Epidemiological association between cigarette smoking and primary open-angle glaucoma: a meta-analysis S. Bonovas a, *, K. Filioussi a , A. Tsantes a , V. Peponis b a Department of General Practice, General Hospital of Athens ‘G. Gennimatas’, Athens, Greece b Department of Ophthalmology, General Hospital of Piraeus ‘Tzaneion’, Piraeus, Greece Received 3 March 2003; received in revised form 24 September 2003; accepted 24 September 2003 KEYWORDS Cigarette smoking; Primary open-angle glaucoma; Meta-analysis Summary Objective. The role of cigarette smoking as a risk factor for primary open- angle glaucoma (POAG) remains controversial. The aim of this study was to examine this association by conducting a detailed meta-analysis of studies published in peer- reviewed literature on the subject. Methods. A comprehensive search for articles published up 31 December 2002 was performed, reviews of each study were conducted, and data were abstracted. Prior to meta-analysis, the studies were evaluated for publication bias and heterogeneity. Results. Our analysis was based on seven reports. We found no evidence of publication bias or heterogeneity among the studies. The summary odds ratios from a fixed-effects model were 1.37 (95% CI: 1.00– 1.87) for current smokers and 1.03 (95% CI: 0.77 – 1.38) for past smokers. Conclusions. Our meta-analysis results suggest that current smokers are at significantly increased risk of developing POAG. Efforts should be directed towards augmenting the campaign against smoking by adding the increased risk of POAG to the better-known arguments against smoking. Q 2003 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. Introduction Primary open-angle glaucoma (POAG) is one of the leading causes of blindness and visual impairment. Despite its importance and public health relevance, some of the underlying reasons for the disease remain unclear. Many believe that POAG has a vascular origin because of compromised blood flow to the optic nerve head. 1 Cigarette smoking contributes to vascular disease by occluding arterial lumina from atherosclerosis and intimal thickening. 2 Conse- quently, cigarette smoking might be a risk factor for POAG, along with other risk factors such as advancing age, family history of glaucoma and black race. However, the evidence for involvement of smoking in the pathogenesis of POAG is controver- sial. Although, several studies have indicated that smoking is a risk factor for its development, others have failed to do so. The overall aim of this study was to evaluate the association between cigarette smoking and POAG Public Health (2004) 118, 256–261 0033-3506/$ - see front matter Q 2003 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.puhe.2003.09.009 *Corresponding author. Address: Asklipiou 17-19, GR-15354, Glika Nera, Greece. Tel.: þ 30-210-6040115. E-mail address: sbonovas@med.uoa.gr