Prevalence and impact of eye disease in an urban homeless and marginally housed population

Abstract

ObjectiveHomeless and marginally housed (HMH) populations have a higher prevalence of visual impairment than the general population. This study is the first to conduct a comprehensive ophthalmic examination using portable equipment at various homeless shelter locations in an urban population to identify objective ocular pathologies in a randomly selected sample. MethodsTen adult shelters were randomly selected in Toronto, Ontario, Canada, and 143 individuals were randomly selected based on their shelter bed numbers at each shelter, in proportion to the shelter's bed capacity. Participants completed a sociodemographic survey and clinical eye examination. Finally, a dilated ocular examination was performed using a portable slit lamp, autorefractor, tonometer, indirect ophthalmoscope, and fundus camera. ResultsThe median age of participants was 53.3 years; 82.5% were male and 17.5% female. The age-standardized prevalence of visual impairment was 27.4% (95% confidence interval [CI], 20.6–35.1) for study participants. Refractive error was present in 48% of participants, 34% with myopia and 11% with hyperopia, and 37.8% (95% CI, 32.2–45.9) of this study population were diagnosed with at least one nonrefractive ocular pathology. Low income and low educational attainment were associated with increased odds of being diagnosed with nonrefractive ocular pathologies. ConclusionsA clear health care gap exists between the ophthalmological disease burden of the HMH population and the amount of resources allocated directed toward their needs. Addressing risk factors such as low income and education, as well as increasing access to free eye examinations and visual aids, may be an effective method of attending to this lack of health equity.