Abstract
Purpose :
To investigate the frequencies and causes of vision impairment among individuals experiencing homelessness in Ribeirão Preto, Brazil.
Methods :
A cross-sectional study was conducted across nine homeless support centers for individuals aged 18 or older experiencing homelessness in Ribeirão Preto, Brazil, from May 2023. The assessment protocol involved presenting (PVA) and best-corrected visual acuity (BCVA) examinations, automated refraction, slit lamp examination, tonometry, indirect ophthalmoscopy, and retinography. Participants were classified by levels of vision impairment visual acuity in the better-seeing eye: mild (<20/32 - ≥ 20/63), moderate (<20/63 – ≥20/200), severe (<20/200 - ≥20/400), and blindness (<20/400). The primary cause of vision impairment was determined per eye.
Results :
Of 371 invited individuals, 349 agreed to participate (297 men, 46 women, five transgender individuals, and one who declined to disclose gender). Of those assessed, 337 completed the visual acuity assessment, and 320 completed the physical examination. The age range was 18 to 83 years, with 186 individuals (53.30%) aged between 40-59 years old. The majority self-identified themselves as Afro-Brazilians (n=239; 68.4%). Additionally, 155 participants (44.41%) had been experiencing homelessness for at least one year, and the majority (n=212; 63.30%) had no formal education or only completed primary education.
The frequency of mild vision impairment in the better-seeing eye was 34.12% (95% CI: 29.23 – 39.38%) with PVA and 6.53% (95% CI: 4.33 – 9.73%) with BCVA. The frequency of moderate visual impairment was 7.71% (95% CI: 5.30 – 11.11%) with PVA and 2.08% (95% CI: 0.99 – 4.31%) with BCVA. The frequency of blindness in the better-seeing eye was 2.67% (95% CI: 1.39 – 5.07%) with PVA and 0.30% (95% CI: 0.04 – 2.09%) with BCVA.
Uncorrected refractive error was the leading cause of vision impairment in at least one eye (n=267; 40.50%), followed by cataracts (n=40; 6.00%) and retinal abnormalities (n=11; 1.67%). Older age (60 years old or older) was associated with vision impairment (PVA<20/32; odds ratio: 3.26 [1.56-6.82]).
Conclusions :
Most cases of vision impairment could be solved by free-of-charge spectacle provision. This underscores the importance of policy measures targeting people experiencing homelessness, ensuring accessible, quality eye care and refractive error services.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.