Journal article
Tobacco Exposure and Risk of Developing Fuchs' Endothelial Corneal Dystrophy in the Women’s Health Initiative Studies (WHI)
Ophthalmology science (Online), Vol.6(2), 100994
02/2026
DOI: 10.1016/j.xops.2025.100994
PMCID: PMC12743551
PMID: 41458318
Abstract
Objective
We prospectively examined the association between tobacco exposure (personal /secondhand smoking) and Fuchs' Endothelial Corneal Dystrophy (FECD) in older women, the group most impacted by FECD.
Design
We conducted a secondary data analysis utilizing the Women’s Health Initiative’s (WHI’s) Observational Study and Clinical Trials data.
Participants
Postmenopausal women aged 65+ who participated in WHI, had available Medicare claims data, and did not have FECD within one year after WHI enrollment were included (N=37,824).
Methods
Smoking status, pack-years, and average cigarettes/day were assessed at baseline (1993-1998). Secondhand smoke exposure (SHS) was assessed by location (childhood or adulthood at home and work). Participant characteristics were compared by personal smoking history and SHS status. Crude and adjusted Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for the risk of FECD by personal smoking exposure and by SHS status.
Main Outcome Measure
Incident FECD cases were identified objectively via Medicare claims data through 2019.
Results
Current smokers compared to never smokers were more likely to be younger, have lower body mass indices, and were less likely to be White, married, and users of hormone replacement therapy. Current smokers had an increased risk of FECD compared to never smokers (HR=1.12, CIs: 0.90-1.38) and former smokers had a slight decreased risk of FECD compared to never smokers (HR=0.92, CIs:0.84-1.01). Current smokers who smoked 15+ cigarettes/day had a 26.0% (HR=1.26, CIs: 0.94-1.68) greater risk of developing FECD compared to never smokers. However, former smokers who smoked 15+ cigarettes/day had a14.0% (HR=0.86, CIs: 0.76-0.97) reduced risk of developing FECD compared to never smokers. Most women (93.6%) were exposed to SHS sometime in their life. Never smokers exposed to SHS at home during childhood or adulthood had approximately a 22-25% non-significant increased risk of developing FECD compared to never smokers without SHS exposure.
Conclusions
In this sample of postmenopausal women, personal smoking and SHS were not significantly associated with increased risk of FECD, but suggestions of an increased risk were observed in current smokers. Our findings may have been impacted by lack of variation in exposures, survival and sick-quitter biases.
Details
- Title: Subtitle
- Tobacco Exposure and Risk of Developing Fuchs' Endothelial Corneal Dystrophy in the Women’s Health Initiative Studies (WHI)
- Creators
- Samantha Rees - University at Buffalo, State University of New YorkJing Nie - University at Buffalo, State University of New YorkYihua Yue - University at Buffalo, State University of New YorkJean Wactawski-Wende - University at Buffalo, State University of New YorkSangita PatelChris A. Andrews - University of MichiganRobert B. Wallace - University of IowaEmily W. Gower - University of North Carolina School of MedicineAmy E. Millen - University at Buffalo, State University of New York
- Resource Type
- Journal article
- Publication Details
- Ophthalmology science (Online), Vol.6(2), 100994
- DOI
- 10.1016/j.xops.2025.100994
- PMID
- 41458318
- PMCID
- PMC12743551
- NLM abbreviation
- Ophthalmol Sci
- ISSN
- 2666-9145
- eISSN
- 2666-9145
- Publisher
- Elsevier Inc
- Grant note
- Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland)
Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Jared Reis, and Candice Price.
- Language
- English
- Electronic publication date
- 11/04/2025
- Date published
- 02/2026
- Academic Unit
- Epidemiology; Injury Prevention Research Center
- Record Identifier
- 9985027464002771
Metrics
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