title: Smoking and visual impairment among older adults with age-related eye diseases.
abstract: BACKGROUND
  Tobacco use is the leading preventable cause of death in the United States. Visual impairment, a common cause of disability in the United States, is associated with shorter life expectancy and lower quality of life. The relationship between smoking and visual impairment is not clearly understood. We assessed the association between smoking and visual impairment among older adults with age-related eye diseases.
  
  
  METHODS
  We analyzed Behavioral Risk Factor Surveillance System data from 2005 through 2008 on older adults with age-related eye diseases (cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy; age ≥50 y, N = 36,522). Visual impairment was defined by self-reported difficulty in recognizing a friend across the street or difficulty in reading print or numbers. Current smokers were respondents who reported having smoked at least 100 cigarettes ever and still smoked at the time of interview. Former smokers were respondents who reported having ever smoked at least 100 cigarettes but currently did not smoke. We used multivariate logistic regressions to examine the association and to adjust for potential confounders.
  
  
  RESULTS
  Among respondents with age-related eye diseases, the estimated prevalence of visual impairment was higher among current smokers (48%) than among former smokers (41%, P < .05) and respondents who had never smoked (42%, P < .05). After adjustment for age, sex, race/ethnicity, education, and general health status, current smokers with age-related eye diseases were more likely to have visual impairment than respondents with age-related eye diseases who had never smoked (odds ratio, 1.16, P < .05). Furthermore, respondents with cataract who were current smokers were more likely to have visual impairment than respondents with cataract who had never smoked (predictive margin, 44% vs 40%, P = .03), and the same was true for respondents with age-related macular degeneration (65% of current smokers vs 57% of never smokers, P = .02). This association did not hold true among respondents with glaucoma or diabetic retinopathy.
  
  
  CONCLUSIONS
  Smoking is linked to self-reported visual impairment among older adults with age-related eye diseases, particularly cataract and age-related macular degeneration. Longitudinal evaluation is needed to assess smoking cessation's effect on vision preservation.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341-3727, USA. XZhang4@cdc.gov
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kahende
authors.forename: Amy Z
authors.initials: AZ
authors.lastname: Fan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Barker
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Thompson
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D001766:Blindness / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002386:Cataract / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D016540:Smoking Cessation; D014481:United States / Q000453:epidemiology