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The relation between parental smoking and hypermetropia
in childrenYair Morad
Yuval Cohen and Lionel Kowal Assaf Herofeh Medical Center, Zrifin, Israel
Royal Victorian Eye and Ear Hospital, Melbourne, Australia
Parental smoking inhibits child myopia
Saw et al: less myopia in children of smoking mothers (-0.28 D v -1.38 D) BJO 2004
Stone et al: If one or both parents ever smoked, their children had a lower myopia prevalence (12.4% vs. 25.4%) IOVS 2006
Can parental smoking cause hypermetropia ?
Maternal smoking associated with moderate hyperopia in six year old but not in 12 year old (N=4321) Ip et al Opthalmology 2008
AimTo examine the relation between
exposure to parental smoking and the development of hypermetropia in children
Design The database of a Pediatric Ophthalmology
Clinic was screened.1207 children with CR > 0.00DOnly one child from each family was selected
All parents underwent a telephone interview
The questionnaire
Father of mother smoking now? In the past?
How many packets per day?Did mother smoke during
pregnancy?
Children of farsighted parents were not included
Results 1007 children included in the studyMean age: 6.2 ± 3.6y (6mo - 17y)Mean spherical equivalent: +3.0±2.3 D
(0.0 - +12.75 D)
Mothers11% smoking today6.6% smoked in the past
Fathers21% smoking today11% smoked in the past
Maternal smoking and child’s refraction
P=0.1
P=0.014
Maternal smoking during pregnancy
0
1
2
3
4
5
6
Non (n=817) 0.2 (n=51) 0.5 (n=50) 0.75 (n=29) 1 (n=27)
Maternal smoking during pregnancy (PPD)
Chi
ld's
ref
ract
ion
P<0.0001
Parental smoking – not significant
Risk to develop esotropia
RR=1.63
Mother: non-smoking
70/817 = 8.5%Age: 6.9 ± 3.39Refraction : +5.2
Mother: smoking
17/122 =14% Age: 8.6 ± 3.18Refraction: +5.4
Pilot study in MelbourneN = 142 participants21% mother smoke; 16% smoked during
pregnancy26% father smoke; 32% smoked during
pregnancy32% have either parent smoking now38% have parent smoking during
pregnancy
ResultsSignificant association between smoking
mother and child hypermetropia (Odd ratio 19.75, CI 95% 1.65-236.51, p 0.02)
Smoking mother increases the odds of moderate to severe hyperopia (>+3 D) by nearly 20 folds
Other studiesStone et al IOVS 2006
N=323If one or both parents ever smoked, their children had
more hyperopic mean refractions (1.83 0.24 vs.0.96 0.27 diopters; P 0.02)
El-Shazaly et al Ophthalmic & Physiological Optics 2012
N=300Passive smoking exposure might be associated
with hypermetropia
Smoking increases the risk for esotropia Tasmania, Australia (n=346) Pediatric eye disease and Baltimore pediatric
eye disease studies (n=9970 )National Institute of Neurological Disorders
and Stroke, Bethesda, Md (n=39,227 )
Possible biochemical mechanism for smoking –refraction interaction
Nicotine stimulate dopamine release
Retinal dopamine
Eye growth
Nicotinic antagonists injected to old chicksinhibition of ocular growthhyperopic shifting of refraction
Stone RA et al IOVS 2001
Conclusions
1. Maternal smoking increase the risk of hypermetropia in children
2. The effect of maternal smoking is dose dependent.
3. Cigarette smoking increase the risk of esotropia in children