EVALUATION OF RETINAL MICROVASCULAR ALTERATIONS IN SMOKERS WITHOUT SYSTEMIC DISEASE USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Purpose: To evaluate retinal microvascular alterations in chronic smokers without systemic comorbidities using optical coherence tomography angiography (OCTA) and to assess the relationship between smoking exposure and retinal microvascular parameters.

Methods: This prospective cross-sectional observational study included 40 chronic smokers (≥2 pack-years) without systemic disease. All participants underwent comprehensive ophthalmic examination and OCTA imaging using a 6×6 mm macular scan and a 4.5×4.5 mm optic nerve head scan. Quantitative parameters analyzed included superficial capillary plexus (SCP) vessel density, deep capillary plexus (DCP) vessel density, foveal avascular zone (FAZ) area, radial peripapillary capillary (RPC) density, and ganglion cell complex (GCC) thickness. Correlation between smoking exposure (pack-years) and OCTA parameters was assessed using Pearson correlation analysis.

Results: The mean SCP and DCP vessel densities were 44.3 ± 3.8% and 46.1 ± 4.1%, respectively. The mean FAZ area was 0.39 ± 0.08 mm². The mean RPC density and GCC thickness were 50.2 ± 4.5% and 89.6 ± 6.2 µm, respectively. Smoking exposure demonstrated a significant negative correlation with SCP vessel density (r = −0.52, p < 0.001) and DCP vessel density (r = −0.47, p < 0.001), while FAZ area showed a significant positive correlation (r = 0.44, p < 0.001).

Conclusion: Chronic smoking is associated with measurable retinal microvascular alterations detectable by OCTA, even in the absence of systemic disease. Increasing smoking exposure correlates with reduced vessel density and enlargement of the FAZ, suggesting early microvascular compromise. OCTA may serve as a sensitive, non-invasive tool for detecting subclinical smoking-related vascular injury.