Doctors of optometry can help patients stop smoking

All over the country, doctors of optometry are talking on a regular basis to their patients about the hazard smoking and tobacco use poses to their eyes. The conversation is especially appropriate today—it's the American Cancer Society's Great American Smokeout.

Not only is smoking an irritant to the eyes, but it also is a major risk factor for age-related macular degeneration (AMD) and the leading cause of preventable disease in the U.S.

For more than a decade, Daniel Bintz, O.D., who practices in Elk City, Oklahoma, has been talking with his patients about smoking. At every visit, he asks:  

• Do you smoke?
• Are you a current or former smoker? Never smoked?
• What kind of tobacco do you smoke, and how often do you smoke?  

For Dr. Bintz, a member of the AOA's Health Promotions Committee, the subject of smoking is more than just a national observance every November.  

"I start out by reviewing the EHR history where the techs will check the boxes on tobacco use," Dr. Bintz says. "I will ask if their primary care physicians have talked to them about quitting and see where that leads.  

"Then I will mention that 'in addition to all the evil things that you know about smoking, you may not know that using tobacco puts you at four times the risk of developing macular degeneration, which is the leading cause of blindness in the U.S.' And if they are interested, we will schedule an appointment with their primary care physician for possible prescription drugs to help them quit. At the least, I remind them of the national 1-800-QUIT-NOW line, and we give them the AOA's Don't Let Smoke Get in Your Eyes pamphlet."  

Smoking rates lowered

Smoking cessation is an opportunity for doctors of optometry to exercise their roles as primary health care providers. For instance, doctors are required to record a patient's smoking status under electronic health record meaningful use requirements.  

According to a Nov. 11 study by the Centers for Disease Control and Prevention, smoking rates are at an all-time low in the U.S. About 20.9% of American adults smoked in 2005, compared to 15.1% a decade later. That's 36.5 million Americans who still smoke though, meaning it remains a public health hazard.  

Stanley Hatch, O.D., M.P.H., presented the results of a study he conducted at the recent American Academy of Optometry meeting in Anaheim, California. Dr. Hatch also is an assistant professor of Public Health at Salus University. The study, on the "Effect of Tobacco Cessation Counseling in an Eye Care Practice," looked at the effectiveness of cessation counseling.  

Of the 193 patients studied at Eye Care for the Adirondacks in northern New York—where Dr. Hatch is an associate—28 (14.4%) had quit using tobacco.  

Consider new parents  

A study, "Father's environment before conception and asthma risk in his children: A multi-generation analysis of the respiratory health in northern Europe," published in August 2016 in the International Journal of Epidemiology, linked a father's smoking with early onset asthma in offspring. The Norwegian study involved 24,000 offspring.  

"Environmental exposures in young men appear to influence the respiratory health of their offspring born many years later," the study's researchers say. "Influences during susceptible stages of spermatocyte development might be important and needs further investigation in humans. We hypothesize that protecting young men from harmful exposures may lead to improved respiratory health in future generations."

Despite the warnings, expectant parents continue to use tobacco.

"Another tobacco-related issue is warning pregnant women about the damage tobacco use does to the unborn child and after the child is born," Dr. Bintz says. "They have heard this from the primary care physicians but need to hear it often."

According to Dr. Bintz, mothers and fathers claim that they don't smoke with their kids in the car or inside the house. "That doesn't matter," he adds. "It's on their clothes and on the upholstery and carpet in the house and car. Just that much secondary smoke can induce asthma attacks."

Tobacco users can deceive themselves, says Mark Swanson, O.D., associate professor of optometry at the University of Alabama at Birmingham, who authored a 2014 study that appeared in Optometry & Vision Science titled, "Smoking Deception and Age-Related Macular Degeneration." One of its key findings was that 1 out of 20 patients seen by doctors of optometry failed to self-report their smoking, even though they were indeed smoking.

Why would they be reluctant to own up to their smoking or even take steps toward cessation?

Although they are aware of the addictive nature of nicotine, they aren't able to stop themselves, doctors of optometry say. "We've also gone from that 'Mad Men' era to a time when smoking is not as socially acceptable," says Dr. Swanson, noting patients' reluctance to be straight with their doctors.

Says Dr. Bintz: "There isn't one smoker who doesn't believe tobacco can adversely affect his or her health. But then it turns into the 'Well, something is going to kill me' attitude."

Adds Dr. Hatch: "They get the message. They don't want to give up their immediate pleasure for future health." Doctors of optometry must continue to explain the risks to patients—as many times as it takes. "The Great American Smokeout is another day to draw attention that smoking is bad for your health," he adds. "The information is out there to support smokers."  

"We have always treated the entire patient and will continue to advance public health," Dr. Hatch says.