cardiovascular diseases include coronary heart disease, arteriosclerosis, atherosclerosis, and
ischemic stroke. Chronic obstructive pulmonary disease encompasses several respiratory
diseases including chronic bronchitis and emphysema. Lung cancer is the most common cancer
that is caused by tobacco, but tobacco use increases the risk of ALL cancers (Levinthal, 2012).
Health conditions caused by tobacco use that are less commonly known are eye conditions that
can lead to blindness. Smoking has been linked to age-related macular degeneration (AMD),
nuclear cataract, Graves ophthalmopathy, and glaucoma (Ng, Roxburgh, Sanjay, & Au Eong,
2010). AMD is the leading cause of blindness (Canoa, Thimmalappula, Fujihara, Nagai, Sporn,
Wang, Neufeld, Biswal, & Handa, 2010).
Discussion
An estimated 13 to 14 million Americans have a form of AMD. This estimate is
expected to double by the year 2020. This visually debilitating disease affects a part of the retina
called the macula. The macula is responsible for central vision acuity. There are three forms of
AMD: early, intermediate and advanced. 88% of AMD caused blindness is in the advanced
stage. Patients in early and intermediate stages can progress to the advanced form. Vision loss
can significantly lower the quality of life of its sufferers. Depression is expressed in a third of
AMD patients. Unfortunately, there is as of yet no cure to this disease. Treatments in advanced
AMD include verteporfin photodynamic therapy, a combination of an intravenous injection of
dye and low intensity laser treatment and a VEGF injection DIRECTLY IN THE EYE every six
SMOKING AND BLINDNESS 4

weeks for a minimum of one year. These treatments slow the progress, but do not cure the
disease. Although there are other causes of AMD, such as cardiovascular disease and
hypertension, smoking continues to be the most consistent modifiable risk factor (Bourla &
Young, 2006).
It is unknown exactly how cigarettes cause AMD, but it is believed that smoking related
oxidative damage may be the main culprit. There are over 4,700 chemicals in cigarette smoke.
The smoke produced by tobacco includes a gas phase and a tar phase, both of which contain free
radicals at high concentrations. Each puff taken by a smoker contains 1,015 free radicals. It has
been proven that cigarette smoke causes oxidation of DNA, protein and lipids in tissue other than
the eye (Canoa, et al, 2011).
A review of 17 studies found that of the studies, 13 found a statistically significant
relationship to AMD and cigarette smoking. The studies concluded that cigarette smokers have a
two to three fold increased risk of developing AMD (Thornton, Edwards, Mitchell, Harrison,
Buchan, & Kelly, 2005). One such study conducted in Great Britain in 2005 found that current
smokers had a twofold increased risk of developing AMD. They attributed 28,000 cases of
AMD related blindness in the UK to cigarette smoking. The researchers in this study found that
this risk for developing AMD lessens once a smoker has been quit for 10 years. Once a person
has been a non-smoker for 20 years, the risk of developing AMD is that of a non-smoker (Evans,
Fletcher, Wormald, 2005).
Awareness
Several studies have been conducted to gauge awareness of the link between smoking
and blindness. A study done at NHS Hospital in England found that 90% of outpatients
surveyed were aware that smoking may lead to lung cancer, however less than 10% were aware
SMOKING AND BLINDNESS 5

of the risk of eye disease with smoking (Thompson, Harrison, Wilkinson, Scott-Samuel,
Hemmerdinger, & Kelly, 2007). Another study was done on hospital outpatients in Scotland and
Singapore. They were surgical, ophthalmological, or general medical patients. The sample
group was comprised of smokers, non-smokers, and ex-smokers. The study found that 36.5% of
respondents in Singapore and 30.5% of respondents in Scotland were aware of the risk of
blindness associated with tobacco. By comparison, over 95% of the sample population knew
that smoking could cause lung cancer. (Ng, et al, 2010). A study was done comprised of
ophthalmology patients at the same hospital in Singapore. This study strictly consisted of
current smokers. The study found that 42.5% were aware of the risk of blindness in tobacco
smoking. 85% were aware that smoking can cause lung cancer (Handa, Woo, Wagle, Htoon, &
Au Eong, 2001).
A study was conducted in the United Kingdom to assess the prevalence of smoking
guidance provided by optometrists. A mail-in questionnaire was completed by 509 of the 709
optometrists asked. Of those optometrists, very few routinely asked if their patients smoke
(6.2% asked new patients, 2.2% ask follow-up patients). The most common reason the
optometrists put for not inquiring about the smoking habits of their patients was that it was not
considered to be their professional role. Others claimed they didnt have time or forgot. The
good news is that the majority of the respondents agree/strongly agree that there is a need to
improve knowledge of smoking and eye disease and that training for smoking cessation would be
beneficial in their practice (Thompson, et al, 2007).
Abstinence/Cessation Motivation
During the Handa, et al (2001) study, respondents were asked to list their biggest
motivating factor for smoking cessation. Blindness was the second biggest motivating factor to
SMOKING AND BLINDNESS 6

quit smoking in this group, preceded by lung cancer. A study done of 206 teenagers in the
United Kingdom found that only 5% were aware that smoking was linked to blindness. The
group consisted of non-smokers, ex-smokers and current smokers. Of this group, blindness was
the biggest motivating factor. 90% of the teens said they would quit smoking once they
developed early stages of blindness. 78% said they would quit in the early stages of lung cancer
(Moradi, Thornton, Edwards, Harrison, Washington & Kelly, 2007). A study was done on 49
current smokers who did not have AMD. 47% of respondents knew the risk of blindness in
smoking. They were each given hypothetical cases. Some were given a hypothetical high
genetic risk of AMD, some generic risk, and some low risk. Researchers found that the high risk
group was the most likely to quit smoking (76%), followed by the generic risk (67%), then the
low risk (46%). Over 60% of the high risk group said they would be likely or very likely to quit
in the next month (Rennie, Stinge, King, Sothirachagan, Osmond, & Lotery, 2012).
A study done in Australia in 2000 compared the efficiency of two advertisements. One
depicted a graphic image of an eye affected by macular degeneration and conveying information
about the link between smoking and blindness. The other was a tar slathered lung. Each
encouraged smokers to call the quit line for help with smoking cessation. They found that the
threat of blindness encouraged more quit line calls (Carroll & Rock, 2003). That is not the only
awareness campaign done by Australia. In 2006, warning labels educating people of the risk of
possible blindness were required on all cigarette packs. A global study was done and found that
the awareness of ocular disease caused by smoking in Australia was the highest at 77% of
respondents (Ng, et al, 2010).
Conclusion
Smoking tobacco is a very dangerous act. It can cause many health problems including
SMOKING AND BLINDNESS 7

cardiovascular disease, respiratory disease, and cancer. Smoking can also be attributed to ocular
disease that can lead to blindness. The fact that smoking tobacco can cause blindness is not very
well known. Educating the public of this fact is of the highest importance and may lead to a
higher incidence of abstinence and/or smoking cessation.



















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