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Collier Jiang, myrna lichter; The prevalence and impact of eye disease in an urban homeless population. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5233.
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© ARVO (1962-2015); The Authors (2016-present)
Homeless and marginally housed (HMH) populations have a high prevalence of visual impairment, yet they face substantial barriers to accessing specialist care. While one past study demonstrated a higher proportion of subjective visual problems in the HMH population compared to the general population, this is the first study to conduct a comprehensive ophthalmology exam using portable equipment at different shelter locations to identify objective pathologic findings.
For this cross-sectional study, 10 adult shelters were randomly selected in Toronto, Ontario, Canada. HMH clients were randomly selected based on their bed numbers, in proportion to the bed capacity at each shelter. A total of 61 participants have been recruited thus far, from August to November 2017. A survey was conducted to obtain details about sociodemographic background, ocular history, subjective visual acuity, and access to care. A comprehensive vision screening and dilated retinal exam was performed using a portable slit lamp, autorefractor, Tono-pen, indirect ophthalmoscope, and fundus camera.
The mean age of participants was 55, with 20% women. The mean lifetime duration of homelessness was 8.8 years. 48% of participants had refractive error, including 35% with myopia (spherical component ≤ -1 diopter) and 13% with hyperopia (spherical component ≥ 1 diopter). 19% of participants had an intraocular pressure reading of 22 mmHg or greater in at least one eye, which is considered higher than normal. Many previously undiagnosed pathologies such as cataracts, diabetic retinopathy, arcus senilis, pterygium, and spastic ectropion were also identified during the shelter clinic visits. 67% of surveyed participants indicated that they were not satisfied with their vision, while only 17% of these participants had seen an eye specialist in the past and only 12% were able to access care. 97% of participants expressed an interest in accessing free eye examinations as well as free eyeglasses, eyedrops or magnifiers if they were offered.
These data reveal a clear healthcare gap between the ophthalmological disease burden of the HMH population, and the amount of resources allocated towards addressing their needs. Increasing access to free eye examinations and providing aids such as eyeglasses and eyedrops may be an effective method of addressing this gap.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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