Vaping is an increasingly popular trend, but you may be underestimating its impact on your patients’ health. You know that it’s harmful, but its effects on eye health are often overlooked. Therefore, without adequate information, it can be difficult to educate patients about the dangers of vaping. Read on to understand the mechanism of vaping and its associated eye health risks. This information will help you contextualize the growing concern around vaping so you can tailor your patient conversations to provide valuable advice.
A vape is an electronic smoking device that delivers nicotine without tobacco. It has evolved to look like many everyday objects (USBs or pens) and can also be used to smoke marijuana and other drugs.[1–3] A battery, a heating element, and a liquid chamber are its three main components. The battery powers the heating element, which in turn heats the chamber containing the nicotine-vape liquid. The vaporized liquid is then inhaled.[1–4]
With over 500 different vaping brands on the market, occasionally the vape liquids are made from countless unknown components. Many vape liquids are unregulated because vaping companies don't have to openly declare their ingredients to the FDA, making it difficult to know what they contain.[5] With this comes the challenge of accurately understanding the health risks associated with vape liquids.[5]
This lack of regulation has sparked more research on eye-related conditions associated with vaping. While vaping was initially thought to be safer than cigarettes, studies now show that nicotine liquids are not as harmless as you may have been led to believe. Several studies suggest links to chronic dry eye disease, meibomian gland dysfunction, and macular degeneration, to name a few.[2–4,6]
Despite the lack of knowledge regarding the specific ingredients of unregulated vaping liquids, certain components have been identified as potentially harmful. These include:
Flavouring additives, carrier oils, and nicotine: Once vaporized, these vape substances directly affect eye immunity, nerves, and severe tear film instability.[2–4,6]
Acrolein and the vaporized ingredients that convert to formaldehyde: These cause excessive dryness, itching, eye pain, increased allergic reactions, irritation, and inflammation of the ocular surface (conjunctiva and mucous membrane), predisposing someone who vapes to other eye-related conditions in the future.[2,4]
As a HCP, remember to be vigilant in looking for signs and symptoms related to such eye-related conditions: discomfort, redness, inflammation, blurred vision, and even vision loss. These ocular changes will be key in deciphering your patients’ vaping habits.
Vaping has now become the primary choice for individuals looking to quit smoking. Unfortunately, it has also become a gateway for first-time smokers, as they opt for vaping over traditional ciga
rettes. Vaping’s appeal to new smokers is due in part to the perception that it is a healthier alternative, despite studies indicating otherwise.[7,8]
The following case study demonstrates an unanticipated effect on the eyes caused by vaping: [9]
In an unusual case, a 23-year-old male presented with central retinal vein occlusion (CRVO), which is typically caused by hypertension, high cholesterol, and diabetes in patients over 50.
The patient had been complaining of intermittent pressure in his left eye for three weeks, accompanied by vision loss. His Optometrist referred him to the hospital due to fear of CRVO in his left eye, causing a decrease in vision.
The patient reported only sports-related asthma and Reynaud's phenomenon, confirming no family history of clotting disorders or tobacco use. However, he admitted to using e-cigarettes for four years, with increased usage over time brought on by stress.
Fortunately, the man's visual acuity returned to 20/20 after treatment and retinal haemorrhages had disappeared. Researchers concluded that "after ruling out organic causes, a significant vaping history was considered the likely aetiology of his hypercoagulable state and resulting CRVO".
With many unregulated vaping liquids on the market, cases like these further illustrate the unusual effects that vapes can cause, emphasizing the need for continuing education for eye professionals and their patients.
Remember: As an HCP, you are trained to be sensitive when discussing vaping with patients—they may not associate it with smoking and feel uncomfortable admitting to it.[2] Use an efficient, non-judgmental approach to gain the necessary information to provide the best advice.[2,3] Additionally, be vigilant in recognising physical changes in the ocular surface (understanding the signs and symptoms of associated conditions to vaping) that may indicate vaping-related habits.[5]
In summary, while the overall effect of vaping on the eyes remains unclear, research shows that the toxic components in vape liquids can cause dry eyes and eye irritation. Despite the perception that vaping is a healthier alternative to traditional cigarettes, its harmful effects are becoming increasingly evident. Therefore, it's essential to educate yourself about vaping’s potential health risks. By doing so, you will create a safe, non-judgmental environment for your patients to discuss their vaping habits and make informed decisions about their health.
Check out these helpful links to educate yourself and your patients who vape: truthinitiative.org, smokefree.gov, and CDC.gov.
REFERENCES:
CDC. Quick Facts on the Risks of E-cigarettes for Young People. Centers for Disease Control and Prevention. Published November 8, 2022. Accessed January 3, 2023. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
Ocular Surface Implications of E-Cigarette Smoking and Vaping. Eyes On Eyecare. Accessed January 3, 2023. https://eyesoneyecare.com/resources/ocular-surface-implications-of-e-cigarette-smoking-and-vaping/
Lesson: Four Hidden Lifestyle Risks Associated with Dry Eye. Accessed January 3, 2023. https://www.revieweducationgroup.com/ce/four-hidden-lifestyle-risks-associated-with-dry-eye
Effect of vaping on the eyes. Ophthalmology Times. Accessed January 3, 2023. https://www.ophthalmologytimes.com/view/effect-vaping-eyes
Vaping: Unregulated, Addictive and Dangerous. Accessed March 3, 2023. https://olsmanlaw.com/vaping-unregulated-addictive-and-dangerous/
Md Isa NA, Koh PY, Doraj P. The Tear Function in Electronic Cigarette Smokers. Optom Vis Sci. 2019;96(9):678-685. doi:10.1097/OPX.0000000000001422
Bell K, Keane H. Nicotine control: E-cigarettes, smoking and addiction. Int J Drug Policy. 2012;23(3):242-247. doi:10.1016/j.drugpo.2012.01.006
Dawkins L, Turner J, Roberts A, Soar K. “Vaping” profiles and preferences: an online survey of electronic cigarette users. Addiction. 2013;108(6):1115-1125. doi:10.1111/add.12150
Balinski AM, Harvey RN, Ko RB, Smalley MM, Cutler NE, Siddiqi MT. Vaping-Related Clotting Phenomena Presenting As Central Retinal Vein Occlusion. Cureus. 2022;14(8):e27700. doi:10.7759/cureus.27700
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