Eyeworld

30 October 2018 EW NEWS & OPINION If patients say they use e-ciga- rettes to help quit cigarette smok- ing, you could share results from a study that found U.S. adult smokers who did not use electronic nicotine delivery systems quit smoking twice as often as those who used those devices, and 90% who both smoked and used e-cigarettes were still smoking a year later. 1 Other studies have reported mixed results about the potential role of e-cigarettes in helping smokers to quit. 2 Benefits of not smoking Ultimately, ophthalmologists should know that their anti-smoking discus- sions may help save vision. "I think many patients are un- aware of how smoking can impact their eyes, and raising awareness of the damage caused by cigarettes and secondhand smoke can be import- ant in preventing blindness," Dr. Andelson said. You can also put a positive spin on your anti-smoking message by letting patients know how their health improves after they stop smoking, Dr. El-Hasan said. For in- stance, after 12 hours of not smok- ing, the carbon dioxide level in the blood drops to normal. After 2 to 3 weeks, the risk for a heart attack de- creases. After 1 year of not smoking, the risk of coronary artery disease lowers to half of that of a smoker. At 15 years, the coronary artery disease risk is the same as a nonsmoker, Dr. El-Hasan said. EW References 1. Weaver SR, et al. Are electronic nicotine delivery systems helping cigarette smokers quit? Evidence from a prospective cohort study of U.S. adult smokers, 2015–2016. PLoS One. 2018;13:e0198047. 2. McKay B. Few who vape stop smoking, study finds. Wall Street Journal. July 10, 2018. Editors' note: The physicians have no financial interests related to their comments. Contact information Andelson: nfarano@youreyes.org El-Hasan: Afif.H.El-Hasan@kp.org Lauer: lauera@ohsu.edu Mendelsohn: admendelsohn@gmail.com Patel: rapatel5462@gmail.com Scott: 410-571-8733 Ticho: bticho@mac.com Smoking program (Freedomfrom- smoking.org) is often used to help those who want to quit. With the program and anti-smoking aids such as nicotine patches and gums, those committed to quitting usually can reach their goal in a month. "It can be a painful month," Dr. El-Hasan said. Dr. Mendelsohn advocates a gradual approach instead of cold turkey; the Freedom From Smoking program also does not recommend cold turkey, Dr. El-Hasan said. "My suggestion is to reduce the num- ber of cigarettes by 50% within a 3-month period then slowly wean themselves totally within 6 months," Dr. Mendelsohn said. He and his staff check in on progress and support them along the way. "When those patients report having stopped smoking, my staff and I clap and shower the patient and family members with praise. Positive reinforcement works, as does regular reminders," he said. Seeking social support from health providers, family, and sup- port groups can also be important, Dr. Ticho said. Ultimately, the patient must want to quit, Dr. Lauer said. This can be a frustrating part of the smoking discussion. He estimates that among his anti-smoking talks, only one in 30 to 50 patients will come back and say they quit. "The odds are stacked against you, but it's still worth it" to discuss the topic, he said. Addressing e-cigarettes Ophthalmologists are still grappling with what to advise patients regard- ing e-cigarettes. "The rise of e-cigarettes com- plicates this conversation because there is no long-term study that can isolate its health impact," Dr. Patel said. "This is particularly concern - ing, given its rise of use in younger individuals." When patients ask him about e-cigarettes, he tells them that the products have not had long-term studies and that they carry more risk than not smoking at all. "If you're a nonsmoker, it's best to avoid them altogether," he said. Although most of his patients are older and likely not using e-cig- arettes, Dr. Lauer wonders if asking about e-cigarette use on intake forms or via the EMR could help spur a discussion about these questionable devices. REGISTER YOUR STAFF FOR THE TECHNICIANS & NURSES PROGRAM T & N Program Saturday, May 4- Monday, May 6 Registration includes access to: • Up to 21 Group A IJCAHPO® Credits • CA BRN Nursing credits, OPS and AOC credits • Dedicated tracks for surgical/ASC & nursing and clinical/medical with expanded case-based presentations and Q & A with faculty • Crossover access to the ASCRS Program, including physician's courses, paper sessions and symposia • Exhibit Hall entry- three days to interact with ophthalmic service and product vendors sharing the latest technologies AnnualMeeting.ascrs.org How continued from page 28

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