The impact of smoking on age-related macular degeneration among tea garden workers of Southern Assam

Objectives: To determine the prevalence of age-related macular degeneration (AMD) and to evaluate its association with smoking, measured in pack-years, among tea garden laborers aged 50 years and above in Southern Assam, India. Material and Methods: A community-based, cross-sectional analytical study was conducted over 12 months (January-December 2024) across five randomly selected tea estates in Southern Assam. A sample of 400 participants was recruited through stratified random sampling. All participants underwent a structured interview to record demographics, smoking history, and systemic comorbidities. A comprehensive ophthalmological examination was performed, including visual acuity testing, slit-lamp biomicroscopy, dilated fundus examination, and optical coherence tomography. AMD was diagnosed and graded according to the age-related eye disease study classification system. Statistical analysis was performed using Statistical Package for the Social Sciences version 26, employing Chi-square tests, t -tests, and multivariate logistic regression to identify independent risk factors and explore correlations between visual acuity and AMD type. Results: The mean age of participants was 59.7 ± 6.3 years. The overall prevalence of AMD was 41% ( n = 164), with early AMD in 26.5% ( n = 106) and late AMD in 14.5% ( n = 58). A total of 238 participants (59.5%) were current or former smokers. The prevalence of AMD was significantly higher among smokers (58.4%) compared to non-smokers (18.8%) ( P < 0.001). On multivariate analysis, smoking ≥20 pack-years was the strongest independent risk factor for late AMD (odds ratio [OR] = 3.92; 95% confidence interval [CI]: 2.10-7.33; P < 0.001). Visual acuity was significantly lower in eyes with late AMD ( P < 0.001), while early AMD showed only mild-to-moderate reduction. Advanced age >60 years (OR = 1.67; 95% CI: 1.14-2.45; P = 0.002) and hypertension (OR = 1.43; 95% CI: 1.03-2.83; P = 0.03) were also significant predictors. Conclusion: Smoking is a potent and modifiable risk factor for AMD in this high-risk population of tea garden workers. The findings underscore the need for targeted public health strategies, including anti-smoking campaigns, community-based eye health education, and integration of regular retinal screening into primary healthcare services.