E-Cigarette, Cigarette Users Have Higher Likelihood of Ocular Symptoms


Severe and frequent ocular symptoms were more likely in adolescents and young adults who used e-cigarettes and cigarettes.

Adolescents and young adults who used cigarettes or e-cigarettes in the previous 7 days had a higher likelihood of experiencing severe and frequent ocular symptoms, according to a study published in JAMA Ophthalmology.

E-cigarette use

E-cigarette use

As of 2014, e-cigarettes are the most common tobacco product among youth in the United States. Ocular damage and increased risk of eye disease have been found in studies that have evaluated the outcomes of tobacco use. The present study aimed to report the “magnitude of ocular symptoms reported by adolescents and young adults using e-cigarettes only, cigarettes only, and both products.”

An observational cross-sectional survey was performed from May 6-14, 2020, in adolescents and young adults aged 13 to 24 years. Quota sampling was used to balance e-cigarette users and nonusers and for obtaining an equal sample of participants from all 3 age groups: 13 to 17 years (adolescents), 18 to 20 years (young adults), and 21 to 24 years (young adults).

All participants provided sociodemographic information including age, gender, and race. They were asked whether they had ever used e-cigarettes and when was their last use. Participants also rated their eyesight with glasses or contact lenses if they wore them, the amount of time worrying about eyesight, and the frequency and severity of ocular symptoms.

There were 4351 participants included in the study. The mean (SD) age was 19.1 (2.9) years, 63.8% were female, and 43.0% werenon-Hispanic White. A total of 2183 (50.2%) participants used e-cigarettes and 1588 (36.5%) had smoked at least once in their life; 55.9% of the e-cigaratte users also used regular cigarettes.

Good (44.5%) and excellent (40.8%) were the most reported eyesight ratings in participants, who also reported not worrying about their eyesight ever (37.8%), a little of the time (32.4%), and some of the time (18.0%). Contact lenses were worn by 26.7% of participants.

Participants who had used regular cigarettes at least once had a higher likelihood of severe ocular burning/stinging (adjusted odds ratio [aOR], 2.68; 95% CI, 1.56-4.62) and blurry vision (aOR, 2.70; 95% CI, 1.41-5.17) compared with other participants after adjustment. Severe ophthalmic dryness/gritty sensation (aOR, 1.60; 95% CI, 1.05-2.43) and blurry vision (aOR, 1.79; 95% CI, 1.21-2.64) were more likely in participants who had used e-cigarettes and cigarettes.

More severe blurry vision (aOR, 2.34; 95% CI, 1.17-4.67) was found in participants who had used cigarettes in the past 30 days. Participants who had used both in the past 30 days were more likely to have ophthalmic discomfort (aOR, 2.10; 95% CI, 1.33-3.32), burning (aOR, 1.81; 95% CI, 1.09-2.99), redness (aOR, 1.98; 95% CI, 1.23-3.17), blurry vision (aOR, 2.19; 95% CI, 1.32-3.65), and headaches (aOR, 1.78; 95% CI, 1.15-2.78).

Further, participants who had used both in the previous 7 days were more likely to have ophthalmic discomfort (aOR, 2.19; 95% CI, 1.30-3.70), burning (aOR, 2.08; 95% CI, 1.24-3.42), redness (aOR, 2.58; 95% CI, 1.50-4.46), blurry vision (aOR, 2.47; 95% CI, 1.36-4.50), headaches (aOR, 2.31; 95% CI, 1.34-4.00), and tiredness (aOR, 2.07; 95% CI, 1.11-3.83), among other symptoms. Frequency of these symptoms was increased in participants who had used cigarettes at all, within the past 30 days, and within the past 7 days.

There were some limitations to this study. The causal or temporal association between ocular symptoms and cigarette usage could not be determined with the observational design of the study, and the results also cannot be generalized to populations outside of the United States. In addition, there could be confounders outside of the ones adjusted for that could affect the outcomes, self-reported outcomes could be subject to recall or subjectivity bias, and e-cigarette use could not be categorized into mild, moderate, and heavy use in the same way cigarette usage could.

The researchers concluded that there was an association between the dual use of e-cigarettes and cigarettes on ocular symptoms in both adolescents and young adults.


Nguyen AX, Gaiha SM, Chung S, Halpern-Felscher B, Wu AY. Ocular symptoms in adolescents and young adults with electronic cigarette, cigarette, and dual use. JAMA Ophthalmol. Published online August 31, 2023. doi:10.1001/jamaophthalmol.2023.3852

Related Videos
Dr Seun Ross: Achieving Equity is Necessary to Sustain the Health Care System
Jennifer Sturgill, DO, Central Ohio Primary Care
Kristin Oaks, DO, Central Ohio Primary Care
Donna Fitzsimons
Ryan Haumschild, PharmD, MS, MBA, director of pharmacy, Emory Winship Cancer Institute
Kristine Slam, MD, FACP, Central Ohio Surgical Associates
Milind Desai, MD, MBA
Dr Monica Taylor-Desir on Taking Mental Health Care Awareness to Action
Dr Veronica Gillispie-Bell Explains the Impact of Implicit Bias on Maternity Care
Related Content
© 2023 MJH Life Sciences
All rights reserved.