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    How vaping affects the ocular surface

    The safety of electronic cigarettes is still unknown despite the number of users

    My father began smoking unfiltered tobacco cigarettes when he was 16 years old. When he was 49, he died of lung cancer. My brother started smoking in college—he has quit smoking, only to begin again more times than I care to remember. Each battle was accompanied by the side effects of nicotine withdrawal that include anxiety, depression, insomnia, and weight gain. Smoking is a topic that is top of mind for me and for my patients.

    Previously from Dr. Mastrota: 5 things you need to know about TFOS DEWS II

    Growing vaping community

    Electronic cigarettes (e-cigarettes) are devices designed to deliver nicotine in a solution rather than smoke without tobacco combustion. Perceived by consumers as a safer alternative to conventional cigarettes, e-cigarettes are aggressively marketed as lifestyle-choice consumables.

    An e-cigarette or electronic nicotine delivery system (ENDS) is a battery-powered vaporizer that simulates tobacco smoking. E-cigarettes or vape pens (vape means to inhale the vapor produced by an electronic cigarette or similar device) and vape mods are similar devices but are so called because of the specific vaporizing materials they use: e-cigarettes are marketed specifically for “e-juices” or “e-liquids.” The e-liquids are manufactured in a selection of tempting flavors—candy, cereal, custards, fruity, beverage, tobacco, among many others—as well as titrated nicotine-containing strengths.

    Vaping has its own glossary of terms. Vaping can be practiced with more experienced users at vape lounges, cafes, or “cloud chasing” events.1 Notably, in August 2016, the U.S. Food and Drug Administration (FDA) extended its regulatory authority to all tobacco products, including e-cigarettes, that did not previously fall under the FDA’s authority.

    Related: The role of lid hygiene in ocular surface disease

    Of note, one study culled comments from e-cigarette users from a content analysis of public postings on Twitter on the users’ rationale for vaping. The data suggested that the reasons people vape are shifting away from cessation of combustible use (regular cigarettes) and toward social image.2

    Vaping as an aid to discontinuing conventional cigarettes has mixed results. A recent Swiss study found no beneficial effects of vaping at follow-up visits for either smoking cessation or smoking reduction.3

    Despite the burgeoning worldwide consumption of e-cigarettes, their safety remains largely unproven, and it is unknown whether these devices cause in vivo toxicological effects that could contribute to cancer. In a rat lung model, co-mutagenic and cancer-initiating effects of e-cigarette vapor was demonstrated.4

    Another question: How does vaping impact the ocular surface?

    Katherine M. Mastrota, MS, OD, FAAO
    Clinical director of Omni Center for Dry Eye Specialty Care in New York City

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