No Eye Health Advantage Seen from Switching to e-Cigs, Vaping

Transitioning from cigarettes to other nicotine products did not confer any ocular benefits and in fact was associated with a modest but consistent increase in the risk of major vision-impairing eye diseases vs. complete nicotine abstinence, a recent study shows. As always, complete cessation of all nicotine products should remain the preferred cessation goal. Photo: Getty Images. Click image to enlarge. Through oxidative stress, microvascular injury, inflammation and dysregulation of intraocular pressure, cigarette smoking is a well-established risk factor for several vision-impairing diseases, including cataract, glaucoma, age-related macular degeneration, diabetic retinopathy and more. With the global rise in noncombustible nicotine or tobacco products (NNTPs), including electronic cigarettes and heated tobacco, an increasing proportion of former cigarette smokers discontinue use of combustible products yet continue nicotine exposure, in hopes of lowering health risks. The ocular safety of this switching behavior remains uncertain, which is why researchers recently sought to determine if switching to NNTPs is safer for eye health compared to complete nicotine abstinence. Unfortunately, they found that switchers had a higher risk of major vision-impairing eye diseases, but noted that the ocular safety of switching to NNTPs after smoking cessation remains uncertain. The findings were reported in American Journal of Ophthalmology.Nearly 180,000 adults from the Korean National Health Insurance Service who smoked cigarettes in 2011 and 2012 but quit between 2018 and 2019 were classified into two groups: quitters and switchers.Among 32,316 propensity score-matched adults who were followed for 4.6 years, 6,328 major vision-impairing eye disease events occurred. The incidence was 41.1 and 44.0 per 1,000 person-years for quitters and switchers, respectively.Switching to noncombustible products was associated with an increased risk of major vision-impairing eye diseases (hazard ratio: 1.07). The risk elevation was most pronounced for diabetic retinopathy (HR: 1.24) and refractive and accommodation disorders (HR: 1.07). Findings remained consistent across various sensitivity analyses.“We hypothesized that, if NNTPs were truly harm-reducing for the eye, switching would not be associated with higher risk than complete abstinence; conversely, an increased risk among switchers would indicate that NNTP-based cessation strategies may not be visually risk-neutral,” the authors wrote in their paper.Two implications are important, they wrote. First, the authors explained, the mechanism of effect likely reflects both microvascular (e.g., in the case of diabetic retinopathy) and functional (e.g., refractive and accommodative) pathways. The former aligns with nicotine-related endothelial and vasoregulatory alterations; the latter, although often correctable, has large population impact due to high prevalence and direct effects on daily function.“A plausible explanation for the association with refractive and accommodation disorders is that this broad outcome may capture changes in visual function related to accommodative dysfunction or ocular surface instability,” the authors wrote in their paper.Prior studies have shown that smoking can transiently reduce tear breakup time and amplitude of accommodation, while electronic cigarette use has also been associated with poorer tear-film quality. “These findings suggest that the observed association may reflect effects on accommodative function or the ocular surface, in addition to the better-established vascular pathways relevant to diabetic retinopathy,” the authors explained.Second, because even modest relative increases in common conditions may translate to meaningful population burden, these findings support smoking-cessation counseling for switchers and risk awareness within routine ophthalmic care. “Given that real-world disability and healthcare demands may be missed by single, narrowly defined measures, the inclusion of refractive and accommodation disorders in the composite allowed a comprehensive population-level evaluation of major vision-impairing diseases,” the authors wrote in their paper.Click here for the journal source. Cheon S, Kim Y, Seok Kang E, et al. Noncombustible nicotine or tobacco product use after smoking cessation and major vision-impairing diseases: a nationwide cohort study. Amer J Ophthalmol. June 12, 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.