title: Visual impairment and unmet eye care needs among homeless adults in a Canadian city.
abstract: OBJECTIVE
  The ocular status of homeless populations remains largely unknown. Given that visual acuity has been shown to be heavily correlated with reduced well-being and decreased earning potential, findings of poor vision could have important health implications for people experiencing homelessness.
  
  
  OBJECTIVE
  To assess the prevalence of visual impairment and to identify unmet eye care needs in an adult homeless population.
  
  
  METHODS
  For this cross-sectional study, we recruited 100 homeless persons using a stratified random sampling technique from January to March 2014. Recruitment took place at 10 randomly selected adult shelters in Toronto, Ontario, Canada. All English-speaking persons older than 18 years of age were eligible to participate. Information was obtained on sociodemographic characteristics, ocular history, and subjective visual acuity. A comprehensive vision screening and an undilated retinal examination were performed for each participant.
  
  
  METHODS
  Rates of functional visual impairment and prevalence of nonrefractive eye pathology.
  
  
  RESULTS
  The median age of participants was 48 years (interquartile range, 36-56 years), and 62% were men. The median lifetime duration of homelessness was 12 months (interquartile range, 5-36 months). Based on the participants' presenting visual acuity, the age-standardized rate of visual impairment was 25.2% (95% CI, 16.7%-33.7%). After pinhole occlusion, this number decreased to 15.2% (95% CI, 7.7%-22.7%). In total, 13.0% (95% CI, 7.8%-20.0%) of participants experienced visual impairment secondary to a correctable refractive error. Although the major problem for this demographic was limited access to refractive correction, a large degree of nonrefractive pathology was also observed. Of all the participants, 34.0% (95% CI, 24.7%-43.3%) had 1 or more abnormal findings during the vision screening, and 8% (95% CI, 2.7%-13.3%) required urgent referral to an ophthalmologist. A large majority of participants (89.0%) indicated interest in accessing free eye examinations.
  
  
  CONCLUSIONS
  These data suggest that homeless adults have a high prevalence of visual impairment, even when living within a system of universal health insurance. Given the high level of interest in eye care among homeless persons, ongoing vision-screening programs and readily accessible free eye clinics may help address this need.
authors: Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Christopher W
authors: CW
authors: Noel
authors: Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Henry
authors: H
authors: Fung
authors: Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Raman
authors: R
authors: Srivastava
authors: Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada3Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors: Gerald
authors: G
authors: Lebovic
authors: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada5Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Stephen W
authors: SW
authors: Hwang
authors: Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Alan
authors: A
authors: Berger
authors: Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Myrna
authors: M
authors: Lichter
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D014786:Vision Disorders / Q000453:epidemiology*; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*