Objective:

To assess the association between smoking and the risk of vision-threatening diseases, highlighting the significance of findings using a large-scale global database analysis.

Key Findings:

• Smokers have a statistically significant increased risk of major ophthalmic conditions compared to non-smokers.
• Cataract risk is nearly doubled in smokers (9.5%) compared to non-smokers (5.4%).
• Posterior subcapsular cataract showed the highest susceptibility among cataract types.
• Glaucoma risk is significantly elevated, particularly for primary angle-closure glaucoma.
• Age-related macular degeneration (AMD) incidence is nearly doubled in smokers.
• Smokers show higher rates of diabetic retinopathy across all stages.
• Uveitis and retinal vascular occlusions also show significant associations.

Interpretation:

The study highlights the significant ocular risks associated with smoking, emphasizing the need for clinicians to assess smoking status and provide cessation support to mitigate preventable vision loss, as many clinicians do not routinely address this issue.

Limitations:

• Retrospective design limits causal inference.
• Potential underreporting of smoking status in electronic health records.
• Confounding factors not fully accounted for may influence results.

Conclusion:

Incorporating smoking history into risk stratification and counseling may help reduce the incidence of preventable vision loss, emphasizing the need for clinicians to address smoking in practice.