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Clinical science
Smoking and progressive retinal nerve fibre layer thinning in glaucoma
  1. Takashi Nishida1,
  2. Golnoush Mahmoudinezhad1,
  3. Robert N Weinreb1,
  4. Sally L Baxter1,2,
  5. Medi Eslani1,
  6. Jeffrey M Liebmann3,
  7. Christopher A Girkin4,
  8. Massimo A Fazio4,
  9. Linda M Zangwill1,
  10. Sasan Moghimi1
  1. 1 Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  2. 2 Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
  3. 3 Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York, USA
  4. 4 Bernard School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Sasan Moghimi, Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA; sasanimii{at}yahoo.com

Abstract

Background/Aims To investigate the relationship between smoking and smoking intensity, and the rate of retinal nerve fibre layer (RNFL) thinning in patients with primary open angle glaucoma (POAG).

Methods In this longitudinal study, patients with POAG who had at least 3 years of follow-up with a minimum of 5 visits of optical coherence tomography (OCT) were enrolled. The smoking intensity was calculated as the pack-year at the baseline OCT. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of RNFL thinning over time. Non-linear least-squares estimation with piecewise regression model was used to investigate the cut-off point for the relationship between circumpapillary RNFL thinning and smoking intensity.

Results A total of 466 eyes of 314 patients were included over the mean (95% CI) follow-up of 6.6 (6.4 to 6.7) years. Of the 314 patients, 121 (39%) had reported any history of smoking. Greater smoking intensity was associated with faster RNFL thinning (−0.06 (95% CI −0.11 to 0.00) µm/year per 10 pack-year higher; p=0.031) after adjusted for confounding factors. RNFL thinning became significantly faster when smoking intensity was >8 pack-year.

Conclusions Smoking intensity is associated with faster rates of RNFL thinning. Evaluation of smoking intensity might add information to the assessment of risk of glaucoma progression. Future studies are required to explore if withdrawing smoking as a modifiable risk factor can decrease progression in patients with glaucoma.

  • glaucoma
  • imaging
  • epidemiology

Data availability statement

Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

https://doi.org/10.1136/bjo-2022-321237

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    Data availability statement

    Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Twitter @SallyLiuBaxter

    • Contributors Involved in design and conduct of study: TN, RW and SM; data collection: TN and SM; analysis or interpretation of data: TN, RW and SM; writing: TN, GM, RW and SM; critical revision of the manuscript: all authors; approval of the manuscript: all authors; Guarantor of work: SM.

    • Funding National Institutes of Health/National Eye Institute Grants R01EY029058, R01EY011008, R01EY034148, U10EY14267, R01EY026574, R01EY019869, R01EY027510, R01EY028284, P30EY022589, and 5K12EY024225; Tobacco Related Disease Research Programme Grant T31IP1511; Core Grant P30EY022589, an unrestricted grant from Research to Prevent Blindness (New York, New York); EyeSight Foundation of Alabama and participant retention incentive grants in the form of glaucoma medication at no cost from Novartis/Alcon Laboratories, Allergan, Akorn and Pfizer.

    • Competing interests RW: financial support—National Eye Institute. Research instruments: Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Konan, Optovue, Consultant—Aerie Pharmaceuticals, Allergan, Eyenovia, Nicox, Novartis; JML: research support—Carl Zeiss Meditec, Heidelberg Engineering, National Eye Institute, Optovue; Consultant—Alcon, Allergan, Carl Zeiss Meditec, Heidelberg Engineering; CAG: financial support—EyeSight Foundation of Alabama; National Eye Institute; Research to Prevent Blindness; MAF: financial support—EyeSight Foundation of Alabama; National Eye Institute; Research to Prevent Blindness; LMZ: research support—Carl Zeiss Meditec, Heidelberg Engineering, National Eye Institute, Topcon, Optovue.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.