Smoking and blindness
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7439.537 (Published 04 March 2004) Cite this as: BMJ 2004;328:537All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Sir,
In the editorial on smoking and blindness, Kelly et al. point out
that patients attending eye clinics recognize many adverse health hazards
of tobacco but remain largely unaware of the possible link between smoking
and eye diseases.1 Smoking is an established risk factor for age related
macular degeneration, and smoking is further associated with poorer
outcome after photocoagulation with argon laser. Reading this article we
also thought about smoking and its possible negative influence on immune-
mediated diseases like rheumatoid arthritis and ankylosing spondylitis.2,3
Besides, it has been reported that smoking is an independent risk
factor for giant cell arteritis (with an odds ratio of 2.3),4 and female
smokers with more than 10 pack-years even have a 17-fold increased risk
for GCA.5 Thus GCA is indeed relevant for smokers: GCA is the most
frequent primary vasculitis in Western countries, and the annual incidence
of GCA is between 15 and 25 per 100 000 people over the age of 50 years.6
Irreversible blindness, mainly due to anterior ischemic optic neuropathy
and frequently preceded by amaurosis fugax, occurs in up to 14.9% of GCA
patients, whereas less severe ischemic complications of the eye are seen
in 26.1% of the patients.7
Taken together, tobacco smoking has to be considered as an important
risk factor for blindness not only due to age related macular degeneration
but also because of blindness due to GCA.
Christian Dejaco, Research Fellow, Christina Duftner, Rsearch Fellow,
Michael Schirmer, Associate Professor of Medicine, Consultant for
Rheumatology
Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
michael.schirmer@uibk.ac.at
REFERENCES
1. Kelly SP, Thornton J, Lyratzopoulos G, Edwards R, Mitchell P. Smoking
and blindness. BMJ 2004;328: 537-8.
2. Stolt P, Bengtsson C, Nordmark B, Lindblad S, Lundberg I, Klareskog L,
et al. Quantification of the influence of cigarette smoking on rheumatoid
arthritis: results from a population based case-control study, using
incident cases. Ann Rheum Dis 2003;62: 835-41.
3. Averns HL, Oxtoby J, Taylor HG, Jones PW, Dziedzic K, Dawes PT. Smoking
and outcome in ankylosing spondylitis. Scand J Rheumatol 1996;25:138-42.
4. Machado EB, Gabriel SE, Beard CM, Michet CJ, O’Fallon WM, Ballard DJ. A
population- based case- control study of temporal arteritis and
degenerative vascular disease? Int J Epidemiol 1989;18:168-72.
5. Duhaut P, Pinede L, Demolombe-Rague S, Loire R, Seydoux D, Ninet J, et
al. Giant cell arteritis and cardiovascular risk factors: a multicenter,
prospective case-control study. Groupe de Recherche sur l'Arterite a
Cellules Geantes. Arthritis Rheum 1998;41: 1960-5.
6. Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, et
al. Estimates of the prevalence of arthritis and selected muscoloskeletal
disorders in the United states. Arthritis Rheum 1998; 41: 778-99.
7. Gonzalez-Gay MA, Garcia-Porrua C, Llorca J, Hajeer AH, Branas F,
Dababneh A, et al. Visual manifestations of giant cell arteritis. Trends
and clinical spectrum in 161 patients. Medicine (Baltimore) 2000;79: 283-
92.
Competing interests:
None declared
Competing interests: No competing interests
Smoking and blindness advertisements are effective in stimulating calls to a national quitline
Editor – We can provide additional information on the effectiveness
of television advertisements on smoking and blindness to that described by
Kelly et al.[1] The Quit Group (funded by the New Zealand Ministry of
Health) has shown “threat appeal” television commercials (TVCs) on
national television channels in New Zealand since 1999. These TVCs were
adapted from an Australian campaign and combine information on a threat to
health along with a "call to action" via the Quitline number at the end.
We analysed data for the years 2002 to 2003 and found that the most
effective of these TVCs in generating calls to the national Quitline was
the one on smoking and blindness (for calls within one hour of the
commercial being shown). This TVC generated 97 calls per 100 target
audience rating points (TARPs - a measure of the size of the audience
exposure to the TVC) over this two-year period (n=1385 calls). The TVC on
stroke and smoking generated 88 calls per 100 TARPs and the TVC on smoking
and lung tumours generated 78 calls per 100 TARPs. Although the blindness
TVC was the most effective of the three for generating calls from Maori
callers, the differences between the three TVCs were not statistically
significant. However, for non-Maori (mainly European) callers, the
blindness TVC was significantly more effective than the tumour one (rate
ratio (RR) = 1.45, 95% CI = 1.15, 1.84).
The smoking and blindness TVCs were also far more effective in
generating calls to the Quitline than the TVCs in two separate campaigns
that focused on second-hand smoke during this two year period (RR = 19.57,
95% CI = 15.06, 25.46; and RR = 34.97, 95% CI = 27.20, 44.53). However,
the TVCs in these campaigns also differed in that they did not include the
Quitline number. The relative effectiveness of this particular smoking
and blindness TVC has also been shown in the Australian setting.[2]
Only one of these “health threat” TVCs shows a Maori person as the
main participant (the tumour TVC) and so there is scope for further
adapting these TVCs to better suit Maori who are a priority audience for
smoking cessation support in New Zealand. Furthermore, the advent of a
dedicated Maori television channel in the near future may provide a more
cost-effective means to reach a Maori audience with these and other TVCs
designed to stimulate smoking cessation.
Nick Wilson, Senior Lecturer (Public Health), Wellington School of
Medicine & Health Sciences, PO Box 7343 Wellington South
(nick.wilson@wnmeds.ac.nz);
Michele Grigg, Research Manager;
Graham Cameron, Researcher;
Ramzan Afzal, Researcher;
Helen Glasgow, Executive Director, The Quit Group, PO Box 12 605,
Wellington, New Zealand.
Competing interests: None declared.
1 Kelly SP, Thornton J, Lyratzopoulos G, et al. Smoking and
blindness. BMJ 2004;328:537-538
2 Carroll T, Rock B. Generating Quitline calls during Australia's
National Tobacco Campaign: effects of television advertisement execution
and programme placement. Tob Control 2003;12(Suppl 2):ii40-4.
Competing interests:
None declared
Competing interests: No competing interests