Smoking is a known risk factor for age-related macular degeneration (AMD) and cataracts. The CDC says people who smoke are twice as likely to develop AMD, and two to three times more likely to develop cataracts, than people who do not smoke. The CDC also says quitting may lower your risk for both. If you smoke or used to smoke and your eye doctor suggests an eye vitamin, the National Eye Institute (NEI) says to choose the AREDS2 formula, not the original AREDS formula.
Smoking is linked to two eye conditions that affect many older adults: AMD and cataracts. This article explains what the research shows, what is known about quitting, and why the type of eye vitamin matters for current and former smokers.
Smoking and macular degeneration
AMD happens when aging damages the macula, part of the retina (the light-sensitive tissue at the back of the eye). NEI says AMD does not cause complete blindness, but losing central vision can make it harder to see faces, read, drive or do close-up work.
NEI's AMD page lists four main risk factors: older age (55 and older), a family history of AMD, being Caucasian and smoking. Of those four, smoking is the only one you can change.
The CDC puts a number on it. Its page on vision loss, blindness and smoking says that if you smoke, you are twice as likely to develop AMD as people who do not smoke.
What the studies show
One of the sources the CDC cites is a systematic review by Thornton and colleagues (Eye, 2005). It gathered 17 studies of smoking and AMD. All were observational, meaning they compared people's smoking habits with who developed AMD, rather than assigning anyone to smoke.
In 13 of the studies, smoking was linked to AMD, with a two to three times higher risk in current smokers compared with people who never smoked. Five studies found no link. (Those counts add up to 18, not 17, as printed in the published summary.) The authors also reported evidence that more smoking went with more risk, that smoking came before AMD developed, and that the effect may be reversible. They concluded that the association was strong and "fulfilled established causality criteria."
Smoking and cataracts
A cataract is a cloudy area in the lens of your eye, the clear part that helps focus light. According to NEI's cataracts page, more than half of Americans age 80 or older either have cataracts or have had surgery to remove them.
NEI lists smoking as a cataract risk factor, along with diabetes, drinking too much alcohol, a family history of cataracts, eye injury or surgery, radiation, sun exposure and steroid use. The CDC says people who smoke are two to three times more likely to develop cataracts than people who do not smoke.
What happens after you quit
The CDC's advice is plain: "If you smoke, stop. Quitting may lower your risk for both AMD and cataracts." It adds that if you already have AMD, "quitting smoking may slow the disease." Note the careful word "may." These are hopeful statements, not guarantees.
Cataracts: risk falls slowly
Numbers on quitting come from a study of 44,371 Swedish men (JAMA Ophthalmology, 2014). The men were aged 45 to 79 and were followed for 12 years, during which 5,713 had cataract surgery.
- Men who currently smoked more than 15 cigarettes a day had a 42% higher rate of cataract surgery than men who never smoked (rate ratio 1.42).
- After quitting, the risk went down over time.
- Even more than 20 years after quitting, men who had smoked more than 15 a day still had a 21% higher rate than never smokers (rate ratio 1.21).
The authors concluded that quitting "seems to decrease the risk of cataract extraction with time, although the risk persists for decades." Keep in mind that this was an observational study, it included only men, and it measured cataract surgery rather than every cataract.
AMD: less is known
For AMD, we could not find a primary source that measures how much or how quickly risk falls after quitting. The Thornton review reported evidence of "reversibility of effect," and the CDC says quitting "may" lower risk. Neither gives a number, so we will not guess at one.
Help to quit: NEI suggests that if you are ready to quit, you can call 1-800-QUIT-NOW (1-800-784-8669) for free support. Your doctor can also talk with you about options.
Smokers, former smokers and eye vitamins
This is where smoking history matters for anyone considering an eye vitamin. The original AREDS formula contained a carotenoid that was later replaced. NEI says current and former smokers should take the AREDS2 formula, not the original. As NEI's AREDS 2 supplements page puts it: "if you smoke or used to smoke, make sure to choose the newer AREDS 2 supplements."
The reason is lung cancer. AREDS2 found more lung cancers in former smokers taking the original formula's carotenoid, which is one reason it was replaced with lutein and zeaxanthin. The numbers:
| Finding | Result | Source |
|---|---|---|
| Lung cancers during AREDS2 | 23 with the original carotenoid vs 11 without it | AREDS2, JAMA 2013 |
| Share of people who got lung cancer | 2% with the original carotenoid vs 0.9% without | NEI AREDS/AREDS2 FAQ |
| Former smokers among those cases | About 91% | NEI AREDS/AREDS2 FAQ |
| Lung cancer at 10 years, people assigned the original carotenoid | Odds ratio 1.82 (95% CI 1.06 to 3.12) | AREDS2 Report 28 |
| Lung cancer at 10 years, people assigned lutein and zeaxanthin | Odds ratio 1.15 (95% CI 0.79 to 1.66), not statistically significant | AREDS2 Report 28 |
If you are comparing products, check the label against the AREDS2 formula. Our label comparison of AREDS2 supplements shows what to look for.
An eye vitamin is not a substitute for quitting
AREDS2 supplements were studied to slow progression in people who already have intermediate AMD, or late AMD in one eye. NEI's FAQ says the formulas showed no benefit for people with early AMD or without AMD, and that "nutritional supplements cannot prevent AMD." Whether a supplement fits you depends on your eye exam, so talk with your eye doctor. Our article Can AREDS2 prevent macular degeneration? explains more.
One nutrition note: the NIH Office of Dietary Supplements says people who smoke need 35 mg more vitamin C a day than people who do not. See vitamin C and vitamin E for eye health for food sources.
Why eye exams matter if you smoke or used to
The CDC notes that "AMD often has no early symptoms, so an eye exam is the best way to spot this eye disease early." Symptoms the CDC lists include blurred vision or a blurry spot in the center of your vision, needing more light to read, straight lines that look wavy, and trouble recognizing faces.
NEI says wavy straight lines are a warning sign for late AMD, and if you notice them you should see your eye doctor right away. NEI's cataracts page advises a dilated eye exam every 1 to 2 years if you are 60 or older. The American Academy of Ophthalmology advises people 65 and older to have their eyes checked every year or two. Our guide to eye health after 50 covers exams in more detail, and The Symptoms of Macular Degeneration describes what to watch for.
Frequently asked questions
I quit years ago. Is my eye risk back to normal?
For cataract surgery, the Swedish study found that risk went down after quitting but was still somewhat higher more than 20 years later in men who had smoked heavily. For AMD, no source we reviewed measures how fast risk falls. Tell your eye doctor about your smoking history either way.
Can former smokers take AREDS2?
NEI specifically says current and former smokers should choose the AREDS2 formula rather than the original formula. Whether you need an AREDS2 supplement at all depends on whether you have intermediate or late AMD, so ask your eye doctor.
Does smoking cause AMD?
The evidence comes from observational studies, which cannot prove cause on their own. The 2005 Thornton review concluded that the link met established criteria for causation, and the CDC says people who smoke are twice as likely to develop AMD. If you are comparing eye vitamins for a former smoker, our science page lists the doses used in the trials.
Related reading
- Are AREDS2 vitamins safe? Side effects and interactions
- The AREDS and AREDS2 trials explained
- Cataracts vs macular degeneration
- What is AREDS2 and who needs it?
References
- Centers for Disease Control and Prevention. Vision Loss, Blindness, and Smoking. Tips From Former Smokers (last reviewed February 24, 2025). cdc.gov
- Thornton J, Edwards R, Mitchell P, Harrison RA, Buchan I, Kelly SP. Smoking and age-related macular degeneration: a review of association. Eye (Lond). 2005;19(9):935-944. doi:10.1038/sj.eye.6701978
- Lindblad BE, Hakansson N, Wolk A. Smoking cessation and the risk of cataract: a prospective cohort study of cataract extraction among men. JAMA Ophthalmol. 2014;132(3):253-257. doi:10.1001/jamaophthalmol.2013.6669
- Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-2015. doi:10.1001/jama.2013.4997
- Chew EY, Clemons TE, Agrón E, et al. Long-term outcomes of adding lutein/zeaxanthin and omega-3 fatty acids to the AREDS supplements on age-related macular degeneration progression: AREDS2 report 28. JAMA Ophthalmol. 2022;140(7):692-698. doi:10.1001/jamaophthalmol.2022.1640
- National Eye Institute. Age-related macular degeneration (updated June 22, 2021). nei.nih.gov
- National Eye Institute. AREDS 2 supplements for age-related macular degeneration (updated June 22, 2021). nei.nih.gov
- National Eye Institute. AREDS/AREDS2 frequently asked questions (updated November 19, 2020). nei.nih.gov
- National Eye Institute. Cataracts (updated August 19, 2026). nei.nih.gov
- NIH Office of Dietary Supplements. Vitamin C: Fact Sheet for Health Professionals (updated July 31, 2025). ods.od.nih.gov
- American Academy of Ophthalmology. Eye Exams 101. aao.org
This article is for general education and is not medical advice. Talk with your eye doctor before starting any supplement, especially if you smoke, take other medicines, or have a health condition. These statements have not been evaluated by the Food and Drug Administration. TruVista products are not intended to diagnose, treat, cure, or prevent any disease.
