Smoking discussion facilitates comanagement

ATLANTA – A speaker here urged optometrists to take a role in educating patients on the effects of smoking on the eye and helping them to quit.

"If optometry is going to build bridges into mainstream health care, considering that smoking is related to so many devastating eye diseases, we have to have that discussion," Muriel Schornack, OD, FAAO, told attendees at the SECO meeting.

A study published in Optometry and Vision Science in 2011 showed that Canadian optometrists and students were reluctant to discuss smoking with their patients even though they agreed "that we should be part of that primary care team that discusses this," Schornack said. Reasons included fear that patients may go see another eye doctor, it took too much time and they did not know where to refer a patient who wished to quit.

Schornack said the Mayo Clinic, where she works in the Department of Ophthalmology, promotes the use of the five "A’s": ask, advise, assess, assist and arrange.

Include questions about smoking on the intake form, she said. Ask if they smoke and, if so, how much.

Advise them to quit. "Discuss a family history of age-related macular degeneration and the effects of smoking on the eyes," she said. "Speak specifically about the eyes; make it personal. Urge them to quit or cut down, because there appears to be a dose-related response."

Assess patients’ willingness to attempt to quit. "The average smoker will not quit once and stay quit," Schornack said. "But one of the times it will take."

Assist in the attempt. "I am fortunate because I work in an environment with a smoking cessation clinic," she said. "It’s easy for me to send the patient there and know they’ll get good care. If you don’t practice in an integrated system, develop a relationship with some primary care physicians in town and find out what they do."

Arrange for follow-up. "Make that referral; talk to the patient’s PCP," she said.

"Celebrate with them when they make progress toward quitting," she added.

"Smokers that are still smoking despite the fact that they know they could die from lung cancer," Schornack said. "However, if you take a look at the number who would consider quitting smoking if they had eye disease, we have a great opportunity for education. Give them that one more reason, that one more tool to make them say today is the day. Or next month is the day."