Unmet eye care needs among a homeless youth population.
OBJECTIVE
To assess the rate of visual impairment and quantify the unmet eye care needs within Toronto's homeless youth community.


METHODS
Prospective and cross sectional.


METHODS
Ninety randomly selected homeless youth aged 16-24 years.


METHODS
From each of 9 participating homeless youth shelters and drop-in centres in Toronto, 10 English-speaking youths between ages 16 and 24 were randomly recruited. Information regarding sociodemographics, medical history, subjective visual acuity, and access to eye care was collected. Comprehensive visual screening and undilated direct fundoscopy were also performed.


RESULTS
The median age of participants was 21 years (interquartile range = 19-23 years), and 62.2% were male. Most participants were homeless for less than 5 years (90%) and earning less than $500 monthly (57.8%). Despite 51.1% of participants having previously owned corrective lenses, only 20% of participants currently owned them when assessed/at study time. When analyzing the better-seeing eye, presenting visual acuity was 20/50 or worse in 18.9% (95% CI 10.8%-27.0%) of participants. Pinhole occlusion decreased the number to 2.2% (95% CI 0%-5.3%). The most common cause of visual impairment was uncorrected refractive error. Ocular pathology was observed in 8 participants. Compared to adults, youth have similar functional visual impairment (adults 24.0%, youth 18.9%) but less impairment uncorrectable by pinhole occlusion (adults 11.0%, youth 2.2%) and are less dissatisfied with their vision (adults 70.0%, youths 36.7%). Although a higher proportion of homeless youths have visited an eye specialist in the past year (adults 14.0%; youths 17.8%), neither group is visiting as frequently as the Canadian average (41%) (p < 0.01).


CONCLUSIONS
Homeless youth have a high prevalence of visual impairment, even when living within a system of universal health insurance. Ongoing vision-screening programs, readily accessible free eye clinics, and particularly low-cost glasses may help address this need.
Faculty of Medicine, University of Toronto, Toronto, Ont. Electronic address: christopher.noel@mail.utoronto.ca.
Christopher W
CW
Noel
Faculty of Medicine, University of Toronto, Toronto, Ont.
Raman
R
Srivastava
Faculty of Medicine, University of Toronto, Toronto, Ont.
Ryan
R
Lo
Department of Ophthalmology, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Alan
A
Berger
Department of Ophthalmology, Hospital for Sick Children, University of Toronto, Toronto, Ont.
Nasrin
N
Tehrani
Department of Ophthalmology, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Myrna
M
Lichter
D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D018453:Homeless Youth / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D009885:Ophthalmology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014786:Vision Disorders / Q000453:epidemiology*; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D055815:Young Adult