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Adverse effects of smoking on patients with ocular inflammation
  1. Anat Galor1,2,
  2. William Feuer1,
  3. John H Kempen3,4,5,
  4. R Oktay Kaçmaz6,
  5. Teresa L Liesegang7,
  6. Eric B Suhler7,8,
  7. C Stephen Foster6,9,
  8. Douglas A Jabs10,11,12,
  9. Grace A Levy-Clarke13,14,
  10. Robert B Nussenblatt13,
  11. James T Rosenbaum7,15,
  12. Jennifer E Thorne12,16
  1. 1Bascom Palmer Eye Institute, University of Miami, USA
  2. 2Miami Veterans Administration Medical Centre, Department of Ophthalmology University of Pennsylvania, Philadelphia, Pennsylvania
  3. 3Ocular Inflammation Service, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
  4. 4Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
  5. 5Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
  6. 6Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
  7. 7Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon, USA
  8. 8Portland Veterans Administration Medical Center, Portland, Oregon, USA
  9. 9Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  10. 10Department of Ophthalmology, Mount Sinai School of Medicine, New York, USA
  11. 11Department of Medicine, Mount Sinai School of Medicine, New York, USA
  12. 12Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  13. 13Laboratory of Immunology, National Eye Institute, Bethesda, Maryland, USA
  14. 14St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida, USA
  15. 15Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
  16. 16Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence toJennifer E Thorne, Wilmer Eye Institute, 550 North Broadway, Suite 700, Baltimore, MD 21287, USA; jthorne{at}


Background To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation.

Methods A retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database.

Results Among 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35).

Conclusions Smoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.

  • Immunology
  • inflammation
  • ocular inflammation
  • smoking

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  • Funding This study was supported primarily by National Eye Institute Grant EY014943 (to JHK). Data analysis was supported by core center grant P30 EY014801 (Bascom Palmer Eye Institute), from the National Eye Institute, unrestricted funds from Research to Prevent Blindness, and the Paul and Evanina Mackall Foundation. JHK is a Research to Prevent Blindness James S. Adams Special Scholar Award recipient. DAJ and JTR are Research to Prevent Blindness Senior Scientific Investigator Award recipients. JET is a Research to Prevent Blindness Harrington Special Scholar Award recipient. GAL-C was previously supported by, and RBN continues to be supported by, intramural funds of the National Eye Institute. AG and EBS receive support from the US Department of Veterans' Affairs.

  • Competing interests None.

  • Ethics approval The Institutional Review Boards of all institutions reviewed and approved this study, which was conducted in accordance with the principles of the Declaration of Helsinki.

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

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