Key takeaways:
- In two analyses, smoking was associated with vision impairment among patients with low myopia.
- Smoking may be the first modifiable risk-factor for preventing vision impairment in low myopes, a presenter said.
DENVER — In patients with low to moderate myopia, smoking was found to be a risk factor for vision impairment, according to a poster presentation at the Association for Research in Vision and Ophthalmology meeting.
Ian Flitcroft, D.Phil., coauthor of the study, told Healio that, because myopia accelerates with age, the aim of the research was to find a modifiable risk factor for older, established myopes.
“I was really expecting to find something on the vascular factors like hypertension and heart failure, but actually, the signal came through on smoking,” he said.
Flitcroft and colleagues initially collected data from 80,757 patients through U.K. Biobank and used multivariable logistic regression to examine associations between vision impairment and factors including age, sex, myopia category, smoking status and cardiovascular risk factors. Upon examination, the data showed a link between smoking and vision impairment specifically in patients with low myopia ( –0.5 D to > –6 D; OR = 1.57, P = .026), with no association found with high myopia (defined as -6 D) or emmetropia.
“Effectively, smoking, age and myopia, the three of them together, increase your odds of becoming visually impaired, and the risk is actually highest in the lower group of myopes,” Flitcroft told Healio. “The theory there is that in the older patients, the anatomical changes probably dominate.”
To confirm these findings, Flitcroft and colleagues initiated a second analysis of 12,300 patients using The National Health and Nutrition Examination Survey U.S. population-based dataset. The results, Flitcroft said, were “exactly the same.”
“When looking for a biological correlate, because the theory is all based around choroidal thickness, we found all the usual variance, which is that myopia of all degrees and age, thin your choroid,” he told Healio. “Of the vascular factors, the only significant association with smoking was in this category of myopes: The low myopes.”
This may be because of a significant thickening of the choroid observed in patients with low myopia who smoke (+8.2 µm, P < .001). According to the poster, thickening was also significant in patients with emmetropia who smoke (+4.4 µm, P = .001) but absent in those with high myopia (+4.2 µm).
“It’s a biological link to a structure that is relevant,” he told Healio.
Flitcroft said that, when comparing results from patients who previously smoked vs. those who are currently smoke, those who previously smoked did not have an elevated risk.
“It’s the people who are smoking as old adults who have the risk, which means it makes it the most modifiable risk,” he told Healio. “This is the first modifiable risk factor we have. For me, it’s just like opening Pandora’s box because, if there is one, there are more.”
When examining patients with eyes that look “surprisingly bad” for their level of myopia, Flitcroft encouraged ophthalmologists to educate these patients on the risk of vision impairment as they get older, and explain that, if they smoke, quitting may directly reduce this risk.
“Eighty-five percent of myopes are beyond myopia control. They are stable adults, and we are doing nothing,” he said. “We should be actively managing those 85%. That’s my current mission.”
Sources/Disclosures
Source:
Flitcroft I, et al. Smoke gets in your eyes: Evidence that smoking is the first modifiable risk factor for myopia-related vision impairment. Presented at: Association for Research in Vision and Ophthalmology meeting; May 3-7, 2026; Denver.
Disclosures:
Flitcroft reports no relevant financial disclosures.
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