Abstract
Purpose :
When compared to adults in the same age-group, the unsheltered population has more ocular findings, with the most common being refractive error (RE). This population is usually not seen in a clinical setting, representing a gap in care. The street medicine team (comprised of internal medicine physicians, nurses, and social workers) provides medical care in locations like encampments, parks, and under bridges. In the prospective SMART Study, the street medicine team used a protocol designed by ophthalmology to screen and treat RE in unsheltered patients of Pittsburgh, PA.
Methods :
In the first encounter, the uncorrected visual acuity (ucVA) was measured using a visual acuity chart (Figure 1). Patients with clinically significant RE, defined as ≥2 line improvement with pinhole testing (phVA), underwent handheld portable auto-refraction (AR). During a second encounter, glasses purchased from an online retailer based on the AR measurements were distributed, and vision was re-measured (ccVA). Those with a final VA >0.3 logMAR were referred to a academic center for further work-up. Then a 5-item 5-point Likert scale survey was given. The average ucVA, phVA and ccVA was calculated along with 95% confidence interval (CI).
Results :
Results from the 85 patients screened including the demographics, the eyes and the AR are shown (Figure 2). The average ucVA was 0.60 (95% CI 0.49 to 0.71) Logarithm of the Minimum Angle of Resolution (logMAR) for the right eye (OD) and 0.53 (95% CI 0.50 to 0.73) logMAR for the left eye (OS). To date 51/64 (80.0%) have received their glasses. The average improvement in VA (ucVA - ccVA) was 0.41 (95% CI 0.30 to 0.52) logMAR and 0.44 (95% CI 0.30 to 0.52) logMAR in OD and OS, respectively. The average glasses was $23.17. 15/85 (17.6%) are being referred for further work-up.
Surveys (1 = strongly disagree to 5 = strongly agree) show that patients are satisfied with the testing (4.7) and the portable AR (4.4). Patients see better with prescribed glasses (4.7) and feel it will help with daily activities (4.7). Most patients would not have been able to obtain glasses without the study (4.6).
Conclusions :
The SMART Study demonstrates a model provide affordable glasses to unsheltered individuals in a non-ambulatory setting. Patients with non-RE can be identified and sent for further work-up.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.