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K. S. Shahid, N. Salameh, G. Pelaez, A. M. Kolomeyer, N. V. Nayak, T. Eck, Y. Xu, B. C. Szirth; Ocular Health and Systemic Risk Factors in an Urban Soup-Kitchen Population. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4371.
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To provide comprehensive ophthalmic health screenings for urban soup kitchen and homeless populations to: a) identify the prevalence of, and refer for management, undetected vision threatening disease (VTD) in this group, b) collect data on factors that may contribute to VTD, c) determine overall risk of VTD.
Between January and August 2009, 341 subjects completed comprehensive ocular health screenings at soup kitchens/ homeless outreach in Newark, NJ. Visual acuity (VA), blood pressure (BP), pulse/O2 saturation, body mass index (BMI), and intraocular pressure (IOP) were assessed. History of diabetes (DM), hypertension (HTN), smoking, last ocular examination, and ocular disease was noted. Ocular imaging was done with an 8.2 mega pixel non-mydriatic CR-DGi digital retinal camera (Canon Inc., Tokyo, Japan).
Positive VTD findings were identified in 105 (31%) subjects (mean age, 53.6 years). Of these, 78% were African American, 73% males, and 62% smokers. BP was >140/90 in 45% and BMI >25 in 59%. Reported history of HTN and DM was 42% and 17%, respectively. Only 56% had an eye examination within the past 2 years. Mean VA (right, left) was 20/42 and 20/63; 16% were visually impaired or legally blind. Mean IOP was 15 mmHg in both eyes; 13% had IOP>21 mmHg. Mean O2 saturation was 97%. VTD Imaging results included: glaucoma detection in 34 (32%), significant cataract in 22 (21%), diabetic retinopathy in 5 (5%), optic atrophy in 1 (1%), age-related macular degeneration in 1 (1%), and other retinal findings in 43 (41%). Based on imaging, 82 (70%) subjects were referred for comprehensive ophthalmic dilated examination, 12 (10%) for glaucoma evaluation, 12 (10%) for retinal follow-up, six (6%) for low-vision consultation, four (3%) for cataract surgery, and one (0.9%) for neuro-ophthalmology work-up. Fifteen subjects (4.4%) were referred for ophthalmic evaluation because of small pupil, media opacities, or dense cataracts.
The higher incidence of VTDs in our soup kitchen/ homeless cohort, as compared to previous screening programs (31% vs. 12%), demonstrates a trend of increased ocular morbidity in a younger, at risk population that has higher rates of HTN, DM, and smoking compared to national average. Functional visual impairment was 2.5 times higher than the national average (16% vs. 6.4%), possibly due to lack of routine, refractive eye care. Comprehensive community-based ophthalmic tele-health screenings can provide more sensitive detection of VTDs and prevention of blindness in at risk groups with low access to ophthalmic care.
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