Visual and Ocular Conditions among a Homeless Adult Population of Boston

Abstract

SIGNIFICANCE The eye care needs of the homeless population in the United States are not well known. This study elucidates those needs for health care for the homeless programs and eye care practitioners. This information could result in an increase in the provision of necessary eye care services. PURPOSE The purpose of this study was to assess the extent of visual and ocular conditions, the frequency of eyeglass orders and receipt of eyeglasses, and the frequency of ophthalmology referrals and receipt of ophthalmological care in an adult homeless population in Boston. METHODS A cross-sectional retrospective chart review was conducted for patients of the Boston Health Care for the Homeless Program's Pine Street Inn eye clinic from September 26, 2016, to December 31, 2017. Data on sociodemographics, medical history, comprehensive eye examination findings, glasses orders and receipt, and ophthalmology referrals and receipt of care were collected and analyzed. RESULTS A total of 424 patients were included in the study. The mean age of the study population was 52.7 (interquartile range, 46 to 60), and the majority were male (74%). The most common systemic conditions were hypertension (40.6%) and diabetes (23.8%). The most common refractive error was presbyopia (67.7%), followed by astigmatism (38.9%), hyperopia (34.0%), and myopia (30.7%). The most common ocular conditions were dry eye (28.6%), visually or clinically significant cataract (20%), and glaucoma/glaucoma suspicion (13.9%). Refractive correction was indicated for 356 patients (84%), but 82 (29%) did not receive ordered eyeglasses. Ophthalmology referrals were placed for 61 patients (14.4%), yet only 20 (32.8%) of those referrals were completed. CONCLUSIONS A significant need for refractive correction and a large gap for ophthalmological care were found among the study population. Health care for the homeless programs and eye care practitioners should be aware of the visual and ocular needs of this patient population so as to better meet their needs.

Prevalence and risk factors for refractive error in older adults in eight ethnicities in China: The China National Health Survey (CNHS)

“…However, the differences in myopia frequency in older adults years in different countries were not as obvious [24]. In the present study, the total myopia frequency was 22.9% in older Han adults, which was similar to that of the Europe Eye Epidemiology (E 3 ) Consortium study (27.5% in those aged 55-59 years) [25] and the Gutenberg Health Study (29.3% in those aged 55-64% years)[26] and even lower in some epidemiological studies in the US (ranging from 30.7% in those aged 46-60 years to 36.1% in those aged 50-59 years) [27,28]. Another reason for the relatively low myopia frequency in the Han population in the present study compared to other epidemiological studies is that this epidemiological investigation used a large multiethnic population-based sampling strategy.…”

Prevalence and Incidence of Dry Eye and Meibomian Gland Dysfunction in the United States

“…Our search yielded 11 133 unique titles and abstracts. After screening 128 full-text reports, we included 13 studies (14 reports) (eFigure 1 in the Supplement) and provided reasons for excluding 14 studies that might have been expected to be included (eTable 2 in the Supplement).…”

“…The included studies covered 3 topics: dry eye prevalence (n = 10), dry eye incidence (n = 2), and MGD prevalence (n = 3) (Table 1). Data sources varied across the 13 studies (Table 1): health care system, multi-institutional, or nationwide studies using secondary data (n = 3); population-based epidemiological studies (n = 3); and single-institution clinic or hospital-based studies (n = 7) . Definitions of dry eye varied across prevalence (Table 2) and incidence studies (Table 3): relevant ICD codes and/or data extracted from medical records (n = 6), symptom questionnaires without signs and/or self-reported diagnosis (n = 4), and signs alone (n = 1) .…”

“… Data sources varied across the 13 studies (Table 1): health care system, multi-institutional, or nationwide studies using secondary data (n = 3); population-based epidemiological studies (n = 3); and single-institution clinic or hospital-based studies (n = 7) . Definitions of dry eye varied across prevalence (Table 2) and incidence studies (Table 3): relevant ICD codes and/or data extracted from medical records (n = 6), symptom questionnaires without signs and/or self-reported diagnosis (n = 4), and signs alone (n = 1) . Definitions of MGD also varied across studies (Table 2): relevant ICD codes and/or data extracted from medical records (n = 1) and signs alone (n = 2) …”

“…Summaries of risk-of-bias assessments for the dry eye and MGD prevalence studies are presented in eTable 3 in the Supplement. Of the 10 studies that reported prevalence of DED, we judged overall risk of bias to be high in 5 studies (50%), moderate in 4 studies (40%), and low in 1 study (10%) . We judged all 3 studies that reported prevalence of MGD to be at overall high risk of bias .…”