Association Between Non-Tobacco Nicotine Use and the Risk of Age-Related Macular Degeneration: A Propensity-Matched Cohort Study Using a National EHR Network

Document Type

Conference Proceeding

Publication Date

6-2026

Publication Title

Investigative Ophthalmology and Visual Science

Abstract

Purpose : Smoking is a well-established risk factor for age-related macular degeneration (AMD). The relationship between AMD and non-tobacco nicotine products such as electronic cigarettes, which were initially promoted as a safer alternative, has not been well described in the literature. This study evaluates the association of such exposures with the incidence and progression of AMD in a large, multi-institutional electronic health record (EHR) database.

Methods : We queried the TriNetX US Collaborative Network from January 2015 to January 2025 to identify adult patients aged 18 years or older with documented exposure to non-tobacco nicotine products (n=68,861) along with control patients (n=2,252,792). Individuals with pre-existing retinal/choroidal disease, prior retinal procedures, or any tobacco product exposure were excluded. Propensity score matching (1:1) was performed for demographics, comorbidities, and ingredients of AREDS. We assessed the risk of developing non-neovascular AMD and neovascular AMD (nAMD) in AMD-naive patients, and the risk of progression of AMD. Hazard ratios (HRs), 95% confidence intervals (CIs), and Kaplan–Meier survival curves were calculated.

Results : Compared to matched controls (n=68,858), AMD naive patients exposed to non-tobacco nicotine products had significantly higher rates of developing non-neovascular AMD (HR;95%CI=7.915;6.071–10.319) and nAMD (11.308;6.773–18.877) within 5 years. In patients with non-neovascular AMD, exposure was associated with significantly higher rates of progression to nAMD (3.131;2.252–4.353). In patients with early/intermediate non-neovascular AMD, exposure was further associated with higher rates of progression to nAMD (2.612;1.877–3.634) and trended higher for geographic atrophy (1.175;0.857–1.612).

Conclusions : These findings suggest that non-tobacco nicotine products may be an independent risk factor for AMD development and progression. With their widespread availability and utilization in recent years, they may pose significant public health concerns, and it would be prudent to further investigate their relationship with AMD.

Volume

67

Issue

7

First Page

5241

Comments

Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, May 3-7, 2026, Denver, CO

Last Page

5241

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