| The smoking ban in public places in England starts | | | | Recent research agrees that smoking increases |
| on the 1st July and is part of a government | | | | the risk of advanced macular degeneration, |
| initiative to reduce smoking related diseases. | | | | however no evidence liking smoking to an |
| These include respiratory, vascular and malignant | | | | increase in early AMD drusen) was seen. The |
| conditions. | | | | EUREYE study shows a five-fold increase in |
| As optometrists, will we see any clinical effect | | | | geographic atrophy and 2.5-fold increase in |
| from the ban? | | | | neovascular AMD in current smokers compared |
| Smoking has clearly been linked to cataracts. | | | | to non-smokers however other studies show |
| Studies have shown that smokers have up to a | | | | these figures to be slightly lower, but the |
| three-fold increase of developing nuclear sclerosis. | | | | association still significant. Giving up smoking shows |
| Although potentially devastating to patients in | | | | a reduction in the risk factor, with patients who |
| developing countries where medical treatment is | | | | have given up smoking for at least twenty years |
| not so readily available, due to the advances in | | | | having nearly the same probability as |
| cataract surgery, many people in the western | | | | non-smokers to developing AMD. If cessation has |
| world with nuclear sclerosis undergo surgery and | | | | been for less than twenty years then they are |
| any degradation to the vision is eliminated. | | | | approximately twice as likely to develop advanced |
| Macular degeneration, affecting 700,000 people in | | | | AMD. |
| the UK in 2004, has many fewer treatment | | | | As clinicians I believe we should give nutritional |
| options and so prevention of the condition is more | | | | advice to patients on keeping their eyes as |
| important. Its prevalence is expected to increase | | | | healthy as possible. The smoking ban will hopefully |
| by 31% by the year 2020. Studies have linked | | | | help to encourage people to stop smoking. |
| smoking to advanced macular degeneration, | | | | However, we should not expect to see any |
| classified as choroidal neovascularization (formation | | | | immediate changes but hopefully the incidence of |
| of blood vessels in the sub retinal space) and | | | | advanced AMD in future generations will be |
| geographic atrophy (extensive loss of the retinal | | | | reduced. |
| pigment epithelium and choriocapillaris). Drusen are | | | | References |
| signs of early macular degeneration but there is | | | | 1. Eyecare Steering Group (2004). First Report of |
| no certainty that the presence of drusen leads to | | | | the National Eyecare Services. |
| the formation of the more advanced stages of | | | | 2. Khan J et al (2006). Smoking and age related |
| macular degeneration. | | | | macular degeneration: the number of pack years |
| Three theories can describe the aetiology of | | | | of cigarette smoking is a major determinant of |
| macular degeneration: | | | | risk for both geographic atrophy and choroidal |
| 1. Vascular theory | | | | neovascularisation. Br. J. Ophthalmology |
| 2. Oxidative Stress theory | | | | 2006;90;75-80 |
| 3. Degradation of Bruch's Membrane | | | | 3. Chakrawarthy et al ( 2007). Cigarette Smoking |
| Smoking is believed to cause macular | | | | and Age-Related Macular Degeneration in the |
| degeneration by the oxidative stress theory, | | | | EUREYE Study. |
| where normal metabolic processes in the retina | | | | Ophthalmology 2007;114:1157-1163 |
| produce free radicals by oxidation. These can be | | | | 4. |
| molecules such as superoxide, hydrogen peroxide, | | | | 5. Bartlett H (2003). Age Related Macular |
| hydroxyl radicals and single oxygen radicals. | | | | Degeneration and Nutritional |
| Lipid peroxidation can be initiated by these free | | | | Supplementation: A Review of Randomised |
| radicals leading to intercellular damage of proteins | | | | Controlled Trials. |
| carbohydrates and DNA. The retina is especially | | | | Ophthalmic And Physiological Optics. 23: 383-399. |
| susceptible due to an abundance of fatty acids in | | | | 6.Winkler B (1999). Oxidative Damage and Age |
| the macular region, the retina being subjected to | | | | Related Macular Degeneration. |
| high levels of light exposure causing the formation, | | | | Molecular Vision 5:32 |
| phagocytosis produces free radicals (during the | | | | 7. Eperjesi F (2004). Reactive Oxygen Species: |
| renewal of the photoreceptors at the level of | | | | Can Ocular Nutritional Supplements |
| Bruch's membrane) and also due to the high | | | | Help? Optometry Today. January 16th 32-33 |
| metabolic activity found in the retina. | | | | 8. National Library for Health - Eyes and Vision. |