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Journal of the Union of Scientists - Varna. Medicine and Ecology Series

Is there an association between smoking and diabetic retinopathy?

Darina Koseva, Zornitsa Zlatarova, Mariana Kaneva


Aim: The purpose of this study is to investigate the potential association between smoking and diabetic retinopathy (DR) prevalence in patients with diabetes due to the conflicting data in the published literature.

Materials and Methods: A total of 137 diabetic patients underwent ophthalmic examination of the posterior segment of the eye. This included instillation of mydriatic eye drops to dilate the pupils, and after about 15 minutes – an indirect ophthalmobiomicroscopy with +90D lens. Patients were given a questionnaire to fill out and they signed an informed consent form. The participants were divided into two groups – diabetic patients without DR and diabetic patients with mild DR. The severity ot DR was determined based on the International Council of Ophthalmology (ICO) Guidelines for Diabetic Eye Care Classification where mild non-proliferative diabetic retinopathy (NPDR) means the presence in the fundus of  microaneurysms only. The participants were 77 females and 60 males.

Results: The group of diabetics without DR included 71 patients (46 females and 25 males) – 32 of them (45.1%) stated that they have never smoked cigarettes, 20 were former smokers (28.2%), and 19 were currently smoking (26.8%). The  mean age in this group was 57±15 years and the mean duration of diabetes was 9 years.

The group  of diabetics with mild DR included 66 patients (31 females and 35 males) – 22 of them (33.33%) answered that they have never been smokers, 29 have smoked in the past (43.94%), but have quit, and 15 were current smokers (22.73%). The mean age in this group was 59±12 years and the mean duration of diabetes was 12 years.

After the statistical processing of the obtained data, no statistically significant relationship was found between the studied traits – DR and cigarette smoking.

Conclusion: The data from this study does not confirm the thesis that the independent influence of the risk factor "cigarette smoking" can be considered as a reason for the development of DR. However, this does not negate the negative impact of smoking on human health and does not detract from the need to discontinue it.


diabetic retinopathy, smoking, diabetes mellitus, statistical proof of hypotheses

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