Effects of Firsthand Tobacco Smoking on Retinal Vessel Caliber: a Systematic Review and Meta-analysis

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2023 Sep 8

PMID 37682335

Authors

Vincent L Yuen

Xiu Juan Zhang

Xiangtian Ling

Yuzhou Zhang

Ka Wai Kam

Li Jia Chen

Patrick Ip

Clement C Tham

Carol Y Cheung

Chi Pui Pang

Jason C Yam

Affiliations

Soon will be listed here.

Abstract

Purpose: To review the effects of firsthand tobacco smoking on central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of firsthand tobacco smokers.

Methods: We performed a search on EMBASE and PubMed for studies up to 15 July 2022. Two independent reviewers selected studies with baseline data of CRAE and CRVE of current smokers, nonsmokers, and former smokers. Initial search identified 893 studies, of which 10 were included in the meta-analysis. Two independent reviewers extracted data from the included studies. The quality of studies was assessed by the Newcastle-Ottawa Scale.

Results: In this meta-analysis, 7431 nonsmokers, 2448 current smokers and 5786 former smokers, as well as 7404 nonsmokers, 2430 current smokers and 5763 former smokers were included in CRAE and CRVE analysis respectively. Nonsmokers had narrower CRVE (Weighted mean difference [WMD], -12.15; 95% CI, -17.33 - -6.96) and CRAE (WMD, -4.77; 95% CI, -7.96 - -1.57) than current smokers, and narrower CRVE (WMD, -3.08; 95% CI, -6.06 - -0.11) than former smokers. Current smokers had wider CRVE (WMD, 10.42; 95% CI, 7.80 - 13.04) and CRAE (WMD, 7.05; 95% CI, 6.65 - 7.46) than former smokers. Subgroup analysis and sensitivity analysis were performed.

Conclusion: Firsthand tobacco smoking resulted in wider CRAE and CRVE in current and former smokers, particularly in CRVE, and such changes may not be reversible after smoking cessation. Therefore, retinal vessel caliber may reflect the effects of firsthand tobacco smoking and be used to estimate the risk of cardiovascular diseases.

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References

Banks E, Joshy G, Korda R, Stavreski B, Soga K, Egger S . Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Med. 2019; 17(1):128. PMC: 6607519. DOI: 10.1186/s12916-019-1351-4. View

Ambrose J, Barua R . The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol. 2004; 43(10):1731-7. DOI: 10.1016/j.jacc.2003.12.047. View

Iida M, Iida H, Dohi S, Takenaka M, Fujiwara H . Mechanisms underlying cerebrovascular effects of cigarette smoking in rats in vivo. Stroke. 1998; 29(8):1656-65. DOI: 10.1161/01.str.29.8.1656. View

Wang J, Leng F, Li Z, Tang X, Qian H, Li X . Retinal vascular abnormalities and their associations with cardiovascular and cerebrovascular diseases: a Study in rural southwestern Harbin, China. BMC Ophthalmol. 2020; 20(1):136. PMC: 7137258. DOI: 10.1186/s12886-020-01407-y. View

Wang L, Wong T, Sharrett A, Klein R, Folsom A, Jerosch-Herold M . Relationship between retinal arteriolar narrowing and myocardial perfusion: multi-ethnic study of atherosclerosis. Hypertension. 2007; 51(1):119-26. DOI: 10.1161/HYPERTENSIONAHA.107.098343. View

Kawasaki R, Cheung N, Wang J, Klein R, Klein B, Cotch M . Retinal vessel diameters and risk of hypertension: the Multiethnic Study of Atherosclerosis. J Hypertens. 2009; 27(12):2386-93. PMC: 2935621. DOI: 10.1097/HJH.0b013e3283310f7e. View

Ogagarue E, Lutsey P, Klein R, Klein B, Folsom A . Association of ideal cardiovascular health metrics and retinal microvascular findings: the Atherosclerosis Risk in Communities Study. J Am Heart Assoc. 2013; 2(6):e000430. PMC: 3886782. DOI: 10.1161/JAHA.113.000430. View

Kim Y, Noh K, Byun S, Lee S, Kim T, Sunwoo L . Effects of Hypertension, Diabetes, and Smoking on Age and Sex Prediction from Retinal Fundus Images. Sci Rep. 2020; 10(1):4623. PMC: 7067849. DOI: 10.1038/s41598-020-61519-9. View

10.

Wong T, Islam F, Klein R, Klein B, Cotch M, Castro C . Retinal vascular caliber, cardiovascular risk factors, and inflammation: the multi-ethnic study of atherosclerosis (MESA). Invest Ophthalmol Vis Sci. 2006; 47(6):2341-50. PMC: 2258139. DOI: 10.1167/iovs.05-1539. View

11.

Sorensen B, Houben A, Berendschot T, Schouten J, Kroon A, van der Kallen C . Cardiovascular risk factors as determinants of retinal and skin microvascular function: The Maastricht Study. PLoS One. 2017; 12(10):e0187324. PMC: 5659678. DOI: 10.1371/journal.pone.0187324. View

12.

Liew G, Gopinath B, White A, Burlutsky G, Wong T, Mitchell P . Retinal Vasculature Fractal and Stroke Mortality. Stroke. 2021; 52(4):1276-1282. DOI: 10.1161/STROKEAHA.120.031886. View

13.

Myers C, Klein R, Knudtson M, Lee K, Gangnon R, Wong T . Determinants of retinal venular diameter: the Beaver Dam Eye Study. Ophthalmology. 2012; 119(12):2563-71. PMC: 3508386. DOI: 10.1016/j.ophtha.2012.06.038. View

14.

Garhofer G, Resch H, Sacu S, Weigert G, Schmidl D, Lasta M . Effect of regular smoking on flicker induced retinal vasodilatation in healthy subjects. Microvasc Res. 2011; 82(3):351-5. DOI: 10.1016/j.mvr.2011.07.001. View

15.

Omae T, Nagaoka T, Yoshida A . Effects of Habitual Cigarette Smoking on Retinal Circulation in Patients With Type 2 Diabetes. Invest Ophthalmol Vis Sci. 2016; 57(3):1345-51. DOI: 10.1167/iovs.15-18813. View

16.

Hollo G . No Acute Effect of Smoking on Peripapillary and Macular Vessel Density in Healthy Middle-aged Smokers. J Glaucoma. 2018; 28(5):e86-e88. DOI: 10.1097/IJG.0000000000001171. View

17.

Yang T, Huang X, Yao J . Effects of Cigarette Smoking on Retinal and Choroidal Thickness: A Systematic Review and Meta-Analysis. J Ophthalmol. 2019; 2019:8079127. PMC: 6791261. DOI: 10.1155/2019/8079127. View

18.

Gu J, Charles L, Klein R, Grady L, Ma C, Allison P . Association Between Blood Pressure and Retinal Vessel Diameters Among Police Officers in the US Northeast. J Occup Environ Med. 2017; 60(3):234-240. PMC: 5843505. DOI: 10.1097/JOM.0000000000001246. View

19.

Howard K, Klein B, Dreyer J, Danforth L, Klein R . Cross-sectional associations of medication and supplement use with retinal vascular diameter in the Beaver Dam Eye Study. JAMA Ophthalmol. 2013; 132(1):23-31. PMC: 4050640. DOI: 10.1001/jamaophthalmol.2013.6326. View

20.

Yanagi M, Misumi M, Kawasaki R, Takahashi I, Itakura K, Fujiwara S . Is the association between smoking and the retinal venular diameter reversible following smoking cessation?. Invest Ophthalmol Vis Sci. 2013; 55(1):405-11. DOI: 10.1167/iovs.13-12512. View

21.

Tano T, Ono K, Hiratsuka Y, Otani K, Sekiguchi M, Konno S . Retinal vessel diameters in a Japanese population: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study. Acta Ophthalmol. 2016; 94(6):e432-41. DOI: 10.1111/aos.12953. View