Purpose: The purpose of this study was to determine the association between cigarette smoking and the severity of primary angle closure glaucoma (PACG) in Malay patients residing in Malaysia. Methods: A cross-sectional study was conducted involving 150 Malay PACG patients between April 2014 and August 2016. Ocular examination was performed including Humphrey visual field (HVF) 24-2 analysis assessment. On the basis of the 2 consecutive reliable HVFs, the severity of glaucoma was scored according to modified Advanced Glaucoma Intervention Study (AGIS) by 2 masked investigators and classified as mild, moderate, and severe. Those with retinal diseases, neurological diseases, memory problem, and myopia ≥4 diopters were excluded. Their smoking status and details were obtained by validated questionnaire from Singapore Malay Eye Study (SiMES). The duration of smoking, number of cigarettes per day, and pack/year was also documented. Multiple linear regression analysis was conducted. Results: There was a significant association between education level and severity of PACG (P=0.001). However, there was no significant association between cigarette smoking and severity of glaucoma (P=0.080). On the basis of multivariate analysis, a linear association was identified between cigarette smoked per day (adjusted b=0.73; 95% CI: 0.54, 1.45; P<0.001) and body mass index (adjusted b=0.32; 95% CI: 0.07, 1.35; P=0.032) with AGIS score. Conclusions: There was no significant association between cigarette smoking and severity of PACG. Cigarette smoked per day among the smokers was associated with severity of PACG. However, because of the detrimental effect of smoking, cessation of smoking should be advocated to PACG patients.

Introduction: The detrimental effects of cigarette smoking include impairment of optic nerve head perfusion and elevation of oxidative stress levels, which are believed to be part of the pathogenesis of glaucoma. However, there is no evidence on the effect of cigarette smoking as a risk for primary angle-closure glaucoma (PACG). Purpose: To determine the association between cigarette smoking and PACG in Malay patients. Study design: Case control study. Materials and methods: Two-hundred Malay PACG patients and 250 controls from  three tertiary hospitals in Malaysia were involved in this study. PACG patients were diagnosed based on the World Glaucoma Association consensus. The smoking status was documented using validated questionnaire adopted from Singapore Malays Eye Study through face-to-face interview. Smoking status was divided into active smokers, ex-smokers, passive smokers, and non-smokers. The association of smoking and PACG was analysed with multiple logistic regression. Confounders such as age, gender, education status, and body mass index (BMI) were considered in the analysis. Results: There was female preponderance in PACG with 3:1 ratio. Active smokers (p = 0.656) and ex-smokers (0.073) were not significantly associated with PACG in Malays. Passive smoking significantly increased the risk of PACG by 6.8-fold (95% CI 2.49,18.67; p < 0.001). Number of cigarettes/day (p = 0.144) and duration of smoking (p = 0.176) were also not significantly associated with PACG (p = 0.144). No formal education, primary and secondary education level increased the risk of PACG (p < 0.001). Each unit increment of BMI increased the risk of PACG by 1.14-fold (95% CI 1.03, 1.27; p = 0.014). A year increased in age increased the risk by 1.05 times (95% CI 1.00, 1.09; p = 0.026). Conclusions: There is no significant association between active smoking and PACG. Passive smoking is a potential risk factor for PACG. The preponderance of women may contribute to this result. However, quantification of exposure to passive smoking is not possible in this study.