An Analysis Of The Association Between Cigarette Smoking And Poag:A Stratification Of Patients By Pack-Years And Age

Background: Glaucoma is still a major oculopathy to the developed and developing nations,it is a neuropathy of the optic nerve that has a characteristic of optic degeneration in a progressive manner that leads to visual impairment and irreversible blindness which is currently affecting around 2% of the contemporary population.Objectives: To analyse the clinical data and the epidemiological inclinations to find the interrelations between cigarette smoking and primary open angle glaucoma by applying a thorough format of stratifying patients according to the age and pack years of smoking in a tertiary hospital.Methodology: this study was a retrospective descriptive approach where an epidemiological investigation was carried out such as prevalence,age,gender,smoking pack years,intraocular pressure,cup disc ratio and anterior depth chamber of the recorded data of patients hospitalised with primary open angle glaucoma within ten years at the Second Affiliated Hospital of Dalian Medical University,from 2007 to 2017;and a clinical study of a relation of primary open angle glaucoma and intraocular pressure with smoking as a causal.A total number of 800 admitted inpatients records of glaucoma were identified.Among which,200 record which was between(2007 October to November 2017)were used to study the clinical manifestation of primary open angle glaucoma and the causal effect of smoking to intraocular pressure with age.The data was collected from the hospital database;a well structure questionnaire was used as a tool for collecting patients’ information.The medical history,demographic data,smoking history,family history,age was retrieved from the system and their first admission intraocular pressure was measured and recorded using a non-contact tonometer(CT-80A)and the anterior chamber was measured using IOL master.Analysis of data was performed using the SPSS program,SPSS(version 23;SPSS Inc.,Chicago,IL).Descriptive statistics(Mean,standard deviation,interquartile range and percentage)were used to describe the characteristic clinical features and causal findings.Data was tested to find normality analysis with Kolmogorov-Smirnov test.ANOVA was used to evaluate the relationship between the intraocular pressures(IOP),Cup Disc Ratio(CDR)and age among the smoking individuals.Independent T test was used to compare in different age groups those that were less than 55 years,those within(56-69)and those above 70 years old.The results were regarded significant if the P value(≤0.05)and the confidence interval(C.I)were estimated to be at 95%.Results:The total number of patients from January 2007 to December 2017 were 800 with presenting case of glaucoma out these 460 had closed angle glaucoma while the remaining 340 had primary open angle glaucoma a follow up study was made and out of 340 patients only 200 met the criteria that was required for this study.The mean age in the total patients that met the inclusion criteria was 61.91 with(Standard Deviation 12.802)years while the Mean intraocular pressure of the total patients was 37.0mm Hg with(Standard Deviation 11.318 mm Hg)the CDR was found to be 0.738(Standard Deviation 0.3973)and the ACD was(2.48±0.717),although there was no significant findings of ACD as related to the high intraocular pressure either for the patients with a shallow depth or deeper depth value of ACD.The mean pack years for all smokers was(23.81±24.650).From the total number of patients selected from the study 111 were males which was(55.5%)of the total and 89 were female which was(44.5%),of these(33%)aged less than 55 years,(37%)were between 56-69 years,while(29.5%)of the total patients were 70 years and above.All the patients selected had primary open angle glaucoma with significantly high intra ocular pressure and a C/D ratio that was above 0.5 as a decisive cut point to relate with the primary open angle glaucoma.The total number of smokers that had POAG was 124(62%)of the total number of the patients,the non-smokers but also with POAG who were used as control group in this study were 76(38%)that met the criteria for this study.Among smokers there were divided into light,moderate and heavy smokers according to number of pack years.The smokers that smoked less than 30 pack-years were categorised as light smokers were 64 patients(32%)of the total population of smokers,moderate smokers ranged between 31-60 pack-years which were 43 patients(21%)and heavy smokers with more than 60 pack-years range and were 17 patients in this study which accounted for(8.5%)of the total population of all smokers.The IOP among light smokers was(37.67±8.703)mm Hg,(43.74±8.110)mm Hg for moderate smokers and(49.29±8.776)mm Hg for heavy smokers.Using ANOVA Post Hoc there was a significant difference between and within the smoking groups(P <0.005)The mean IOP for all smokers was(43.34±9.680)mm Hg and the Mean IOP for all non-smokers was 26.83±3.866 mm Hg.Using with Levene’s Test for equality of variance(P <0.000)which was highly significant in the study.The mean intraocular pressure among males was(44.19±9.461)mm Hg and among the female patients it was(28.18±5.822)mm Hg.Conclusion:1.Smoking has proved to affect highly people with primary open angle glaucoma as a cause of increasing intraocular pressure and optic disc neuropathy from the acquired CDR values.2.The prevalence of high intraocular pressure is much higher among the male patients than the female.3.The intraocular pressure among the light smokers with less pack years is less as compared to the heavy smokers.4.There is a significant correlation between intraocular pressure and cup disc ratio.5.There was no actual relation between the anterior chamber depth in relation to intraocular pressure.6.The intraocular pressure was highly associated with pack years as it showed increase in pack years increased the intraocular pressure.