Smoking is topical. Smoking can cause a slow and painful death; it says so on cigarette packets smoked by a quarter of the UK population. Smoking can also cause blindness, but this fact is less well known, despite the accumulating evidence. The debate about smoking involves many complex issues: societal, political, economic, environmental, and health related. It is a global issue, as five million people die from tobacco related illness each year and many will also become blind.

In the United Kingdom the consultation on the smoke free elements of the Health Improvement and Protection Bill closed on 5 September 2005. The Royal College of Ophthalmologists, in its response, supported a total ban on smoking in all enclosed workplaces and public places because the planned legislation, despite “shifting the balance,” would have failed to protect the vulnerable in our society, 10 000 of whom die annually from exposure to secondhand smoke.¹

The importance of drawing attention to the risk of blindness from smoking was also stressed in the response, as at present, despite growing evidence, there is a remarkable lack of awareness by both the public and medical profession. In a survey conducted by AMD Alliance International,² 41% of respondents did not think that smoking would harm their eyes and in a recent study reporting the attitudes and behaviours of ophthalmologists to smoking cessation, it was concluded that the assessment of smoking status and provision of targeted support for smokers to quit could be …