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ORIGINAL ARTICLE
1638 P J M H S Vol. 14, NO. 4, OCT – DEC 2020
Effect of Cigarette Smoking on Intraocular Pressure in individual with
Normal Blood Pressure
IQRA IQBAL1, RABIA SAEED2, SADAF QAYYUM3, NIMRA GUL4, ZUBAIR WAHAB5, AYISHA SHAKEEL6, SONIA
GHAFOOR7
1Senior Lecturer, The University of Lahore
2Optometrist, Aziz Fatimah Hospital Faisalabad
3Senior Lecturer, Pakistan Institutes of Ophthalmology, Al-shifa Trust Hospital Islamabad
4Lecturer, The University of Faisalabad
5Senior Lecturer, The University of Lahore
6Assistant Professor, Al-Nafees Medical College Islamabad
7(PhD in Optics and Optical Engineering), Department of Optometry and Vision Sciences, The University of Lahore.
Correspondence to: Iqra Iqbal, Email ID; Seventhsky41@yahoo.com
ABSTRACT
Objective: The purpose of this study was to determine the effect of smoking on intraocular pressure in individual
with normal blood pressure and to compare the smoking effects on intraocular pressure in smoker and non-
smoker.
Material and Methods: A hospital based descriptive cross sectional study was conducted at Aziz Fatimah
Hospital Faisalabad including 480 patients of age between 20-50 years. The person with normal visual acuity and
normal blood pressure were included in the study. After history taking and visual acuity measurement
Ophthalmoscopy was performed to evaluate different eye conditions. After that the intraocular pressure of both
eyes was measured by using Goldman Applanation tonometer.
Results: There were 192 (40%) patients of age 20-30 years, 160 (33.3%) patients of age 31-40 years of age, and
128 (26.6%) patients of age 41-50 years. The percentage of the subjects who smoke 1-5 cigarettes per day was
12.9% and for those who smoke 6-10 cigarettes per day was 37.08%. The mean IOP of smoker’s right and left
eye was 21.50+2.5 mmHg and 22.3+2.9 mmHg respectively. The mean IOP of non-smokers right and left eyes
was 15.99+1.8 mmHg and 16.96+2.1 mmHg respectively.
Conclusion: There was a highly significant association of rise in intraocular pressure in smokers as compared to
non-smoker. This study also concludes that intraocular pressure increases more in smokers left eye as compared
to the left eye.
Keywords: Cigarette smoking, Intraocular pressure, Glaucoma, Ocular hypertension
INTRODUCTION
Nicotine is the primary active ingredient of cigarette which
increases the level of catecholamine which is responsible
for increases heart rate and blood pressure1. Cigarette
Smoking is major cause of several ocular and systemic
diseases. The toxin associated with cigarette smoking may
decrease the blood flow or cause clot to develop within the
eyes capillaries. Cigarette smoking also caused the
expansion of fragmented molecules which could disrupt the
normal function of healthy cells and lead to eye diseases 2.
Smoking also increases the platelet aggregation; thrombus
formation and it release growth factors that lead to vascular
smooth muscle cell proliferation that are responsible for
macular degenerations. Decrease blood flow to retina due
to smoking cause deterioration of macula which leads to
loss of central vision1.
The World Health Organization declares that smoking
is a long-established risk factor of many cancers, cerebro-
and cardiovascular diseases and chronic obstructive
pulmonary diseases3. Among the 1.3 billion smokers in the
world, over 6 million die annually duexto tobacco intake 4.
Several epidemiologic studies reported the association of
cigarette smoking with glaucoma and increased of
intraocular pressure 5. When the intraocular pressure is
greater than normal but the person does not show signs of
glaucoma this is considered as ocular hypertension.
Person with elevated intraocular pressure is considered as
a glaucoma suspect6. The relatively high intraocular
pressure can cause optic disc damage and visual field
defects3. Cigarette smoking adds to vascular sicknesses by
obstructing arterial lumen with atherosclerosis plaque and
intimal thickening. Retinal ganglion cell and trabecular
meshwork cell damage due to smoking involving
inflammation and apoptosis have been proved in
glaucoma. Smoking also causes high oxidative stress
because of oxidizing agents that produce free radicals
which proves that smoking is responsible in pathogenesis
of primary open angle glaucoma4.
The purpose of this study was to determine the effect
of smoking on intraocular pressure in individual with normal
blood pressure and to compare the smoking effects on
intraocular pressure in smoker and non-smoker.
MATERIAL AND METHODS
This cross sectional study was conducted in the
ophthalmology department of Aziz Fatimah Hospital
Faisalabad from December 2019 to August 2020. A total of
480 male subjects with the age limit 20-50 years were
included in the study after informed consent was sought
and obtained from each of them. One group was control
(Non-smoker) and the other group was case (smokers).
The smoking group was further dividing according to the
consumption of cigarette smoking per day 1-5 cigarette per
day and 6-10 cigarettes per day. The smokers with the
history of smoking for at least one year with normal blood
pressure 130/80 and visual acuity at least 6/9 were
Iqra Iqbal, Rabia Saeed, Sadaf Qayyum et al
P J M H S Vol. 14, NO. 4, OCT – DEC 2020 1639
included in this study with age matched non-smokers. A
person with diabetes, hypertension, tuberculosis, pseudo
exfoliation history of contact lens used, any eye surgery ,
glaucoma , cataract , current infectious eye disease or any
other ocular and systemic history were excluded from the
study.
Data were collected from the patients with the help of
self-designed performa. After the history taking systolic and
diastolic blood pressure was measured with
sphygmomanometer and the status of diabetes was
checked with glucometer, 80-130 mg/dl (random) was
considered as normal individual. After that visual acuity of
both eyes was measured with snellen chart at 6 meter
distance. After the visual acuity measurement complete
ocular eye examination was done in all subjects. Distant
direct ophthalmoscope was performed to evaluate different
eye conditions like cataract, keratoconus and refractive
error and Slit lamp bio-microscopy was performed with
+90D lens to evaluate pathological condition for the
fulfillment of exclusion criteria. Intraocular pressure in each
eye was assessed by using Goldman Applanation
tonometer.
SPSS version 20 was used for statistical K analysis.
Descriptive statistics was used to measure the effects of
smoking on intraocular pressure to find out the mean and
standard error of intraocular pressure in smokers and non-
smokers. ANOVA test was used to explore the effect of
smoking in smokers and non-smokers. P-value <0.05 was
taken as significant.
RESULTS
There were 192 (40%) patients of age 20-30 years, 160
(33.3%) patients of age 31-40 years of age, and 128
(26.6%) patients of age 41-50 years (Fig 1).
The frequency of subjects who used to smoke 1-5
cigarettes per day were 62 (12.9%) and the frequency of
smokers who used to smoke 6-8 cigarettes per day were
178 (37.08%). Frequency of smokers who smoked from 1-2
years was 36 (7.5%), the frequency of smokers who used
to smoke from 3-5 years was 146 (30.41%) and the
frequency of smokers who used to smoke between 6-10
years of duration was 54 (12.08%) (Table 1).
Table 1: Data of smokers Cigarette consumptions
Cigarette consumptions
Frequency
Percentages
1-5 Cigarette
62
12.9%
6-10 Cigarette
178
37.08%
None
240
50%
1-2 years
36
7.5%
3-5 years
146
30.41%
6-10 years
58
12.08%
Table 2: Descriptive statistics IOP of smokers and non-smokers.
IOP R.E
N
Means
Standard deviation
Smokers
240
21.50
2.528
Non-smokers
240
15.90
1.896
Total
480
19.63
2.654
Smokers
240
22.30
2.980
Non-smokers
240
16.96
2.194
Total
480
19.34
3.574
The mean B value L of intraocular pressure of
smoker’s right eye was 21.50±2.5 and for non-smokers was
15.90±1.8. The mean value of intraocular pressure of left
eye in smokers was 22.3±2.9 and in non-smokers was
16.96±2.4 (Table 2).
By using ANOVA test, the result shows the p value
<0.05 of smokers and non-smokers R.E which mean
statistically significant at the level of 5 % confidence
interval, shows that there was statistically significant (p-
0.01) effect of smoking on intraocular pressure. The results
also shows p value <0.05 of smokers and non-smokers L.E
which means there was a highly significant (p-0.01) effect
of smoking on intraocular pressure. The intraocular
pressure of smoker’s right and left eye was relatively higher
than the non-smoker right and left eye.
DISCUSSION
Elevated intraocular pressure is a major risk factor for
glaucoma. There is a conflicting epidemiologicalddata on
whether cigarette smoking affects IOP. Some studies show
that there is no association between smoking and
intraocular pressure and some studies reported that there
is an association between smoking and intraocular
pressure.
A study was conducted by Kamble et al1 to see the
effects of tobacco smoke on the intraocular pressure. They
found that the mean value of intraocular pressure of
smoker right and left eye was 23.46+1.45 and 23.65+1.46
respectively and the mean value of non-smoker right and
left eye was 19.38+1.55 and 19.39+1.53 respectively.
Similarly, my study concluded that the mean value of
smoker right and left eye was 21.50+2.50 and 22.30+1.8
respectively and for non-smoker the mean value of right
and left eye was 15.90+2.9 and 16.96+2.1 respectively.
Another similar study conducted by Trimothy et al2 to
determine the effect of smoking on intraocular pressure.
The result showed the significant rise in intraocular
pressure (p<0.01). The result of my study also show similar
results that smoking effects on intraocular pressure P-0.01.
They also concluded in their study that the mean value of
intraocularKpressure was higher in smoker left eye as
compared to right eye.
My study result shows significant rise in intraocular
pressure in smoker when compared to normal healthy
individual. Another similar study conducted which also
shows that the intraocular pressure of smokers was
significantly elevated P-<0.001 when compared with
controls 7.
Yoshida et al. conducted a research to clarify the
effect of smoking on intraocular pressure. The result of
their study show a positive association of cigarette smoking
with intraocular pressure in men (P < 0.05) and a negative
association of cigarette smoking with intraocular pressure
in women (P-0.06). In above study intraocular pressure
was measured with non-contact tonometer which is
different from my study design. In my study Goldman
Applanation tonometer was used to measured intraocular
pressure because accuracy of non-contact tonometer loss
when intraocular pressure was higher than 21 mmHg.
Another similar study conducted by Okoro and observed
that there was a positive association of cigarette smoking
on intraocular pressure8.
Previously, conducted research also noted the direct
or passive effect of smoking onnintraocular pressure and
Effect of Cigarette Smoking on Intraocular Pressure in individual with Normal Blood Pressure
1640 P J M H S Vol. 14, NO. 4, OCT – DEC 2020
on arterialKblood pressure 2,9,10. It was considered that both
intraocular pressure and arterial blood pressure increases
dueJto nicotine. There is also needed to be study the effect
of smoking on arterial blood pressure to confirm the above
statement on a larger scale.
CONCLUSION
There was a highly significant association of rise in
intraocular pressure with smoking. This study also
concludes that intraocular pressure increases more in
smokers left eye as compared to the left eye.
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