Effects of Smoking on Optic Nerve Head Microvasculature Density in Glaucoma

Precis: Decreased superficial whole image capillary density was observed in open angle glaucoma (OAG) patients with high smoking intensity. Purpose: To investigate the effects of smoking on optic nerve head capillary density measured by optical coherence tomography angiography in patients with OAG. Methods: In this retrospective cross-sectional study, perimetric and preperimetric glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS) with optical coherence tomography angiography follow-up were included. Univariable and multivariable linear mixed analysis were performed to determine the effects of different variables on the superficial whole image capillary density. Results: A total of 432 eyes of 271 glaucoma patients comprising 63 preperimetric (106 eyes) and 208 perimetric OAG (326 eyes) were included. A history of tobacco consumption was reported in 105 (38.8%). Among smokers, mean (95% confidence interval) smoking intensity was 12.8 (10.2, 15.5) pack-years. After adjusting for age, glaucoma severity and other confounders, each 10 pack-year increase in smoking intensity (95% confidence interval) was associated with -0.54 (-1.06, -0.02) % lower whole image capillary density (P=0.041). Conclusions: Smoking intensity is associated with reduced optic nerve vessel density in glaucoma.