Smoking Associated with Increased Risk of Cataracts, Glaucoma, AMD, Uveitis

Smoking is significantly associated with an increased risk of multiple vision-threatening ocular diseases. These findings highlight the need for optometrists, ophthalmologists and other healthcare professionals to incorporate smoking history into risk stratification and screening programs and to emphasize ocular health during smoking cessation counseling. Photo: Reza Mehrad/Unsplash. In a recent study, researchers sought to quantitatively estimate the 10-year risk of various vision-threatening conditions in smokers compared to non-smokers to inform clinical counseling. Consistent with previous research, they found that smoking is a significant risk factor for multiple vision-threatening ocular diseases, including cataracts, glaucoma and retinal vascular occlusions. The findings were published in Clinical Ophthalmology.A retrospective cohort study analyzed 12,183,254 patients using the TriNetX platform. Propensity score matching was used to create balanced cohorts of 300,867 smokers and 300,867 non-smokers matched for demographic factors and presence or absence of hypertension and diabetes. The study concludes that smoking is a significant risk factor for multiple vision-threatening ocular diseases, including cataracts, with an overall increased risk of 1.77—posterior subcapsular cataract showed the highest relative risk (RR: 2.60). “The pathogenesis is likely related to the accumulation of harmful ions like vanadium, aluminum and cadmium, the increased reactive oxygen species in the lens and reduced systemic antioxidants,” the researchers explained in their paper. “These factors all contribute to opacification and lens protein degradation.”Glaucoma also has a significantly elevated risk (RR: 1.57), specifically for primary angle-closure glaucoma (RR: 2.47) and ocular hypertension (RR: 2.19). Previous studies on association between smoking and the risk of glaucoma or ocular hypertension have yielded mixed results, with some finding a significant positive association with primary open-angle glaucoma and others reporting no association, or even a protective one. The association between smoking and primary open-angle glaucoma is less studied, and a lack of association between smoking and angle-closure glaucoma severity has similarly been reported.A significant association was found between smoking and both forms of age-related macular degeneration (AMD). This aligns with previous studies showing an established association between smoking and an increased risk of both the incidence of new AMD and the progression to advanced stages (exudative AMD and geographic atrophy.) “The pathogenesis is suggested to relate to an inflammatory microenvironment with reactive oxygen species, and mitochondrial DNA damage with accumulation of degradation products in the retinal pigment epithelial cells,” the authors wrote.The authors also found that smokers had a significantly higher risk of developing uveitis (RR: 2.4), which is consistent with findings from a recent meta-analysis that found nearly twofold increased odds of uveitis among smokers.Taken together, this suggests that smoking is a key modifiable risk factor for uveitis development and carries implications to the counseling of patients suffering intraocular inflammation, the authors noted in their paper.The incidence of diabetic retinopathy (DR)—both nonproliferative and proliferative —was significantly higher among smokers, although the risk was lowest (RR: 1.21) compared to other ocular diseases. “The pathogenesis of vascular pathology may be related to the vasoconstrictive properties of nicotine and increased carboxyhemoglobin as a result of smoking cause a reduction in retinal blood flow which exacerbates retinal hypoxia,” the authors explained in their paper. These effects may also explain the increased risk of retinal vascular occlusion and ischemic optic neuropathy among smokers compared to non-smokers in the study, the researchers suggested.The authors recommend that eye doctors incorporate smoking history into risk assessments and emphasize ocular health during smoking cessation counseling.Click here for the journal source. Gad El Sayed M, Vu Pham N, Bandaru D, et al. Smoking and risk of vision threatening complications: a global database analysis. Clin Ophthalmol. April 2, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.