Comparison of ocular pathology among homeless and housed adults visiting a safety-net hospital

Abstract

Purpose

People experiencing homelessness have a higher risk for chronic illness and mortality compared to the general population. Furthermore, visual impairment is an independent risk-factor for mortality. We sought to characterize the prevalence of ophthalmic conditions and visual impairment among homeless individuals.

Methods

A retrospective chart review between January 1, 2018, to February 9, 2022 conducted at Denver Health and Hospital Authority in Denver, CO, USA. Adults 18 years of age or older identified as homeless in the electronic medical record system and randomly selected controls among all eye clinic patients seen during the same period were included for analysis. Visual acuity was recorded as best-corrected or pinhole occluder visual acuity when available, or otherwise presenting visual acuity (with or without correction).

Results

A total of 718 homeless and 240 control patients were identified within the specified time frame. Compared to the housed controls, homeless patients had a higher prevalence of trauma-related injuries (25.2% versus 2.7%, p<0.001) and worse best-reported visual acuities. The most common ocular diagnoses among the homeless cohort were refractive error (43.5%), trauma-related injury (25.2%), and cataract (24.2%).

Conclusions

To our knowledge, this is the largest clinic-based retrospective cohort study of ocular pathology among individuals experiencing homelessness. Our study reinforces the importance of providing access to ophthalmic care to the homeless population while highlighting specific priorities distinct from the general patient population, namely management of higher rates of ocular trauma.