Ophthalmic Problems among Homeless Individuals in Los Angeles County, California

Abstract

Purpose : Homeless populations face barriers to medical care, yet have greater morbidity/mortality than the general population. With limited access to care, vision-threatening ophthalmic diseases and uncorrected refractive errors can remain undetected, profoundly impacting activities of daily living. We investigated prevalence and spectrum of ophthalmic problems among individuals attending a clinic for the homeless in Los Angeles County (LAC).

Methods : We reviewed medical records for all homeless individuals evaluated through the UCLA Mobile Eye Clinic at a monthly free clinic conducted at a Salvation Army facility in West Hollywood from August 2015 - July 2019. Data, including demographics and medical history, had been recorded on a standard form. Certified ophthalmic technicians determined visual acuity (VA) and intraocular pressure. Those with reduced VA underwent manifest refraction. Board-certified ophthalmologists performed slit lamp biomicroscopy and dilated fundoscopy.

Results : A total of 233 homeless individuals were examined during the study period. Mean age was 48 years (range 18-90 years). Sex/gender distribution was consistent with that of homeless populations across the US: 66.4% male; 33.2% female; 0.4% transgender. Race/ethnicity differed substantially from the general LAC population; specifically, 25.6% of individuals in the homeless population were black compared to 9% in the general population. Uncorrected VA <20/40, but >20/200, in the better eye at presentation was found in 44.6% of individuals, while uncorrected VA of ≤20/200 in the better eye was found in 24.6%. VA improved with refraction in 94.1% of individuals. Glaucoma was suspected in 4.6% of individuals, which is more than double the prevalence reported for the general US population. Prevalence of diabetic retinopathy (DR) among diabetics was 20.8%, which is comparable to prevalence estimates for the general US population.

Conclusions : There is a substantial burden of refractive errors, glaucoma, and DR among homeless individuals. In many cases, individuals are at risk for permanent vision loss, despite the fact that these conditions are treatable. Additional community outreach strategies are needed to improve access of homeless populations to evaluation and treatment of ophthalmic problems. The chronic nature of glaucoma and DR highlight the need for strategies to ensure adequate follow-up care for these individuals.

This is a 2020 ARVO Annual Meeting abstract.