Presented at: the Association for Research in Vision and Ophthalmology meeting, May 2009, Fort Lauderdale, Florida.
Received 1 June 2009; received in revised form 12 July 2009; accepted 6 August 2009. published online 24 December 2009.
Purpose
To determine the association between tobacco smoking history and uveitis.
Design
Retrospective, case-control study.
Participants
A total of 564 patients with ocular inflammation seen in the Proctor Foundation uveitis clinic between 2002 and 2009, and 564 randomly selected patients seen in the comprehensive eye clinic within the same time period.
Methods
A retrospective medical record review of all cases and controls.
Main Outcome Measures
A logistic regression analysis was conducted with ocular inflammation as the main outcome variable and smoking as the main predictor variable, while adjusting for age, gender, race, and median income.
Results
The odds of a smoker having ocular inflammation were 2.2-fold that of a patient who had never smoked (95% confidence interval [CI], 1.7–3.0; P<0.001). All anatomic subtypes of uveitis were associated with a positive smoking history, with odds ratios (ORs) of 1.7 (95% CI, 1.2–2.4; P = 0.002) for anterior uveitis, 2.7 (95% CI, 1.4–5.6; P = 0.005) for intermediate uveitis, 3.2 (95% CI, 1.3–7.9; P = 0.014) for posterior uveitis, and 3.9 (95% CI, 2.4–6.1; P<0.001) for panuveitis. In patients with panuveitis and cystoid macular edema (CME), the OR was 8.0 (95% CI, 3.3–19.5; P<0.001) compared with 3.1 (95% CI, 1.8–5.2; P<0.001) for patients without CME. Patients with intermediate uveitis and CME also had a higher OR (OR 8.4; 95% CI, 2.5–28.8; P = 0.001) compared with patients without CME (OR 1.5; 95% CI, 0.6–3.8; P = 0.342). Patients with a smoking history were at greater odds of having infectious uveitis (OR 4.5; 95% CI, 2.3–9.0; P<0.001) than noninfectious uveitis (OR 2.1; 95% CI, 1.6–2.8; P<0.001), although both were associated with smoking.
Conclusions
A history of smoking is significantly associated with all anatomic subtypes of uveitis and infectious uveitis. The association was greater in patients with intermediate uveitis and panuveitis with CME compared with those without CME. In view of the known risks of smoking, these findings, if replicated, would give an additional reason to recommend smoking cessation in patients with uveitis.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: December 24, 2009.
1F. I. Proctor Foundation, University of California, San Francisco, California
2Department of Ophthalmology, University of California, San Francisco, California
Correspondence: Nisha Acharya, MD, MS, F. I. Proctor Foundation, University of California San Francisco, 95 Kirkham St, San Francisco, CA 94143-0944
Manuscript no. 2009-737.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by a National Eye Institute K23EY017897 grant and a Research to Prevent Blindness Career Development Award to Dr. Acharya. Dr. Lin is supported by an institutional Clinical and Translational Science Institute resident research grant. The sponsor or funding organization had no role in the design or conduct of this research. Dr. Margolis is an equity owner in Chakshu, Los Gatos, CA.
ABSTRACT