Young Vapers and Smokers Beware: Eye Problems Abound 

Donavyn Coffey

August 31, 2023

Adolescents and young adults who smoked and vaped were more likely to report ocular problems including dryness, redness, pain, blurry vision, light sensitivity, and headaches, according to an observational study published today in JAMA Ophthalmology.  

Eye symptoms were significantly worse among young people who reported using both cigarettes and e-cigarettes than for those who said they used only one of the products, according to researchers. Symptoms were particularly frequent and severe among those who had used both products in the prior week. 

"In ophthalmology clinics, I've increasingly noticed patients, particularly adolescents and young adults, presenting with eye-related symptoms such as dryness, irritation, and even vision disturbances," said Anne Xuan-Lan Nguyen, MDCM, an ophthalmology resident at the University of Toronto, Canada, who led the study. 

Many of these patients said they did not use contact lenses or take medications associated with eye problems, but they did report a history of using e-cigarettes and cigarettes. 

This "sparked my curiosity about the possible link between smoking or vaping and ocular symptoms," Nguyen, who conducted the research as a medical student at McGill University in Montreal, told Medscape Medical News

E-cigarettes are the most popular tobacco product among young people. Public health data show an increasing trend toward both vaping and smoking cigarettes, known as dual use.  An estimated 40% of middle and high school-aged tobacco users report using two or more tobacco products, according to the Centers for Disease Control and Prevention. Cigarette use has been linked to ocular damage, but the effects of e-cigarettes on eyesight and the combined effect with cigarettes are not as well known. 

Nguyen and her colleagues surveyed more than 4000 people aged 13-24 about their use of cigarettes or e-cigarettes in the last 30 days, the last 7 days, or ever. Half said they had never used any tobacco product and one quarter reported having used cigarettes, vapes, or both in the last month. More than 900 respondents said they had used one or both tobacco products in the last week. 

Of the respondents who had ever vaped, 55.9% said they also used cigarettes. These dual users reported more severe and frequent eye symptoms compared with users of either product alone. Up to 4% of respondents who had ever been a dual user reported daily, severe, or very severe ocular symptoms — more than in the cigarette-only or e-cigarette-only groups. 

More frequent tobacco use also was associated with more ocular symptoms. Young people who smoked or vaped in the previous week reported more symptoms than the 30-day group, who reported more symptoms than the ever-user group (those who had taken at least a puff but not in the last month).

"All these conditions we know are worse as you get older," said Laura Enyedi, MD, pediatric ophthalmologist at the Duke Eye Center in Durham, North Carolina, who was not associated with the study. "So if young people are having symptoms, it doesn't bode well for them as they age."

E-cigarette use alone did not appear to be linked to eye ailments, according to the findings. But to Nguyen's surprise the survey results showed users of vaping products spent the most time worried about their eye health compared to all other participants. Users who smoked only cigarettes reported ocular symptoms, but not as severe or frequent as dual users. 

The researchers hypothesize that ocular problems caused by vapes and cigarettes could be classified as oxidative damage. The combustion of the cigarette and the e-cigarette solvent (propylene glycol) potentially generate free radicals that can cause oxidative stress, damaging the ocular surface and film, Nguyen said. 

Ophthalmologists are "always asking about contact lens use, lid hygiene, and screen time. Here's another thing to consider when we get those common, nonspecific complaints of symptoms like dryness, redness, and burning," Enyedi said.

Given the observational nature of the study, the researchers cannot confirm that dual use causes ocular symptoms. But given the public health challenge that tobacco use already presents for young people, the findings provide yet another reason to counsel against tobacco use and provide cessation options, Nguyen said. 

"This study is just one of many, many studies showing a significant relationship among smoking, e-cigarette use, and health outcomes," said Bonnie Halpern-Felsher, PhD, professor of pediatrics at Stanford University and a co-author of the study. "We clearly need to help young people not use at all, or quit or cut back if using." 

This study was supported by the Taube Research Faculty Scholar Endowment, the National Heart, Lung, and Blood Institute, the US Food and Drug Administration Center for Tobacco Products, the National Cancer Institute, the Stanford Maternal and Child Health Research Institute, and the Research to Prevent Blindness and National Eye Institute. 

Halpern-Felsher reported receiving personal fees as an expert scientist in litigation against some e-cigarette companies. The other study authors and Enyedi report no relevant financial relationships.

JAMA Ophthalmol. Published online August 31, 2023. Full text

Donavyn Coffey is a Kentucky-based health and environment journalist.

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