Aman P Sayal1, Jacqueline Slomovic2, Nishaant Shaan Bhambra3, Marko M Popovic4, Myrna Lichter5. 1. Faculty of Medicine, University of Toronto, Toronto, Ont. 2. Faculty of Medicine, McMaster University, Hamilton, Ont. 3. Faculty of Medicine, McGill University, Montreal, Que. 4. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. 5. Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.. Electronic address: mlichter@rogers.com.
Abstract
BACKGROUND: Homelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally. METHODS: A systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test. RESULTS: There were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children. CONCLUSIONS: Visual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.
BACKGROUND: Homelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally. METHODS: A systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test. RESULTS: There were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children. CONCLUSIONS:Visual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.
Authors: Michele Fornaro; Elena Dragioti; Michele De Prisco; Martina Billeci; Anna Maria Mondin; Raffaella Calati; Lee Smith; Simon Hatcher; Mark Kaluzienski; Jess G Fiedorowicz; Marco Solmi; Andrea de Bartolomeis; André F Carvalho Journal: BMC Med Date: 2022-07-12 Impact factor: 11.150
Authors: Marie-Christine Etty; Sonia Michaelsen; Brittany Yelle; Kimberlie Beaulieu; Patricia Jacques; Sarah Ettaleb; Dan Samaha; Benoit Tousignant; Thomas Druetz Journal: Can J Public Health Date: 2022-08-15