Cigarette smoking and primary open angle glaucoma: a systematic review.

Area of Science:

• Ophthalmology
• Epidemiology
• Public Health

Background:

• Tobacco smoking is a global health concern with numerous documented adverse effects.
• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide.
• The potential link between smoking and POAG requires thorough investigation.

Purpose of the Study:

• To systematically evaluate the epidemiologic evidence for a causal association between tobacco smoking and primary open-angle glaucoma (POAG).

Main Methods:

• A systematic review of published analytical epidemiologic studies was conducted.
• Included studies underwent quality assessment and evidence evaluation using established causality criteria.
• Causality criteria included strength, consistency, temporality, dose response, reversibility, and biologic plausibility.

Main Results:

• Eleven papers comprising 9 case-control studies and 3 cohort studies were reviewed.
• Methodologic quality of most studies was poor; stronger evidence came from cohort studies.
• Neither the single prospective cohort study nor the pooled analysis of two cohort studies found a significant association between smoking and POAG.

Conclusions:

• The current systematic review provides limited evidence for a causal link between smoking and POAG development.
• Further high-quality research is necessary due to the limitations of existing studies.
• Despite limited evidence for POAG, patients should be advised against smoking due to its clear links to other ocular and systemic diseases.