Do AMD patients fail to report smoking at higher rates?

Do you have a patient with age-related macular degeneration (AMD) who identifies as a nonsmoker or former smoker? Use exam time to start a conversation about smoking habits rather than just checking the box on a patient's form.

Smoking is a major risk factor for development of AMD and worsening of symptoms. In fact, studies have shown that smoking doubles an individual's risk for AMD, whereas smoking cessation decreases risk for AMD.

"People who are self-reported former smokers may not necessarily have stopped smoking."

But smoking is also one of the risk factors that can be controlled and modified.A recent study published in Optometry & Vision Science found that patients with AMD who smoke fail to self-report smoking more frequently than patients in the general American population.Mark Swanson, O.D., associate professor of optometry at the University of Alabama at Birmingham and study author, found that 1 out of 20 patients seen by optometrists who say, "I don't smoke," actually do.Estimates of potential smoking deception—among adults over 40 with macular degeneration and those at risk of late-stage disease—were calculated by comparing self-reported rates of cigarette use, any nicotine product use, and serum cotinine levels.How to better communicate with AMD patientsIt's important for optometrists and other eye care professionals to be aware that some smokers may not be forthright about their habits."The take-home message is that people who are self-reported former smokers may not necessarily have stopped smoking," Dr. Swanson says.Smokers may be deceptive because smoking is not as socially acceptable as it used to be—and because of how difficult it can be to quit."On average, studies have found that it takes around 7 times to try to quit smoking before someone is successful. If someone reports being a former smoker, it's easy for them to fall back into the habit," he notes.For ODs dealing with AMD patients who self-report as former smokers, Dr. Swanson suggests having a discussion with them about the difficulties of sticking with cessation—whether it's cigarettes or other forms of tobacco, including cigars.

August 27, 2014