Association between glaucoma and smoking in an eye bank sample

Isabela Vianello Valle; Jacqueline Coblentz; José Joao Mansure; Miguel N Burnier

doi:10.4103/pajo.pajo_32_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 4 | Issue : 1 | Page : 48

Association between glaucoma and smoking in an eye bank sample

Isabela Vianello Valle¹, Jacqueline Coblentz², José Joao Mansure³, Miguel N Burnier²
¹ Cancer Research Program, Research Institute of the McGill University Health Centre; MUHC-McGill University Ocular Pathology and Translational Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Ophthalmology Residency Program, Dr. João Penido Burnier Foundation, Campinas, São Paulo, Brazil
² Cancer Research Program, Research Institute of the McGill University Health Centre; MUHC-McGill University Ocular Pathology and Translational Research Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
³ Cancer Research Program, Research Institute of the McGill University Health Centre; McGill Urologic Oncology Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada

Date of Submission	21-Jun-2022
Date of Decision	30-Aug-2022
Date of Acceptance	16-Sep-2022
Date of Web Publication	28-Oct-2022

Correspondence Address:
Isabela Vianello Valle
1001 Boulevard Decarie, E02.2389, Montreal, QC H4A 3J1

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pajo.pajo_32_22

Abstract

Introduction: Glaucoma is the most common cause of irreversible blindness in the world. Although smoking has an important vascular and oxidative role in cardiovascular diseases, the association of smoking with the development and evolution of glaucoma is still controversial. In this study, we aimed to correlate smoking with the incidence of glaucoma.
Subjects and Methods: A retrospective study of 442 postmortem paired donor eyes obtained from the Minnesota Lions Eye Bank of Canada (Toronto, Ont.) between 2015 and 2019 was evaluated. All donors' eyes were collected with detailed clinical history, including the glaucoma diagnosis, gender, and smoking habits. A statistical analysis and correlation between these variables were performed.
Results: No correlation was found between glaucoma and smoking when the total number of smokers of both genders were examined (P = 0.258). However, male patients demonstrated a significant positive correlation (P = 0.008). This correlation was not observed when only female patients were evaluated (P = 0.077). In addition, the eyes of patients, between 70 and 75 years of age (P = 0.04) and 76 and 80 years of age who were smokers, demonstrated an increased risk of glaucoma (P = 0.027). This relationship was even stronger for males between 76 and 80 years of age (P = 0.006). Interestingly, the duration of the smoking habit showed no correlation to the development of glaucoma.
Conclusion: An association of smoking and glaucoma was found in patients between 70 and 80 years of age, particularly male patients. Further investigation will be conducted examining the histopathological features and other comorbidities to better elucidate these findings.

Keywords: Glaucoma, human specimens, smoking

How to cite this article:
Valle IV, Coblentz J, Mansure JJ, Burnier MN. Association between glaucoma and smoking in an eye bank sample. Pan Am J Ophthalmol 2022;4:48

How to cite this URL:
Valle IV, Coblentz J, Mansure JJ, Burnier MN. Association between glaucoma and smoking in an eye bank sample. Pan Am J Ophthalmol [serial online] 2022 [cited 2023 Jun 3];4:48. Available from: https://www.thepajo.org/text.asp?2022/4/1/48/359844

Introduction

Glaucoma is the leading cause of irreversible blindness in the world.^[1] It is an optic neuropathy that can be classified in two main entities: primary open-angle glaucoma, which is the most common and angle-closure glaucoma.^[2] The disease is characterized by damage to retinal ganglion cells and their axons in the optic nerve head (ONH), causing increased cup-to-disc ratio.^[1],[2] The mean age at diagnosis is over 60 years and its frequency increases in elderly patients.^[3]

Pathological mechanisms enrolled in ONH alterations are still under investigation. The most important risk factor associate is a higher intraocular pressure (IOP), but many theories examine other possible mechanisms, including anatomical structure of the lamina cribrosa and abnormal blood flow in the optic nerve.^[2],[4] Genetics may play a role in the incidence and severity of glaucoma, as well as ethnicity of individual patients.^[2],[5] Other nonmodifying factors that may contribute to the development of glaucoma include a thinner central cornea, myopia, and larger disc diameter.^[5],[6]

Early diagnosis and treatment are critical to avoid permanent vision loss that occurs progressively over time. Ocular hypertension associated with risk factors (functional and/or structural evidence of glaucomatous damage) should lead to a clinical decision for treatment or close follow-up.^[4] All clinical and surgical treatments available aim to lower the IOP to avoid further damage.^[4],[7]

The role of smoking in the development and evolution of glaucoma is still not clear.^[8] Some studies indicate that the interaction between smoking and other factors, such as genetics^[9] and corneal thickness,^[10] may increase the risk of glaucoma.

As IOP is the main modifiable factor associated with glaucoma and considering that ocular alterations in this disease are irreversible, it is important to try to identify other possible targets for prevention and treatment. The role of tobacco in glaucoma development may be related to its effects in systemic vascular diseases and should be further investigated.

In this retrospective study, we aimed to correlate the incidence of glaucoma and clinical history of smoking in patients using donor eye bank eyes.

Subjects and Methods

A retrospective chart review was performed. A total of 442 formalin-fixed postmortem paired donor eyes of 221 patients from the Minnesota Lions Eye Bank of Canada (Toronto, Ont.) were obtained between 2015 and 2019. All data accumulation was in accordance with the Canada and Province of Quebec legislation and the tenets of the Declaration of Helsinki. Prerecorded patient clinical data were obtained from the Eye Bank, including age, gender, smoking history, and duration and glaucoma diagnosis. Patients were sampled based on these cited variables. Glaucoma classification, duration, and stage were not available in the files.

All data were analyzed using SPSS version 28.0.1.1 software (SPSS Inc., Chicago, Illinois, USA). Statistical significance was consistently defined as P < 0.05. Nonparametric Chi-square was used to compare the incidence of glaucoma based on smoking history in the sample. Nonparametric Chi-square was also used to compare the correlation between glaucoma and smoking in different groups based on gender and age.

Results

Among the 221 patients included in this study, 17 had diagnosis of glaucoma (7.7%) and 48 were smokers (21.7%). Of the total number of patients, 109 patients were male (49.3%), 111 were female (50.2%), and for one patient, the sex was not available, as shown in [Graph 1]. The average age of patients with glaucoma and nonglaucoma was 86.53 ± 6.59 years (range: 73–99 years) and 81.74 ± 8.34 years (range: 56–99 years), respectively as observed in [Table 1].

Table 1: Distribution of the variables in the sample

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The nonglaucoma group comprises 100 males (49%) and 103 females (50.5%). A total of 43 patients were smokers (21.1%) with an average duration of 36.32 ± 18.89 years (range: 10–80 years). Among the glaucoma patients, 9 were male (52.9%) and 8 were female (47.1%). In addition, 12 patients recorded smoking history (70.6%) with 31.25 ± 10.94 years (range: 15–40 years) of mean duration.

In the total sample, there was no statistically significant relationship between glaucoma and smoking (P = 0.258). However, male patients demonstrated a significant positive correlation between glaucoma and smoking (P = 0.008). This trend was not observed in the female patient group (P = 0.077).

According to age, individuals between 70 and 75 years of age (P = 0.04) and 76–80 years of age (P =-0.027) of both genders demonstrated s significant correlation between glaucoma and smoking, as shown in [Table 2]. This relationship was stronger for males between 76 and 80 years of age (P = 0.006), as shown in [Table 3].

Table 2: Correlation between glaucoma and smoking by age with corresponding P value for all cases and by age

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Table 3: Correlation between glaucoma and smoking by gender and age with corresponding P

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Discussion

Glaucoma is an important ocular disease due to its high incidence and potential of irreversible blindness. The physiological mechanisms enrolled in the development and progression are still under investigation, as many theories were examined through the last decades.^[11] Multicentered clinical studies aimed to determine the most important risk factors relating to glaucoma developments hewed conflicting results.^[5],[12] The IOP is the most well-accepted modifiable factor; therefore, it is the major target for treatment. A recent study determined that the IOP is higher in smokers, especially in those patients with glaucoma diagnosis or of younger age.^[13]

As glaucoma pathophysiology shows multifactorial mechanisms, different cohorts of patients seem to be associated with different risk factors. The role of smoking is still controversial.^[14],[15] Few studies in the past have determined a positive correlation between glaucoma and smoking habits,^{[16],[17],[18],[19]} although others have been unable to confirm this hypothesis.^[20],[21] In at study with Japanese patients, a positive association between elevated IOP and smoking in men was observed.^[22] Recently, a study with a large cohort could establish a correlation between glaucoma and patients that are heavy smokers.^[23] Even in these studies with conclusive results, the mechanism of the association between glaucoma and smoking remains unclear.^[24]

In other ocular diseases, tobacco has been proven to have an association, acting inhibiting corneal epithelial healing for example.^[25] In cardiovascular diseases, smoking is an important independent risk factor,^{[26],[27],[28]} the same way the association between glaucoma and smoking could be related to similar vascular and oxidative effects in the ocular tissues. Smoking is associated with coronary vasospasm and other vascular and endothelial alterations.^{[29],[30],[31]} In some cases of glaucoma, especially those with normal IOP, the vascular theory plays an important role.^[32] Several studies have tried to correlate vascular alterations to a high risk for glaucoma, with conflicting results.^[6],[12] New diagnostic tools, such as optical coherence tomography angiography, have been proven to be useful to confirm the vascular hypothesis,^[33] constituting an excellent technique to further evaluate those vascular changes.

Ongoing studies in our unit will explore the histopathological features of those donor eyes with the duration and severity of the glaucomatous changes.

Conclusion

We observed a positive correlation between smoking and the incidence of glaucoma, particularly in elderly men. Ongoing studies are evaluating histopathological features of the trabecular meshwork and optic nerve, in order to assess the severity of the glaucomatous changes, as well as to shed light to the possible mechanisms involved. Certainly, by establishing the relationship between glaucoma and smoking, physicians will have a strong argument to educate patients to avoid smoking.

Acknowledgment

We are grateful to Christina Mastromonaco for her organization of the present eye bank data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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