Abstract
Purpose :
Unhoused individuals face barriers to care and an increased risk of visual impairment. Existing studies on ocular health in this population are limited in size. To address this gap, we conducted a retrospective observational study to characterize ophthalmic diagnoses among unhoused individuals receiving care at a safety net hospital in Denver, Colorado.
Methods :
All unhoused adult patients who had Denver Health Medical Eye Clinic encounters between 1/1/2018 and 2/9/2022 were identified for retrospective chart review. We randomly sampled every 200th adult eye appointment in this same period for the control cohort. Statistical testing compared the two groups with t-test for age, Wilcoxon rank sum test for best reported visual acuity (BRVA), and Chi-square test or Fisher’s exact test for categorical variables.
Results :
The study included 718 unhoused patients and 240 controls. Demographics differences were notable with a younger mean age and higher percentage of male patients in the unhoused group (Table 1). The appointment no-show rate was higher in the unhoused group (54.3%) compared to the control group (38.3%, p<0.0001). Unhoused patients were more likely to be referred from Emergency department visits (14.8% vs. 3.3%, p<0.0001). Table 2 lists the top 10 most common diagnoses among the 534 unhoused patients and 223 controls with documented ocular diagnoses. Trauma-related injuries (TRI) were significantly higher among unhoused patients (25.1% vs. 2.7%, p<0.0001), while refractive error and cataract were significantly lower. 353 unhoused patients and 199 controls had a documented BRVA. Visual impairment (VA 20/50 or worse) was significantly higher among unhoused patients (13.7% vs. 7.6%, p=0.030). The prevalence of blindness was also significantly higher among the unhoused group (7.7% vs. 2.5%, p=0.013). The average BRVA of the unhoused group were OD 0.38 (20/48) and OS 0.44 (20/55), which was worse than control with OD 0.22 (20/33, p=0.0003) and 0.24 OS (20/35, p=0.0006).
Conclusions :
To our knowledge, this study is the largest retrospective analysis of ophthalmic diagnoses among unhoused individuals in the U.S. Unhoused individuals have higher rates of clinic non-attendance, TRI, visual impairment, and blindness compared to controls. Our findings underscore the need for interventions to reduce barriers to clinic attendance and to ensure continuous care for this vulnerable population.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.