Age-related macular degeneration (AMD) ranks among the most common causes of vision loss in older individuals. It involves the gradual degeneration of the retina’s central region, which is essential for sharp, detailed vision (1).

 While AMD’s effects on sight are well-documented, emerging evidence suggests it may also impair other senses, such as hearing . Smoking—a key, modifiable risk factor—has been closely associated with oxidative stress and inflammation, two major contributors to age-related diseases like AMD 2, 3.

The connection between smoking and visual impairments, particularly AMD, has been firmly established. Smoking accelerates retinal damage and fosters inflammation,

which leads to thinning of retinal tissues and reduced visual clarity 4,5. Similarly, the impact of smoking on hearing has been explored extensively. Research indicates that smoking increases the risk of sensorineural hearing loss, likely by reducing cochlear blood flow and causing oxidative damage to auditory structures 6. Smokers also tend to score lower in speech discrimination tests, further highlighting the negative influence of smoking on auditory processing 7.

Although much is known about smoking’s effects on sight and hearing individually, few studies have examined these impacts simultaneously in AMD patients. Understanding how smoking exacerbates visual and auditory deficits in this group is critical for shaping prevention and treatment strategies. This study aims to evaluate, and compare, the extent of sensory impairments in smokers and non-smokers with AMD.

A cross-sectional study was systematically conducted over a period of 12 months at a tertiary care hospital and research center to investigate the impact of cigarette smoking on visual and auditory functions in patients with age-related macular degeneration (AMD). Ethical approval was formally obtained from the institutional review board, and informed consent was voluntarily provided by all participants before enrollment.A total of 300 patients aged 50–80 years, clinically diagnosed with AMD, were equally divided into two groups: smokers (n=150) and non-smokers (n=150). Smokers were defined as individuals with a history of smoking at least 10 cigarettes per day for a minimum of five years. Non-smokers included individuals who had either never smoked or had quit smoking more than 10 years prior to the study. Inclusion criteria were carefully applied to select patients diagnosed with AMD, confirmed through fundus examination and optical coherence tomography (OCT), and aged between 50 and 80 years. Patients with congenital or acquired retinal disorders other than AMD, a history of ear infections, ototoxic medication use, noise-induced hearing loss, or cognitive impairments affecting test reliability were systematically excluded. Visual Acuity Tests: Visual acuity was accurately measured using the logarithm of the minimum angle of resolution (logMAR) chart under standard lighting conditions. Optical Coherence Tomography (OCT): Retinal thickness was thoroughly assessed through OCT, with scans focusing on the central macula. Retinal thinning was precisely quantified in micrometers. Auditory Function Assessment Pure-Tone Audiometry: Hearing thresholds were consistently measured across frequencies ranging from 250 Hz to 8 kHz using calibrated audiometric equipment. Sensorineural hearing loss was defined as a hearing threshold exceedingly above 25 dB HL at any frequency. Speech Discrimination Tests: Speech discrimination scores were accurately recorded as the percentage of phonetically balanced words correctly identified when presented at a comfortable listening level.

Smokers with AMD exhibited significantly worse visual acuity (mean logMAR: 0.85 ± 0.16) compared to non-smokers (mean logMAR: 0.64 ± 0.13; p<0.001). OCT analysis revealed considerably greater retinal thinning in smokers (p=0.02). Auditory function tests showed markedly higher prevalence of sensorineural hearing loss in smokers (63%) compared to non-smokers (39%; p=0.004), with notably poorer performance in speech discrimination scores (smokers: 73% ± 11%; non-smokers: 86% ± 9%; p<0.001). Smoking was identified as an independently significant risk factor for both visual and auditory deterioration in patients with AMD.

Table 1:  Comparative Analysis of the Impact of Cigarette for Visual Acuity

Table 2:  Comparative Analysis of the Impact of Cigarette forRetinal Thinning Prevalence

Table 3:   Comparative Analysis of the Impact of Cigarette for  Sensorineural Hearing Loss

Table 4:  Comparative Analysis of the Impact of Cigarette for  Speech Discrimination Scores

This study provides crucial insights into how smoking affects both vision and hearing in individuals with AMD. Smokers showed significantly worse visual acuity and more pronounced retinal thinning, reinforcing the idea that smoking speeds up retinal degeneration. These findings align with earlier studies showing that smoking accelerates retinal damage, which results in impaired vision 8,9. The higher prevalence of retinal thinning among smokers (p = 0.02) supports the theory that smoking-related oxidative stress and inflammation play a significant role in retinal tissue damage. These results further confirm that smoking contributes to the rapid decline in visual function observed in AMD patients 10, 11. In addition to its effects on vision, smoking was also linked to greater hearing loss in AMD patients. Smokers had a much higher incidence of sensorineural hearing loss (62%) compared to non-smokers (38%; p = 0.004). This aligns with previous research identifying smoking as a risk factor for hearing impairments, due to reduced cochlear blood flow and oxidative stress, which damages auditory structures 12, 13 Smokers also performed worse on speech discrimination tests, with scores averaging 72% ± 10%, compared to 85% ± 8% in non-smokers (p < 0.001), further underscoring the negative impact of smoking on auditory processing and communication 14,15,16 These dual sensory impairments in AMD patients highlight the compounded challenges they face in daily life, potentially leading to greater disability. These findings emphasize the importance of smoking cessation programs, especially for high-risk groups like AMD patients. Smoking, as a preventable factor, significantly worsens sensory impairments and diminishes quality of life. Research shows that quitting smoking can improve both visual and auditory health, making it a vital component of comprehensive care plans for AMD patients 17,18,19). Healthcare providers should prioritize integrating smoking cessation support into AMD management, to slow sensory decline. Moreover, the study underscores the need for early detection and intervention in AMD patients who smoke. Routine screening for visual and auditory impairments should be a standard part of their care, enabling timely diagnosis and treatment.20 Patients should also receive education on how smoking exacerbates sensory issues, along with access to effective resources for quitting.

In summary, cigarette smoking significantly worsens both visual and auditory impairments in individuals with AMD. Implementing smoking cessation programs and routine sensory screenings is crucial to preventing further sensory decline and improving the quality of life for these patients. Future research should focus on uncovering the specific mechanisms behind smoking’s impact on the retina and auditory system, and on developing targeted therapies to counteract these effects.