Can Smoking Affect LASIK Surgery Results?

The Femtosecond laser can improve wavefront-guided LASIK surgery

An increasing number of physicians and eye surgeons now believe that smoking behavior can negatively affect the outcome of LASIK, as well as eye health in general. Many studies have previously indicated a role for smoking in the incidence and progression for age related macular degeneration (AMD), cataract and thyroid eye disease. Now, the first study to specifically examine the impact of smoking on uveitis (inflammation of the eye's middle layer of tissue) indicates that tobacco smoke likely plays a role in this serious eye disease as well. However, the greatest challenge to date is: how to inform the general population about the devastating impact of smoking on the eye health and outcome of eye surgeries including LASIK.

Smoking – The alarming statistics
In the US alone, an estimated 46.2 million or 22.6 percent of adults (18 and older) currently smoke cigarettes. It is now a universally established fact that cigarette or tobacco smoking has been linked to death due to lung cancer and emphysema, and has also been established as a contributing factor to other diseases, including heart disease and stroke. However, many people are still not aware of the fact that smoking can actually “indirectly” affect a number of body’s other “natural” processes such as “healing” and “repair”. According to an estimate, the incidence of smoking is about 30% for general people undergoing elective surgical procedures such as LASIK.

How does smoking harm your eyes?
It has been suggested that smoking increases the stickiness of blood cells, which increases the chances of blood vessel buildups and clogs. Blood vessel clogs, or “retinal vascular occlusions” can cause visual loss. These effects can be more severe in pregnant women or those who use “the pill” for birth control. Smoking also worsens the blood vessel disease that develops in people with diabetes (known as diabetic retinopathy).

Does smoking affect eye health?
Growing evidence is now emerging for relationships between various exposures and common eye diseases. For some potential risk factors, such as smoking, the evidence is compelling, while associations with other behaviors are less well supported in the literature or findings are contradictory. Smoking is a risk factor for several types of potentially blinding eye conditions, including retinal vascular occlusions, ischemic optic neuropathy, diabetic retinopathy and age-related macular degeneration (AMD). All of these conditions can lead to partial or, sometimes, complete vision loss or blindness. Smoking is considered the single most consistently documented risk factor associated with visual loss in AMD. Twin studies have demonstrated that approximately one third of the risk of developing advanced AMD may be due to smoking. Smokers are 5 times more likely to develop advanced AMD with visual loss than non-smokers.

Here are some more examples of how smoking could affect your eye health:

  • Most chronic eye diseases, with possible exception of glaucoma, appear to be associated with smoking.
  • People who smoke cigarettes are at increased risk for developing cataracts, a clouding of the naturally clear lens of the eye
  • AMD, the leading cause of severe visual impairment and blindness, is directly accelerated by smoking

In addition, the optic nerve is also susceptible to damage from smoking. People with poor diets who smoke heavily and drink excessive amounts of alcohol run the risk of developing optic nerve-related vision loss (called tobacco-alcohol amblyopia). Certain optic nerve problems run in families (called Leber's optic neuropathy). People with this condition who smoke have increased risk of vision loss. In some patients with thyroid disease (called Graves' disease) who also have eye involvement, smoking can cause the eyes to become worse, with vision loss possible.

Smoking and the outcome of LASIK
While the systems most commonly affected by smoking are lungs, heart and blood vessels, the immune response, and tissue healing (which is essential for recovery after any surgery and wound healing) is also severely affected. Studies show that the most common post-surgical complications related to smoking are impaired wound and tissue healing and wound infection. In case of LASIK, this could involve delayed corneal tissue healing and increased risk of eye inflammation and infection.

One of the main side effects of LASIK procedure is dry eye. People who do not produce enough tears to keep their eyes comfortably lubricated have a condition called dry eye and this condition has been observed in a number of people who underwent LASIK surgery. In fact, dry-eye-related symptoms are more common in smokers than non-smokers due to changes in tear proteins caused by smoking. For these people, smoking is a significant irritant, worsening the symptoms of scratchiness, stinging or burning of the eyes, and excess tearing from irritation.

Smoking also impairs immune function leading to an increased risk of infection. The immune system appears to recover after 4–6 weeks of abstinence from smoking.

To reduce the risk of these and other serious complications after LASIK surgery and increase your chances of a good surgical outcome, it is recommended that you quit smoking at least eight weeks before surgery.

Also, after surgery, it is important you do not start smoking again, even if you only quit 12 hours before surgery. Allow your eye time to recover and heal properly. Smoking makes recovery harder by stressing your heart, affecting your blood pressure, reducing oxygen in your blood and eye tissues and damaging your lungs. Use of tobacco in smoking increases carbon monoxide in your blood. This carbon mono oxide reduces tissue oxygenation and impairs the microcirculation within healing cornea and adjacent eye tissues. Nicotine is also a potent vasoconstrictor and impairs blood supply to your eye. All these factors delay recovery and increase chances of a potential threat to your vision.

All in all, smoking affects many parts of the body, both inside and outside. Some of the effects happen straight away and others take longer to occur. Like high blood pressure, lung cancer and heart disease, smoking can directly affect your eye health and the outcome of various eye therapy procedures such as LASIK. However, the good news is that the increased risk of smoking-related LASIK complications or developing eye disease can be reversed over time. Therefore, experts are of the opinion that abstinence starting at least 3 to 8 weeks before surgery will significantly reduce the incidence of several serious postoperative (after-surgery) complications, such as wound complications, delayed healing and infections.

It is important to recognize the effort it takes to give up smoking. Not everybody is successful without help. The first tip is to know more and seek professional advice. Smoking cessation clinics are run by most GPs, some pharmacists and even optometrists. By stopping smoking well before LASIK surgery you will be more likely to have a faster recovery, better vision after LASIK and less likely to need further LASIK surgery.

Has smoking affected your Lasik surgery results? Are your eyes back to their old prescription? Post your comments below.

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I think smoking is just bad for your health overall. It's probably wise not to smoke to keep your eyesight at 20/20. It seems like it could have adverse effects on lasik surgery. Has anyone here experienced problems with their surgery from smoking?