Impact of Smoking on Visual Field Progression

Abstract

Purpose : To investigate the effect of smoking on the rates of progressive visual field damage over time in glaucoma.

Methods : In this longitudinal study, 354 primary open-angle glaucoma (POAG) patients with a minimum of 3 years follow-up and 5 visual fields (VF) tests were enrolled from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). Univariable and multivariable linear mixed models were used to investigate the effects of smoking on the rates of 24-2 VF mean deviation loss after adjusting for confounding factors such as alcohol consumption and Body Mass Index. VF progression was defined using pointwise linear regression (three test locations having a significant regression slope (p<0.01) of ≤-1dB per year). Logistic regression was used to identify whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier curve and the log-rank test were used to compare the cumulative risk ratio of progression between different smoking intensity categories.

Results : A total of 511 eyes of 354 patients with glaucoma followed from multicenter glaucoma registries were included over the mean follow-up of 12.4 years. Mean baseline age was 62.3 years; 124 (35%) were African ethnicity. Of the 354 patients, 168 (59.8%) and 149 (42.1%) had reported a history of smoking or alcohol consumption, respectively. 39 (11%) were heavy smokers. In a multivariable model, higher smoking intensity was associated with faster VF loss (coefficient -0.05 (-0.08,-0.01)dB/year per 10 pack-years, P=0.01). Developing VF progression in eyes of heavy smokers (>20 pack-years) was 2.2 times greater than in eyes of non-smokers after adjusting for confounding factors (OR=2.21; 95% CI: 1.02,4.76; P=0.04), Figure 1. A significantly higher proportion of progressing eyes were found in heavy smokers compared to non-smokers by Kaplan-Meier analysis (log-rank test, P<0.01), Figure 2.

Conclusions : Heavy smokers are more likely to have VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be associated with glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

The proportion of VF progressors for different smoking intensity categories.

 

Cumulative probablity of visual field progression in glaucoma eyes in different smoking intensity categories.