Abstract
Purpose :
Housing insecurity is a significant public health issue with up to 4.2% of the U.S. population experiencing homelessness for one month or more during their lifetime. Individuals experiencing homelessness have a greater number of unmet healthcare needs than the housing secure. Rates of ocular pathology and visual impairment in the unhoused have been documented in several global urban populations, however, little has been published regarding this population in smaller cities. The purpose of this project is to evaluate the prevalence of ocular pathology and visual impairment in the sheltered population of Winston-Salem, North Carolina.
Methods :
Free complete eye exams were conducted at a local homeless shelter as part of a student-run, volunteer clinic. New and return patients were evaluated by medical students, ophthalmology residents, and an attending ophthalmologist. Information collected included: demographics, ocular and medical history, results of an 8-part eye exam, and manifest refraction. Patients were provided spectacles when untreated refractive error was identified. Patients with pathology that required medical or surgical management were scheduled for follow up at the Atrium Health Wake Forest Baptist Eye Center.
Results :
19 patients were seen over 21 total visits. 15 patients (79%) were men, and 4 (21%) were women. 4 (21%) had hypertension, and 4 (21%) had diabetes. Ocular pathology was identified in 100% of patients, the most common being: presbyopia (42%), refractive error (42%), and cataracts (42%). Average presenting visual acuity (VA) was 20/60. 19 eyes (52.8%) had a VA <= 20/40, and 17 eyes (47.2%) had a VA >20/40. The mean spherical equivalent was -1.81 D. 5 patients (26.3%) had >/= 1 diopter of astigmatism. On average, VA improved to 20/28 with refraction. Average intraocular pressure (IOP) was 16.66, and 5 eyes (13%) had an IOP >21. 3 patients were referred for further evaluation at the Atrium Health Wake Forest Baptist Eye Center. Refractive error was directly addressed in 10 patients (53%) - 3 pairs of reading glasses were given, and 7 pairs of prescription glasses were ordered.
Conclusions :
Ocular pathology and visual impairment are common in individuals experiencing homelessness in Winston-Salem. A volunteer clinic with access to free glasses can help overcome barriers to healthcare these patients face and address the primary reason for visual impairment in a majority of patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.