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The smoking intensity was calculated as the pack-year at the baseline OCT. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of RNFL thinning over time. Non-linear least-squares estimation with piecewise regression model was used to investigate the cut-off point for the relationship between circumpapillary RNFL thinning and smoking intensity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 466 eyes of 314 patients were included over the mean (95% CI) follow-up of 6.6 (6.4 to 6.7) years. Of the 314 patients, 121 (39%) had reported any history of smoking. Greater smoking intensity was associated with faster RNFL thinning (\u22120.06 (95% CI \u22120.11 to 0.00) \u00b5m\/year per 10 pack-year higher; p=0.031) after adjusted for confounding factors. RNFL thinning became significantly faster when smoking intensity was &gt;8 pack-year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Smoking intensity is associated with faster rates of RNFL thinning. Evaluation of smoking intensity might add information to the assessment of risk of glaucoma progression. Future studies are required to explore if withdrawing smoking as a modifiable risk factor can decrease progression in patients with glaucoma.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjo-2022-321237","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T17:20:21Z","timestamp":1663089621000},"page":"1658-1664","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Smoking and progressive retinal nerve fibre layer thinning in glaucoma"],"prefix":"10.1136","volume":"107","clinical-trial-number":[{"clinical-trial-number":"nct00221897","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8312-6623","authenticated-orcid":false,"given":"Takashi","family":"Nishida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golnoush","family":"Mahmoudinezhad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert N","family":"Weinreb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5271-7690","authenticated-orcid":false,"given":"Sally L","family":"Baxter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medi","family":"Eslani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M","family":"Liebmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A","family":"Girkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7489-089X","authenticated-orcid":false,"given":"Massimo A","family":"Fazio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"M Zangwill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9375-4711","authenticated-orcid":false,"given":"Sasan","family":"Moghimi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"key":"2023102002150978000_107.11.1658.1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ajo.2019.11.002","article-title":"Ganglion Cell-Inner plexiform layer and retinal nerve fiber layer changes in glaucoma suspects enable prediction of glaucoma development","volume":"210","author":"Shin","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"2023102002150978000_107.11.1658.2","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1016\/j.ophtha.2015.06.015","article-title":"Estimating lead time gained by optical coherence tomography in detecting glaucoma before development of visual field defects","volume":"122","author":"Kuang","year":"2015","journal-title":"Ophthalmology"},{"key":"2023102002150978000_107.11.1658.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2014.01.017"},{"key":"2023102002150978000_107.11.1658.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2007.03.017"},{"key":"2023102002150978000_107.11.1658.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(01)00964-3"},{"key":"2023102002150978000_107.11.1658.6","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.03-1274"},{"key":"2023102002150978000_107.11.1658.7","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1486-3"},{"key":"2023102002150978000_107.11.1658.8","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.124.8.1185"},{"key":"2023102002150978000_107.11.1658.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03470030069026"},{"key":"2023102002150978000_107.11.1658.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.08.051"},{"key":"2023102002150978000_107.11.1658.11","first-page":"195","article-title":"The association between cigarette smoking and ocular diseases","volume":"6","author":"Cheng","year":"2000","journal-title":"Hong Kong Med J"},{"key":"2023102002150978000_107.11.1658.12","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.59.4.211"},{"key":"2023102002150978000_107.11.1658.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2007.05.032"},{"key":"2023102002150978000_107.11.1658.14","doi-asserted-by":"publisher","DOI":"10.1001\/archophthalmol.2010.373"},{"key":"2023102002150978000_107.11.1658.15","unstructured":"Zhang X , Kahende J , Fan AZ . 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