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Switching from cigarettes to electronic vapes is often seen as a healthier move, but a massive nationwide study published in the American Journal of Ophthalmology suggests that smokeless alternatives could increase the risk of serious eye diseases compared to quitting nicotine altogether.

Researchers from the Korea University College of Medicine in Seoul, South Korea, analyzed health data from a group of 179,273 adults through the Korean National Health Insurance Service, according to a press release.

All participants had smoked traditional cigarettes between 2011 and 2012 and then quit smoking by 2018 or 2019, they reported.

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To ensure a fair comparison, the researchers paired up participants who shared similar backgrounds, including their age, gender, medical history, existing health conditions and general lifestyle habits.

This process created a balanced group of 32,316 matched participants, who were divided into two categories: complete quitters who stopped using all nicotine products and those who transitioned to smokeless nicotine products, such as vapes.

The researchers followed the participants for an average of 4.6 years to determine whether they developed eye conditions, including cataracts, glaucoma, age-related macular degeneration, diabetic retinopathy and focus-related eyesight disorders.

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Over the tracking period, the group experienced a total of 6,328 major eye disease events. People who quit nicotine entirely had the lowest disease rate in the study, at 41.1 cases per 1,000 person-years (a measure that accounts for both the number of people in the study and how long they were followed).

In comparison, that rate rose to 44 cases for individuals who had switched over to smokeless alternatives like vapes.

Ultimately, the data showed that switching to alternative nicotine products carried a steady 7% increased risk of serious eye diseases compared to quitting nicotine completely.

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Most notably, those who switched faced a 24% higher risk of developing diabetic retinopathy, a condition that damages the blood vessels in the light-sensitive tissue at the back of the eye.

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Additionally, those who ditched cigarettes for vapes had a 7% higher risk of developing refractive and accommodation disorders, which affect the eye’s ability to focus clearly.

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“These findings challenge the assumption that substituting noncombustible nicotine or tobacco products for conventional cigarettes is visually harmless,” the researchers noted.

The authors did point out a few limitations of the research. Because this was a study looking back at health insurance data, it cannot definitively prove that vaping directly causes eye damage.

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Additionally, the study relied on people filling out questionnaires about their own smoking and vaping habits, which can sometimes lead to underreporting or simple memory errors.

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Still, the researchers concluded the findings suggest that replacing cigarettes with alternative nicotine products may not eliminate the risk of certain eye diseases.

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