1. The relation between parental smoking and hypermetropia in children Yair Morad Yuval Cohen and Lionel Kowal Assaf Herofeh Medical Center, Zrifin, Israel Royal Victorian Eye and Ear Hospital, Melbourne, Australia

2. Parental smoking inhibits child myopia Saw et al: less myopia in children of smoking mothers (-0.28 D v -1.38 D) BJO 2004 Stone et al: If one or both parents ever smoked, their children had a lower myopia prevalence (12.4% vs. 25.4%) IOVS 2006

3. Can parental smoking cause hypermetropia? Maternal smoking associated with moderate hyperopia in six year old but not in 12 year old (N=4321) Ip et al Opthalmology 2008

4. Aim To examine the relation between exposure to parental smoking and the development of hypermetropia in children

5. Design The database of a Pediatric Ophthalmology Clinic was screened. 1207 children with CR > 0.00D Only one child from each family was selected

6. All parents underwent a telephone interview

7. The questionnaire Father of mother smoking now? In the past? How many packets per day? Did mother smoke during pregnancy?

8. Children of farsighted parents were not included

9. Results 1007 children included in the study Mean age: 6.2 ± 3.6y (6mo - 17y) Mean spherical equivalent: +3.0±2.3 D (0.0 - +12.75 D)

10. Mothers 11% smoking today 6.6% smoked in the past Fathers 21% smoking today 11% smoked in the past

11. Maternal smoking and child’s refraction P=0.1 P=0.014

12. Maternal smoking during pregnancy P<0.0001

13. Parental smoking – not significant

14. Risk to develop esotropia RR=1.63 Mother: non-smoking 70/817 = 8.5% Age: 6.9 ± 3.39 Refraction : +5.2 Mother: smoking 17/122 =14% Age: 8.6 ± 3.18 Refraction: +5.4

15. Pilot study in Melbourne N = 142 participants 21% mother smoke; 16% smoked during pregnancy 26% father smoke; 32% smoked during pregnancy 32% have either parent smoking now 38% have parent smoking during pregnancy

16. Results Significant association between smoking mother and child hypermetropia (Odd ratio 19.75, CI 95% 1.65-236.51, p 0.02) Smoking mother increases the odds of moderate to severe hyperopia (>+3 D) by nearly 20 folds

17. Other studies Stone et al IOVS 2006 N=323 If one or both parents ever smoked, their children had more hyperopic mean refractions (1.83 0.24 vs.0.96 0.27 diopters; P 0.02) El-Shazaly et al Ophthalmic & Physiological Optics 2012 N=300 Passive smoking exposure might be associated with hypermetropia

18. Smoking increases the risk for esotropia Tasmania, Australia (n=346) Pediatric eye disease and Baltimore pediatric eye disease studies (n=9970 ) National Institute of Neurological Disorders and Stroke, Bethesda, Md (n=39,227 )

19. Possible biochemical mechanism for smoking –refraction interaction Nicotine stimulate dopamine release Retinal dopamine Eye growth

20. Nicotinic antagonists injected to old chicks inhibition of ocular growth hyperopic shifting of refraction Stone RA et al IOVS 2001

21. Conclusions 1.Maternal smoking increase the risk of hypermetropia in children 2.The effect of maternal smoking is dose dependent. 3.Cigarette smoking increase the risk of esotropia in children