Response to Comments on ‘Smoking and Risk of Uveitis: A Systematic Review and Meta-Analysis‘

In response to recent comments on our meta-analysis, we reaffirm that smoking is a major modifiable risk factor for uveitis, with consistent evidence demonstrating increased odds of disease across multiple anatomic subtypes. Biological plausibility is supported by mechanisms such as oxidative stress, endothelial dysfunction, and cytokine activation. Smoking also affects treatment response: current smokers with immune-mediated diseases such as psoriasis, Crohn's disease, and rheumatoid arthritis show reduced likelihood of achieving remission or near-complete clearance after biologic therapy. Tobacco use contributes to systemic organ damage, including cardiovascular, pulmonary, and ocular complications such as macular edema. Heterogeneity in exposure assessment and limited e-cigarette data highlight the need for further research. Nevertheless, clinicians should actively counsel patients to stop smoking or vaping. Reducing modifiable risk factors may improve treatment efficacy, lower inflammation, and prevent recurrence. Ophthalmologists play a key role in prevention and optimizing outcomes in uveitis.