Department of Ophthalmology, St Michael's Hospital Health Centre, University of Toronto, Toronto, Ontario, Canada.
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.
JAMA Ophthalmol. 2015 Apr;133(4):455-60. doi: 10.1001/jamaophthalmol.2014.6113.
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.
To assess the prevalence of visual impairment and to identify unmet eye care needs in an adult homeless population.
DESIGN, SETTING, AND PARTICIPANTS: 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.
Rates of functional visual impairment and prevalence of nonrefractive eye pathology.
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.
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.
无家可归人群的眼部状况在很大程度上尚不清楚。 鉴于视力已被证明与幸福感降低和收入潜力降低密切相关，因此视力不佳的发现可能对无家可归者的健康产生重要影响。
评估成年无家可归人群中视力障碍的患病率，并确定未满足的眼部护理需求。
设计、地点和参与者： 这是一项横断面研究，我们于 2014 年 1 月至 3 月期间使用分层随机抽样技术从 10 个随机选择的安大略省多伦多市成人收容所招募了 100 名无家可归者。所有年龄在 18 岁以上、会讲英语的人均有资格参加。收集了参与者的社会人口统计学特征、眼部病史和主观视力信息。对每位参与者进行全面的视力筛查和非散瞳视网膜检查。
功能性视力障碍的发生率和非屈光性眼病的患病率。
参与者的中位年龄为 48 岁（四分位距，36-56 岁），62%为男性。终生无家可归的中位时间为 12 个月（四分位距，5-36 个月）。根据参与者的表现视力，视力障碍的年龄标准化发生率为 25.2%（95%CI，16.7%-33.7%）。在使用小孔掩蔽后，该数字下降至 15.2%（95%CI，7.7%-22.7%）。总的来说，13.0%（95%CI，7.8%-20.0%）的参与者因可矫正的屈光不正而出现视力障碍。尽管该人群的主要问题是难以获得屈光矫正，但也观察到了很大程度的非屈光性病变。在所有参与者中，34.0%（95%CI，24.7%-43.3%）在视力筛查中出现 1 种或多种异常发现，8%（95%CI，2.7%-13.3%）需要紧急转介至眼科医生。绝大多数参与者（89.0%）表示有兴趣接受免费眼部检查。
这些数据表明，即使在全民医疗保险体系下，成年无家可归者的视力障碍患病率也很高。鉴于无家可归者对眼部护理的高度关注，持续的视力筛查计划和方便获取的免费眼科诊所可能有助于满足这一需求。
