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5 Tips for Recommending Smoking Cessation Programs

By Timothy Earley, OD

During a recent webinar I gave on age-related macular degeneration (AMD) and the importance of smoking cessation, a fellow optometrist posted a striking comment. “Let’s be honest,” they said. “Most smokers have no desire to quit smoking. You can see it in their eyes as soon as you broach the subject.”

This got me thinking. Are we, as primary eye care providers, doing a good enough job educating our patients about the negative impact smoking has on their eyes? And if not, is there something we can do to change that?

Fortunately, there is. Learn more about how we can ensure our patients understand the correlation between smoking and AMD, as well as what we can do to help encourage them to quit smoking.

How Smoking Affects Acute Macular Degeneration

We know the facts. Smoking is the largest modifiable risk factor for AMD, and people who smoke 20 or more cigarettes daily have twice the risk as a nonsmoker of developing AMD. Furthermore, we know that active smokers carry a 2.5 to 4.8 times higher risk for progressing to late-stage AMD. As health professionals, we also know that smoking cessation may reduce the incidence and progression of AMD — but do our patients know this?

Data shows that the patients we serve do not fully know the risks smoking has on their eyesight. Shockingly, a 2011 study showed that almost 90% of patients with AMD had never been advised by their eye care provider to stop smoking. Another study revealed that less than 50% of smokers were aware that smoking may contribute to blindness. Given the Meaningful Use and MIPS requirements and the passing of ten years since these startling statistics were published, I hope we are doing better as a profession now. But I still encounter many patients surprised about the dangers of smoking. Can we do something to change that?

As eye care professionals, we are in a unique position when it comes to smoking intervention. Blindness remains a key motivational factor in smoking cessation, so we have a much higher chance than other health care providers of positively impacting our patients’ smoking habits. While it’s ultimately up to each individual to decide to quit smoking, there are ways we can encourage our patients. From assistance in developing a smoking cessation plan to providing them with beneficial resources, it’s never too late to mitigate the risks of AMD.

Five Tips for Eye Care Providers When Recommending Smoking Cessation

We know the importance of antismoking interventions, but you may be worried about coming across as preaching rather than sympathetic or concerned about your patients’ welfare. Take a look at these five tips that can help you speak to your patients about quitting and work with them to develop a smoking cessation plan.

1. Don’t be Judgmental

Nicotine is an addictive substance. Be genuine and compassionate when acknowledging this fact because it’s what makes quitting smoking difficult. It is important to begin the smoking cessation discussion in a very non-judgmental way. Many smokers have been berated about their addiction for years and might get defensive when given yet another unsolicited advice.

I usually say “I want to begin by saying that I am in no means judging you for smoking, and I understand how addictive smoking can be and how hard it can be to quit. However, I would not be a very caring doctor if I didn’t explain the ways in which smoking can cause serious damage to your retina. I very much encourage you to quit or at least begin the journey toward quitting in the future.”

When presented with a soft touch, patients are indeed quite open to what we have to say.

2. Have the Conversation at Every Appointment

As mentioned previously, nearly 90% of AMD patients reported that their eye care providers had never advised them to quit. We can help to reduce those statistics by bringing up smoking cessation at every appointment. Make this topic a routine part of your eye exams. Remember to take a caring, patient-centric approach, guiding each individual on how to go about quitting.

3. Help Patients Realize the Benefits of Quitting Smoking

Help your patients come up with potential benefits of quitting smoking, such as walking without becoming winded, saving money, or reducing the risks of AMD. For older adults, the main motivating factor might be to see their grandchildren grow or travel more. Having healthy future goals can inspire people to keep pushing forward. When things get tough, the “Why” will help them stick to their smoking cessation plan.

4. Explain What Does and Doesn’t Work

As your patients work to quit smoking, there are a variety of tools that can help them, including nicotine replacement treatments, therapy quit-smoking mobile apps, and the support of family and friends. Patients should also try avoiding triggers, such as drinking alcohol or coffee and other activities that their brain may associate with smoking. If, for example, patients usually smoke when drinking coffee, they might benefit from switching to tea for a few weeks.

Other items, like e-cigarettes, can be counterproductive as they emit a number of potentially toxic substances that cause clear health risks. As you undoubtedly know, vaping actually replaces one dangerously addictive substance with another. Be honest about the challenges of quitting and provide information about what does and doesn’t work for your patients. This ensures they have the greatest chance of success.

5. Advise Patients on Where to Get Help

Research smoking cessation resources both online and in your area so that you can recommend specific programs to your patients. Better yet, print out a list of individual counseling programs, phone quitlines, support group programs, multilingual resources, and web-based smoking cessation programs. With tangible resources in their hands, your patients may feel more empowered to take their first steps toward quitting. To get started, you can download this list. Add local resources available in your area, print the list out, and share it with your patients.

Give Your Patients Extra Time by Diagnosing AMD Early

While AMD is not curable, early detection offers your patients their best chance to slow its progression. The earlier you diagnose the disease, the earlier you can empower your patients to make informed decisions about their eye health. Knowing they have AMD may help them open up to your treatment recommendations.

By measuring dark adaptation function, you can detect AMD at least three years before structural signs are clinically visible. This extra time gives you and your patients a valuable opportunity to develop an action plan unique to their needs.




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About the Author

Dr. Timothy Earley joined Medina Vision Centre in 1998. He was born and raised in Honesdale, PA and earned his Bachelor’s degree in Biology/Pre-Med from the University of Scranton. He earned his Bachelor’s degree in Visual Science and his Doctorate in Optometry from the Pennsylvania College of Optometry. Dr. Earley is a national speaker and consultant on age-related macular degeneration, specialty contacts and practice management.

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