The World Health Organisation (WHO) estimates that around one in every seven people in the world smoke tobacco every day (WHO, 2014). Tobacco smoke contains around 4,000 active chemicals, of which at least 250 are known to be harmful to humans and more than 50 are considered carcinogenic. Moreover, a majority of these chemicals are found to be harmful to the eye.

But unlike the rising awareness of heart and lung diseases caused by smoking, the public is not aware about the effects of cigarettes on our eyes. A study on the knowledge about the relationship between smoking and blindness conducted by the International Tobacco Control Four-Country Project (ITC-4) in 2011 in Canada, the United States, the United Kingdom and Australia found that a very low proportion of smokers (only 10.73 percent) believed that smoking causes blindness. Given that the study was carried out in some of the most developed countries in the world, it is not hard to determine that the situation is worse in a developing country like Nepal.

Long-term tobacco consumption causes irritation and itching in the eyes, which happens due to the drying out of the outer surface of the eye. It also doubles the rate of cataract (Motibindu in Nepali), increases the risk of macular degeneration by two to four folds and doubles the rate of eye complications created by high blood pressure and diabetes. But the most complicated and dreadful condition caused by smoking is the damage to blood vessels in the back of the eye, which eventually leads to the loss of vision. Also, the treatment and management of eye-related problems associated with smoking brings about an unwanted economic burden that can otherwise be easily avoided.

 Increasing awareness about the ill effects of smoking is more pertinent in our part of the world. Because, while the overall prevalence of smoking seems to be decreasing in Western countries, rampant poverty, illiteracy, lack of awareness and lax regulations have contributed to the consistent rise in the number of smokers in countries like Nepal. The World Health Organisation has already estimated a four-fold increase in the number of people who will be affected by tobacco consumption by 2030, with almost 80 percent of the total consumers residing in the low- and middle-income countries like ours.

Although we might not be economically and technically well-equipped to counter this menace, there are a few policies that can be implemented to counter the swelling number of smokers.    Rules like comprehensive ban on the advertising of cigarettes and other tobacco-related products, health warnings on tobacco and cigarette packets, increasing taxes on tobacco products and making public places smoke-free can be implemented immediately to decrease tobacco and cigarette consumption and rein in its ill effects.

Moreover, since most of the awareness programmes aimed at educating the people about the risks of smoking have only limited themselves to its effects on the heart and lungs until now, it is imperative that we broaden the scope of diseases to include the different ocular complications of smoking. And since research suggests that the fear of blindness may be more likely to motivate consumers to stop smoking than the fear of lung and heart disease, it is possible that including eye complications caused by smoking can act as a better deterrent.     

Healthcare professionals round the world have already warned that tobacco consumption-related conditions are slowly rising to an epidemic level and would be the leading cause of death in the coming decade. And we can be pretty sure that eye-related complications are going to rise proportionately with the surge in the number of other cigarette-related complications. So this is an ideal opportunity for both public-health and eye-health communities to educate smokers and nonsmokers about the effects of smoking on the eye to improve quit rates and help discourage people from taking up smoking.

Khanal is a Kathmandu-based optometrist