Smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden

Abstract

Abstract Purpose: The present study aimed to identify if smoking was a risk factor for visual field progression in exfoliation glaucoma patients. Methods: Prospective nonrandomized cohort study. The study included patients with diagnosed exfoliation glaucoma. All included patients were followed for at least three years with reliable visual fields. At least five reliable visual fields were needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test point pattern of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). Results: Totally, n=113 patients were included; of them, n=57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p=<0.001/p=<0.001/p=<0.001). Other predictors were in the MD model: IOP at diagnosis (p=0.04) and SLT treatment (p=0.001). In the ROP model: MD (p=0.01), VFI (p=0.005), number of medications (p=0.001) and SLT (p=0.001). In the GPA model: the number of medications (p=0.002). Conclusions: Smoking strongly predicted visual field deterioration in all the models studied. Therefore, patients should be advised to quit smoking when establishing the glaucoma diagnosis to slow down the progression of the disease.