Long-Term Effects of Smoking on Retinal and Choriocapillaris Perfusion: An Optical Coherence Tomography Angiography Study

<b>Purpose:</b> To evaluate the long-term effects of smoking on retinal microcirculation and choriocapillaris flow, and to compare microvascular alterations between healthy smokers and nonsmokers using optical coherence tomography (OCT) angiography. <b>Methods:</b> A total of 160 patients (86 smokers, 74 nonsmokers) were enrolled in this prospective, cross-sectional study. Non-flow and foveal avascular zone (FAZ) parameters, vessel density parameters of the macula and optic disc, and choriocapillaris flow area were obtained using OCT angiography. <b>Results:</b> The mean FAZ area in the whole retina and FAZ perimeter were significantly larger in the smoker group compared with the nonsmoker group (<i>P</i> = .003 and <i>P</i> = .002, respectively). Significant differences were also observed in vessel density of the superficial and deep capillary plexus, except in some zones of superficial perifovea, deep perifovea, and deep parafovea. No significant differences were found in vascular density of the optic disc region between groups (<i>P</i> > .05) The choriocapillaris flow within the 3 mm radius area was lower in smokers than in nonsmokers (<i>P</i> < .05). <b>Conclusions:</b> Cigarette smoking was associated with reduced retinal and choroidal vascularity as measured by OCT angiography. These findings support a potential detrimental role of smoking in the development of ocular diseases.