Heavy smokers with glaucoma prone to faster visual field loss

Heavy smoking is associated with progressive visual field (VF) loss in eyes with glaucoma, results of a study have shown.

A total of 511 eyes of 354 patients with primary open-angle glaucoma with a minimum follow-up of 3 years and five VF tests enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study were included in this retrospective cohort study.

The authors used univariate and multivariate linear mixed models to examine the effects of smoking on rates of 24-2 VF mean deviation loss. VF progression was defined using pointwise linear and significant negative VF mean deviation loss.

Baseline factors and whether different levels of smoking intensity correlated with VF progression were assessed using logistic regression. The cumulative risk ratio of progression between smoker and never smoker groups were compared using Kaplan–Meier survival analysis and the log-rank test.

Patients had a median baseline age of 64.8 years, of whom 124 (35 percent) were Black, 149 (42.1 percent) had a history of smoking and 168 (59.8 percent) a history of alcohol consumption.

Multivariate analysis revealed the association of higher smoking intensity with faster VF loss (coefficient, ‒0.05 dB/year per 10 pack-years [PY], 95 percent confidence interval [CI], ‒0.08 to ‒0.01; p=0.010). Development of VF progression was 2.2 times greater in the eyes of heavy smokers (≥20 PY) than in those of never smokers (odds ratio, 2.21, 95 percent CI, 1.02‒4.76; p=0.044).

Kaplan‒Meier analysis showed significant differences between heavy smokers and never smokers (p=0.011, log-rank test).

“The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression,” the authors said. “Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.”