{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:11:37Z","timestamp":1790014297033,"version":"4.0.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016275","name":"Seoul National University Bundang Hospital","doi-asserted-by":"publisher","award":["Grant No. SNUBH-14-2025-0001"],"award-info":[{"award-number":["Grant No. SNUBH-14-2025-0001"]}],"id":[{"id":"10.13039\/100016275","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Smoking has been suggested to influence choroidal circulation and structure, but population-based evidence regarding its association with choroidal thickness remains limited. This cross-sectional, population-based study investigated the association between smoking status and subfoveal choroidal thickness (SFCT) in a nationally representative Korean population, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2017\u20132021. A total of 22,130 participants from KNHANES who had gradable optical coherence tomography images and without ocular pathologies affecting choroidal thickness were included. Smoking status was categorized as never, former, and current smoking based on standardized KNHANES questionnaires. Weighted mean SFCT across smoking groups was compared, and association between smoking status and SFCT were estimated using survey-weighted multivariate linear regression. Mean SFCT showed a stepwise increase from never to former to current smokers in both eyes (right eye: 297.3\u2009\u00b1\u20091.3 \u00b5m, 307.0\u2009\u00b1\u20092.1 \u00b5m, and 330.6\u2009\u00b1\u20092.3 \u00b5m, respectively; left eye: 297.2\u2009\u00b1\u20091.3 \u00b5m, 305.5\u2009\u00b1\u20092.2 \u00b5m, and 330.1\u2009\u00b1\u20092.2 \u00b5m, respectively; all p\u2009&lt;\u20090.001). In multivariate analysis, current smoking was associated with thicker SFCT (right eye: \u03b2\u2009=\u200917.55\u2009\u00b1\u20093.45 \u00b5m, left eye: \u03b2\u2009=\u200920.47\u2009\u00b1\u20093.40 \u00b5m; both p\u2009&lt;\u20090.001). Older age, female sex, longer axial length, greater central macular thickness, and the presence of cardiovascular disease were independently associated with thinner SFCT in both eyes (all p\u2009&lt;\u20090.05). Current smoking was independently associated with greater SFCT, providing large-scale population-based evidence of the association between smoking status and choroidal structural changes.<\/jats:p>","DOI":"10.1371\/journal.pone.0358964","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:47:28Z","timestamp":1790012848000},"page":"e0358964","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between smoking status and choroidal thickness in the Korean population: Korea National Health and Nutrition Examination Survey 2017\u20132021"],"prefix":"10.1371","volume":"21","author":[{"given":"Jae Shin","family":"Song","sequence":"first","affiliation":[{"name":"Seoul National University College of Medicine, Seoul National University Bundang Hospital","place":["Seongnam, Korea"],"department":["Department of Ophthalmology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7092-5429","authenticated-orcid":true,"given":"Min Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"Seoul National University College of Medicine, Seoul National University Bundang Hospital","place":["Seongnam, Korea"],"department":["Department of Ophthalmology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"issue":"8","key":"pone.0358964.ref001","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s00417-011-1620-1","article-title":"Subfoveal choroidal thickness in typical age-related macular degeneration and polypoidal choroidal vasculopathy","volume":"249","author":"H Koizumi","year":"2011","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"pone.0358964.ref002","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s40942-018-0136-9","article-title":"Change in subfoveal choroidal thickness in diabetes and in various grades of diabetic retinopathy","volume":"4","author":"V Ambiya","year":"2018","journal-title":"Int J Retina Vitreous"},{"issue":"1","key":"pone.0358964.ref003","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/s12886-018-0791-5","article-title":"Correlation of subfoveal choroidal thickness with axial length, refractive error, and age in adult highly myopic eyes","volume":"18","author":"B Liu","year":"2018","journal-title":"BMC Ophthalmol"},{"key":"pone.0358964.ref004","doi-asserted-by":"crossref","first-page":"783519","DOI":"10.3389\/fmed.2021.783519","article-title":"Evaluation of choroidal thickness using optical coherent tomography: a review","volume":"8","author":"R Xie","year":"2021","journal-title":"Front Med (Lausanne)"},{"issue":"6","key":"pone.0358964.ref005","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1080\/02713683.2018.1428995","article-title":"Sex-dependent choroidal thickness differences in healthy adults: a study based on original and synthesized data","volume":"43","author":"W Wang","year":"2018","journal-title":"Curr Eye Res"},{"issue":"5","key":"pone.0358964.ref006","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.oret.2020.08.012","article-title":"Patterns and determinants of choroidal thickness in a multiethnic Asian population: the singapore epidemiology of eye diseases study","volume":"5","author":"Y Song","year":"2021","journal-title":"Ophthalmol Retina"},{"issue":"1","key":"pone.0358964.ref007","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3390\/vision6010016","article-title":"Choroidal thickness in correlation with axial length and myopia degree","volume":"6","author":"HS Muhiddin","year":"2022","journal-title":"Vision (Basel)"},{"issue":"1","key":"pone.0358964.ref008","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1038\/s41433-024-03383-9","article-title":"Distribution and associated factors of choroidal thickness in highly myopic eyes-a real-world study based on a Chinese population","volume":"39","author":"L Shao","year":"2025","journal-title":"Eye (Lond)"},{"key":"pone.0358964.ref009","doi-asserted-by":"crossref","first-page":"104511","DOI":"10.1016\/j.pdpdt.2025.104511","article-title":"Age and gender-related changes in choroidal thickness: insights from deep learning analysis of swept-source OCT images","volume":"52","author":"D Song","year":"2025","journal-title":"Photodiagnosis Photodyn Ther"},{"key":"pone.0358964.ref010","doi-asserted-by":"crossref","first-page":"895147","DOI":"10.1155\/2013\/895147","article-title":"Smoking and age-related macular degeneration: review and update","volume":"2013","author":"S Velilla","year":"2013","journal-title":"J Ophthalmol"},{"issue":"2","key":"pone.0358964.ref011","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/aos.16782","article-title":"Is tobacco consumption a risk factor for central serous chorioretinopathy? 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Cardiol"},{"issue":"3","key":"pone.0358964.ref024","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/0041-008X(87)90252-3","article-title":"Studies on the mechanism of carbon monoxide-induced vasodilation in the isolated perfused rat heart","volume":"87","author":"SJ McFaul","year":"1987","journal-title":"Toxicol Appl Pharmacol"},{"issue":"5","key":"pone.0358964.ref025","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1152\/jappl.1996.81.5.1996","article-title":"Effect of cigarette smoke extract on arteriolar dilatation in vivo","volume":"81","author":"WG Mayhan","year":"1996","journal-title":"J Appl Physiol (1985)"},{"issue":"10","key":"pone.0358964.ref026","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/j.jacc.2003.12.047","article-title":"The pathophysiology of cigarette smoking and cardiovascular disease: an update","volume":"43","author":"JA Ambrose","year":"2004","journal-title":"J Am Coll 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