Mobile eye screenings for Hawaii’s homeless: results and applications

Jason B Barnes¹, Shawn S Barnes², Christian R Small², Clifton S Otto³, Michael D Bennett<sup>3

1</sup>John A Burns School of Medicine, University of Hawaii; ²Outbound Eye Health International, ³Retina Institute of Hawaii, Honolulu, Hawaii, USA

Purpose: To describe the status and perceptions of ocular health in Oahu’s homeless ­population in Hawaii.

Patients and methods: A total of 127 participants were included in this community-based cross-sectional study. Examinations included demographic history, near and far presenting visual acuity (PVA), autorefractometry, and nonmydriatic retinal photography. PVA was measured using the participants’ current eyeglasses or contacts, or without correction if they did not use glasses. Visual disability was categorized as “legally blind” (20/200 or worse), “impaired vision” (20/40 to 20/150), or “not impaired” (better than 20/40). Refraction data were categorized using the eye with a greater absolute spherical equivalent. Hyperopia was defined as more than 0.5 D of plus and myopia as more than 0.5 D of minus. Astigmatism was defined as cylindrical values more than 0.50 D of minus or 0.50 D of plus.

Results: Of 127 participants, 60.5% were displeased with their vision, 48.8% did not know where to go to seek eye care, and 66.7% did not know where to go to seek corrective lenses. Self-reported diabetes (17.1%) was significantly higher (P < 0.001) than that of the general population of Hawaii (7.5%). Less than one-third of diabetic participants had ever been evaluated by an ophthalmologist. The prevalence of refractive error was comparable with national rates, with myopia, hyperopia, and astigmatism at 23.5%, 1.2%, and 35.3%, respectively. Presenting visual acuity was found to be impaired or blind in 19.5% of participants for near vision testing and 12.1% for distance vision. The rates of retinal pathology in participants were found to be 1.6% with diabetic retinopathy, 0.8% with retinal hypertension, 2.4% with epiretinal membrane, 4.0% with drusen, and 0.8 with nevus.

Conclusion: The homeless population of Oahu has a high dissatisfaction with vision, ­comparable rates of ocular pathology with national samples, and poor knowledge of eye care services. This suggests that mobile eye screening could provide an ideal setting for providing ocular health care to the homeless population, and has enormous potential for improving health care in this population.

Keywords: homeless, visual acuity, refractive error, retina, Hawaii