by Dr. Rohit Narayan is a therapeutic optometrist based in the Midlands in England. October 27th, 2018
Dr. Narayan summarizes what is known about smoking and AMD and what approach he would take (last 4 items):
- Smoking is a major modifiable risk factor associated with AMD.
- Smoking increases the risk of AMD two to four-fold.
- Pack-years smoked better reflects the amount of exposure.
- Cigarette smoke is comprised of a gas and tar phase containing chemicals with a high concentration of free radicals.
- Cigarette smoke induces ‘pro-inflammatory’ changes in the RPE, along with oxidative damage.
- Risk of AMD remains present for many years after cessation of smoking.
- Passive smoking carries risk of AMD.
- Public awareness of the link between smoking and ocular health is lacking.
- Eye care providers have a duty of care to inform patients of the long-term ocular risk of smoking and AMD.
- Electronic cigarettes are considered ‘safer’ than conventional cigarettes, although more research is needed.
- Smoking cessation (using Very Brief Advice; VBA) with a discussion of dietary modification is recommended.
- AREDS and AREDS II formulations only indicated in intermediate/late stage AMD.
- AREDS formula (beta carotene) carries increased risk of lung cancer in smokers.
- AREDS II: lutein plus zeaxanthin a better substitute for beta carotene.
Smoking and AMD: Detailed Information
In this article, Dr. Narayan writes, “Smoking status and history is important and, although currently lacking a standardised definition, generally falls into three categories:
- Current smoker
- Previous smoker
- Never smoked
“Several studies have compared different levels of smoking, classified as pack-years, and most of them confirmed a dose-response effect for AMD. Pack-years smoked better reflects the amount of exposure over a lifetime of smoking. To calculate pack-years of smoking, the average of the number of cigarettes smoked per day is divided by 20 to give packs per day and multiplied by the total number of years of smoking.
“Current-smokers have two to four-fold increase in risk for developing AMD when compared to patients that never smoked. Current and former smokers were found to have an increased prevalence of late AMD, although a recent study also found an association of early AMD features with smoking. The increased AMD risk appears to be higher in those patients who have smoked 20 pack-years and more. There is bad news for people living with smokers too: passive smoking, ie living with a smoker for five years or more, increases the risk for AMD among non-smokers.”
For MUCH more, please read the full article.
NEXT: LAYER 5 – Aging of the eye
I’ve not had the time to do this page. Here is the article ‘Beyond the Tip of the Iceberg: Getting Older’–>https://www.opticianonline.net/cet-archive/5054
The summary says, “The majority of the population have age as their only AMD risk factor.
Discussions of positive lifestyle modifications including:
- Mediterranean diet
- Greater consumption of chicken rather than red meat
- Absence of smoking
- Regular physical exercise
- Vitamin D awareness
AREDS-based supplements not indicated.”
