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Glaucoma is the leading cause of irreversible blindness worldwide. Prior literature investigating the link between tobacco smoking and glaucoma has reported contradictory findings on the association between tobacco smoking and POAG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematically EMBASE, MEDLINE, and Web of Science were searched, encompassing articles published up until April 2025. The inclusion criteria comprised observational and randomised controlled studies that provided a statistical analysis exploring the association between tobacco smoking and POAG in adult populations. The ROBINS-E tool was utilised to assess the risk of bias of studies and meta-analyses were completed using RevMan software. The main outcomes were effect estimates that measured the association between tobacco smoking and POAG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across 26 eligible studies and 289,930 participants, there was a prevalence of 6,454 cases of POAG. The meta-analyses revealed that current smokers (OR\u2009=\u20091.00, 95%CI 0.76\u20131.33,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.97, n\u2009=\u200911), past smokers (OR\u2009=\u20090.92, 95%CI 0.75\u20131.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.38, n\u2009=\u20096) as well as both current and past tobacco smoking combined (OR\u2009=\u20091.00, 95%CI 0.84\u20131.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20091.00, n\u2009=\u200917) exhibited no statistically significant association with POAG when compared to individuals who had never smoked. Heterogeneity ranged from low to substantial across comparisons, and risk of bias was frequently rated as high among included observational studies. The lack of an associative effect was sustained, on exclusion of studies with a high risk of bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although the results suggest no significant statistical association between tobacco smoking and POAG, given the substantial morbidity and mortality associated with tobacco smoking and the detrimental impact on systemic and ocular health, tobacco smoking cessation should remain at the forefront of health promotion. PROSPERO registration ID: CRD42023409440.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10792-026-03944-9","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:18:20Z","timestamp":1770005900000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tobacco smoking is not associated with primary open-angle glaucoma: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"46","author":[{"given":"Saajan","family":"Ramji","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohail","family":"Daniel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdus Samad","family":"Ansari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulmalik","family":"Alsaif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obeda","family":"Kailani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"3944_CR1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.optom.2016.02.003","volume":"10","author":"CW McMonnies","year":"2017","unstructured":"McMonnies CW (2017) Glaucoma history and risk factors. 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TLJ: None relevant to the work conducted. Consultant to 2CTech, Alcon, Dutch Ophthalmic Research Centre, iLumen, Opthea, Outlook Therapeutics, Oxurion, and Regeneron. Conference support from Roche. Free equipment use for non-commercial trials from Zeiss, Oraya and LKC. His National Health Service employer receives site payments for participants recruited to commercial clinical trials, including glaucoma trials. He served on the National Institute of Health and Care Research (NICE) Interventional Procedures Advisory Committee, which advises the National Health Service on the adoption of medical technologies including several glaucoma implants. OK: None relevant to the work conducted. Consultant to Santen, Glaukos, and Sight Sciences and has received educational grants or research funding from Glaukos, Scope Ophthalmic and Thea Pharma. His National Health Service employer receives site payments for participants recruited to commercial and non-commercial clinical trials, including glaucoma trials. SR: None, SD: None, ASA: None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This study is a systematic review and meta-analysis and did not involve the collection of new, individual patient data. Therefore, institutional review board (IRB) or ethics committee approval and informed consent were not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}}],"article-number":"96"}}