The Effect of Tobacco Smoking on Corneal Endothelium and Central Corneal Thickness

Abstract

We aimed to study the impact of tobacco smoking towards central corneal thickness, morphology, and corneal endothelial cell density (ECD) in healthy subjects. This cross-sectional study recruited consecutive patients who visited the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre, from April 2017 to August 2018 who were active smokers and non-smokers. Active smokers were further divided into heavy and light smokers according to the number of pack-years smoked. The nicotine dependency level was measured using the Fagerstrom test and divided into low, moderate, and severe dependency. Non-contact specular microscopy was performed. Parameters studied included the ECD, percentage of hexagonality (HEX), coefficient of variation of cell size (COV), and central corneal thickness (CCT). A total of 84 eyes from 84 subjects were included, with 42 in the smoker and 42 in the non-smoker groups. The mean age was 38.3 ± 6.7 and 39.2 ± 10.7 years in the smoker and non-smoker groups, respectively. The mean ECD, HEX, and COV were 2783 ± 316 vs. 2877 ± 333 cells/mm2, 55.0 ± 6.7% vs. 55.0 ± 7.7% and 32.7 ± 4.4% vs. 32.2 ± 4.1% in the smoker and non-smoker group, respectively. However, none were statistically significant (p>0.05). The mean CCT was also not statistically different, with 532.6 ± 30.8 μm in the smoker group and 530.5 ± 30.8 μm in the non-smoker group. No statistically significant difference was found between light and heavy smokers and addiction levels. There was a statistically significant but weak negative correlation between ECD and duration of smoking (r = -.370, p = 0.016) and a weak positive correlation between COV and number of pack-years smoked (r = .344, p = 0.025). Smoking did not significantly affect corneal ECD, cellular morphology, or CCT.