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Cigarette Smoking on Severity of Primary Angle Closure Glaucoma in Malay Patients

Niven, Teh Chong Seong, MBChB*; Azhany, Yaakub, MD, MMED (Ophthal)*; Rohana, Abdul J., PhD (Comm Nutrition) (USM); Karunakar, Tirmandas V.N., MBBS, MS; Thayanithi, Sandragasu, MBBS, MMED (Ophthal); Jelinar Noor, Mohd N., MD, MMED (Ophthal); Norhalwani, Husain, MD, MS (Ophthal)§; Zuraidah, Mustari, MBBS, MS (Ophthal); Siti Azrin, Ab H., MBBS, MSc Medical Statistics; Ahmad, Mt S., MD, MS (Ophthal)#; Aung, Tin, MBBS, MMed(Ophth), FRCS(Ed), FRCOphth, FAMS**,††,‡‡; Liza-Sharmini, Ahmad T., MBBS, MMed (Ophthal), PhD*

doi: 10.1097/IJG.0000000000001120
Original Studies

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.

*Department of Ophthalmology

Department of Community Medicine

Department of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus

§Department of Ophthalmology, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan

Department of Ophthalmology, Hospital Kuala Lumpur, 5300 Jalan Pahang, Wilayah Persekutuan, Kuala Lumpur

Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu

#Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia

**Singapore Eye Research Institute

††Singapore National Eye Centre

‡‡Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore

Partially supported by Universiti Sains Malaysia (USM) Research Universities Individual (RUI) grant 1001/PPSP/812152

Disclosure: The authors declare no conflict of interest.

Reprints: Liza-Sharmini Ahmad Tajudin, MBBS, MMed (Ophthal), PhD (UK), AM (Malaysia), Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Health Campus (e-mail:;

Received February 18, 2018

Accepted October 13, 2018

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