Most optometrists providing publicly funded eye care services in Wales report assessing patients’ smoking status during eye examinations, with 96% reporting that they aim to identify smoking status in patients aged 16 years or older.
The findings come from a cross-sectional survey of optometrists delivering Wales General Ophthalmic Services (WGOS), conducted following the introduction of national regulations requiring clinicians to ask patients about smoking status and offer cessation advice when appropriate. The study, published in Clinical Optometry, evaluated current practice patterns, clinician confidence, and perceived barriers to smoking-related discussions in optometric care.
Researchers distributed an anonymous online questionnaire to optometrists providing National Health Service (NHS) optometry services in Wales over a 4-week period beginning May 21, 2025. The survey included questions on demographics, training history, current practices related to smoking status identification and counseling, confidence in discussing smoking behaviors, and barriers to these discussions. Data were analyzed using descriptive statistics and multiple ordinal regression analysis.
A total of 778 optometrists completed the survey, representing a 72% response rate among the 1,086 clinicians listed as providing NHS services in Wales. Most respondents worked in practice-based settings, and the median time since professional registration was 16 years.
Overall, 96% of respondents reported that they aim to identify whether patients smoke during WGOS eye examinations. Once smoking status was identified, clinicians most frequently reported advising patients about the link between smoking and eye health (78%) and assessing patient motivation to stop smoking (56%).
Other commonly reported actions included providing written or online resources about smoking cessation support options (44% often) and advising patients to cut down or gradually reduce smoking (43% often). In contrast, clinicians were less likely to refer patients to a general practitioner (4% often), recommend alternative nicotine delivery methods such as vaping (9% often), or follow up or assess whether the patient successfully quit (13% often).
Training and Resources
Training appeared to support clinician engagement in smoking-related discussions. Eighty-three percent of respondents reported feeling adequately trained to advise patients about smoking cessation, and 98% said they had sufficient knowledge about the relationship between smoking and eye disease. Mandatory Making Every Contact Count training—an online educational program required for optometrists delivering WGOS services—was considered adequate by 83% of respondents.
Clinicians also reported generally high confidence in initiating conversations about smoking. Forty-two percent said they felt very confident asking patients whether they smoke, and 30% reported being very confident discussing the impact of smoking on eye health. Confidence was lower for counseling activities such as providing strategies for smoking cessation or discussing smoking behaviors with family members.
More than half of respondents (52%) indicated that optometrists are ideally positioned to discuss smoking cessation with patients.
Barriers to Smoking Discussions
Despite these findings, several barriers to smoking-related conversations were reported. Sixty percent of respondents said patients’ reluctance to discuss health behaviors made it difficult to identify smoking status, and 59% cited limited consultation time as a barrier.
Regression analysis suggested that optometrists with longer professional tenure were more likely to view patient reluctance as a barrier to discussing smoking behaviors. Conversely, optometrists working across multiple practices were less likely to view patient reluctance as a significant barrier. Additional smoking-related training and practice location were not significantly associated with identifying patient reluctance as a barrier.
The study also contextualized the findings against earlier research in the United Kingdom. Prior surveys reported that only 35% of optometrists routinely asked new patients about smoking status and 29% offered cessation advice when smoking was identified. The current survey suggests a notable change in practice in Wales, with almost all optometrists reporting that they aim to assess smoking status.
Study Limitations
The researchers noted several limitations. Survey-based data may be subject to response bias, as clinicians could report socially desirable answers instead of their genuine opinions or behaviors. The researchers also noted that quantitative survey methods provide limited insight into clinicians’ motivations or patient experiences and suggested that future research could incorporate qualitative approaches.
The researchers suggested that training and national guidance may have supported increased engagement in smoking-related discussions. Future research should evaluate whether these interventions influence patients’ likelihood of quitting smoking.
Roche Products Ltd supported article submission charges through a hands-off grant. The company had no involvement in the preparation, drafting, or editing of the manuscript, and the researchers reported no conflicts of interest.
Source: Clinical Optometry