Study links switch from cigarettes to vapes with higher risk of eye disease

Electronic vapes are often seen as a safer alternative for people trying to quit smoking, but a new large study suggests they may carry hidden risks.

Researchers found that former smokers who moved to vaping could face a higher risk of developing serious eye diseases such as diabetic retinopathy compared to those who stopped using nicotine completely.

Diabetic retinopathy is caused by damage to blood vessels in the retina, the light‑sensitive tissue at the back of the eye. It is often linked to prolonged high blood sugar levels and can lead to vision loss if untreated.

Previous studies have associated electronic cigarettes with breathing problems, nicotine addiction, heart and blood vessel complications, inflammation, reduced lung function, and potential effects on brain development, particularly among younger users.

The findings, published in the American Journal of Ophthalmology, are based on health data from 179,273 adults with a history of smoking traditional cigarettes.

Researchers examined records collected through a national health insurance database to assess whether switching to smokeless nicotine products offered measurable health advantages over complete nicotine cessation.
The study focused on adults who smoked traditional cigarettes between 2011 and 2012 and later quit by 2018 or 2019. To improve reliability, participants with similar characteristics were matched by age, sex, medical conditions, health history, and lifestyle habits.

From the larger population, researchers created a balanced group of 32,316 participants divided into two categories: complete quitters who stopped using all nicotine products, and those who switched to alternatives such as electronic vapes.

Participants were followed for an average of 4.6 years to assess whether they developed major eye conditions. The study tracked cataracts, glaucoma, age‑related macular degeneration, diabetic retinopathy, and disorders affecting the eye’s ability to focus.

During the monitoring period, researchers recorded 6,328 major eye disease cases.

People who quit nicotine completely showed the lowest rates of eye disease, recording 41.1 cases per 1,000 person‑years. In comparison, individuals who switched to smokeless alternatives experienced a higher rate of 44 cases per 1,000 person‑years.

The analysis found that people who transitioned to alternative nicotine products had a 7 per cent greater risk of developing serious eye diseases than those who stopped using nicotine altogether.

One of the strongest findings involved diabetic retinopathy, which damages blood vessels in the retina and can lead to blurred vision or permanent vision loss if untreated.

According to the study, “People who switched from cigarettes to vaping faced a 24 per cent higher risk of developing diabetic retinopathy compared with complete quitters.”

Researchers also found that switchers experienced a 7 per cent increased risk of refractive and accommodation disorders, conditions that reduce the eye’s ability to focus clearly on nearby or distant objects.

The findings add to growing discussions around the long‑term effects of vaping, often marketed as a lower‑risk alternative to smoking. While e‑cigarettes avoid many toxic compounds created through tobacco combustion, experts say nicotine exposure and other chemicals in vaping products may still have health consequences not yet fully understood.

The researchers noted that the results challenge assumptions that replacing conventional cigarettes with non‑combustible nicotine products is harmless for vision and eye health.

However, the study acknowledged several limitations. Because it relied on existing health insurance records rather than a controlled clinical trial, it cannot establish a direct cause‑and‑effect relationship between vaping and eye disease.

Information about smoking and vaping behaviour was partly based on self‑reported questionnaires, which may introduce recall errors or underreporting.

Despite these limitations, the researchers concluded that switching from cigarettes to alternative nicotine products may not fully eliminate the risk of developing certain eye diseases, and that complete nicotine cessation may provide greater benefits for long‑term eye health.

Although cigarette smoking has declined in many countries, the use of electronic cigarettes and other nicotine products continues to grow, particularly among young people.

In Kenya, tobacco use remains a major public health concern. Recent estimates show about 2.3 million adults currently smoke, representing roughly 6.4 per cent of the adult population. Men account for 12.1 per cent of smokers compared with 0.9 per cent of women.

Emerging nicotine products are also gaining popularity among younger populations. A recent survey among university students found that 5.8 per cent reported using e‑cigarettes or vapes, while 4.6 per cent used nicotine pouches. Another survey estimated that 3.4 per cent of Kenyan youth have tried e‑cigarettes, with flavours cited as a major reason for uptake.

Globally, vaping has expanded rapidly. According to the World Health Organisation (WHO), more than 100 million people worldwide use e‑cigarettes, including at least 86 million adults.

The agency also estimates that at least 15 million adolescents aged 13 to 15 are using e‑cigarettes, with young people in some countries up to nine times more likely to vape than adults.

Health experts warn that while vaping is often marketed as a lower‑risk alternative to smoking, growing evidence continues to link it to nicotine addiction and a widening range of health concerns.