Effects of Smoking on Corneal Thickness

Candice Giordano, MD

February 25, 2011

Smoking and the Eye

• Cataracts

• Thyroid eye disease

• Macular degeneration

• Polypoidal choroidal vasculopathy

• Uveitis

• Macular edema

Background

• Cigarette smoking is known to increase systemic reactive oxygen species.

• It is not known if smoking decreases the antioxidant properties of the aqueous humor.– IL-6 has been shown to be elevated in the aqueous

of smokers.

• It is known if the aqueous is unhealthy, then corneal thickness increases.

Background

• Corneal thickness has also been found to be a predictor of glaucoma risk and can increase after intraocular surgery and in unhealthy eyes

• Corneal guttata, which can be related to corneal thickness, have been shown to be associated with a 20 pack-year smoking history.

Background• A transcription factor known to bind the antioxidant

response element and activate antioxidant defense, is down-regulated in Fuchs’ endothelial corneal dystrophy

• Ex vivo, oxidative stress caused characteristic morphological changes and apoptosis of corneal endothelium

• Significantly higher levels of oxidative DNA damage and apoptosis were detected in FECD endothelium compared with normal controls.

Hypothesis

• It is hypothesized that a positve smoking history will be associated with increased corneal thickness. The objective of this study is to determine if smoking is related to corneal thickness as well as recovery from intraocular surgery.

Methods

• Observational case series involving persons 18 years old or greater.

• The patients are being questioned regarding:– their smoking history including duration of

smoking and number of packs per day

– history of ocular surgery

– history of antioxidant use

Methods

• Examination includes the following: – visual acuity

– intraocular pressure

– corneal pachymetry

– anterior and posterior eye exams if indicated for that visit.

• Currently in data collection….

References

• Cackett P, Yeo I, Cheung CM, et al. Relationship of smoking and cardiovascular risk factors with polypoidal choroidal vasculopathy and age-related macular degerenation in chinese persons. Ophthalmology 2010 Dec 9. (Epub)

• Csiszar A, Podlutsky A, Wolin MS, Losonczy G, Pacher P, Ungvari Z. Oxidative stress and accelerated vascular aging: implications for cigarette smoking. Front Biosci 2009 Jan 1;14:3128-44.

• Hager A, loge K, Fullhas MO, Schroeder B, Grossherr M, Wiegand W. Changes in corneal hysteresis after clear corneal cataract surgery. Am J Ophthalmology 2007 Sep; 144(3):341-6.

• Jurjunas UV, Bitar MS, Funaki T, Azizi B. Evidence of oxidative stress in the pathogenesis of fuchs endothelial corneal dystrophy. American Journal of Pathology 2010 Nov;177(5):2278-89.

• Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002; 120:701.

• Lin p, Loh AR, Mergolis TP, Acharya NR. Cigarette smoking as a risk factor for uveitis. Ophthalmology 2010 Mar; 117(3) 585-90.

• Zoega GM, Fujisawa A, Sasaki H, et al. Prevalence and risk factors for corneal guttata in the Reykjavik Eye Study. Ophthalmology 2006; 113 565-569.