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  • Ocular Pathology/Oncology, Pediatric Ophth/Strabismus

    Review of: Ocular symptoms in adolescents and young adults with electronic cigarette, cigarette, and dual use

    Nguyen A, Gaiha S, Chung S, et al. JAMA Ophthalmology, in press 2023

    In US adolescents and young adults, using e-cigarettes alone or in addition to regular cigarettes led to frequent and severe ocular symptoms.

    Study design

    This observational cross-sectional study, conducted in May 2020, used online surveys to ask about smoking use and ocular symptoms (e.g., pain, burning, itching, glare, headaches) in adolescents and young adults aged 13–24 years. Respondents were stratified into never users and ever users; those in the latter group were further stratified into those who used at any time in their lives, past-30-day users and past-7-day users. For this study, only tobacco use was quantified: e-cigarettes, regular cigarettes, or both (“dual users”).


    Out of 4351 respondents, 2183 were ever users: 1092 had used within the last 30 days and 919 within the last 7 days. Between 1.1% and 3.9% of dual users reported severe to very severe ocular symptoms, and had more frequent and more severe ocular symptoms than either regular cigarette−only users or e-cigarette−only users, especially those in the past-7-days group.


    There were more female respondents than male respondents, which does not reflect current US smoking trends (typically, men and boys smoke more than women and girls). The authors did not report on ocular symptoms as related to marijuana or to other tobacco products (e.g., cigars). With greater numbers of Americans smoking marijuana as access increases, this would be important to know.

    Clinical significance

    Results of this study confirmed that smoking is associated with increased likelihood of severe and frequent ocular symptoms, even in this young cohort. Since younger people generally tend to have fewer ocular symptoms, one might erroneously assume that their eyes would not be affected by e-cigarette smoke. However, this study demonstrates an association between severe ocular symptoms and e-cigarette smoking in this group, particularly when combined with regular cigarette smoking. This information could help physicians to guide and educate patients on the importance of their decisions/actions.

    Financial Disclosures: Dr. Anne Barmettler discloses no financial relationships.