This retrospective cohort study compared the risk of major vision-impairing eye diseases (cataract, glaucoma, AMD, diabetic retinopathy, and refractive/accommodation disorders) among former smokers who switched to non-combustible nicotine or tobacco products (NNTPs) vs. those who completely quit all nicotine, using South Korean national insurance data with up to 6 years of follow-up.
Among 32,316 propensity score–matched participants (mean follow-up 4.6 years), NNTP switchers had a modestly but significantly higher risk of vision-impairing eye disease vs. complete quitters (SHR 1.07; 95% CI 1.02–1.13; incidence 44.0 vs. 41.1 per 1,000 person-years). The largest effect was seen for diabetic retinopathy (SHR 1.24; 95% CI 1.00–1.53).
- Observational design limits causal inference despite propensity score matching. - NNTP type (e-cigarettes, heated tobacco, smokeless tobacco) was not disaggregated, preventing product-specific conclusions. - Reliance on diagnostic codes may miss subclinical disease or introduce misclassification.
When counseling patients on smoking cessation, ophthalmologists and primary care clinicians should not frame NNTP switching as visually safe — it carries a small but real increase in eye disease risk compared with quitting all nicotine entirely. Complete nicotine abstinence remains the preferred goal from an ophthalmic standpoint.
Explore related topics
