Perceptions of providers and unhoused patients on access to eye care in Santa Clara County: A qualitative study.

Significance: Perspectives on eye care barriers differ between low-income patients and vision care providers. Comparing these views provides valuable insight into strategies for addressing disparities in underserved communities, especially in regions with significant income inequality and opportunity gaps.

Purpose: The aim is to identify obstacles that prevent individuals who are unhoused, have low income, or are publicly insured in Santa Clara County from accessing basic refractive eye exams and corrective glasses.

Methods: Patients aged ≥18 years with low income presenting to a free vision care clinic in Northern California (n = 15) and vision care providers who primarily work with underserved patients in Santa Clara County, California (n = 11) participated in one-on-one phone interviews. Interviews were transcribed and analyzed.

Results: Most participants (87% patients and 82% providers) say that basic vision care (refractive eye exam and eyeglasses) in Santa Clara County is unaffordable and that in-person eye exams can be physically inaccessible (67% patients and 91% providers) due to busy work schedules or limited access to transportation. However, patient and provider perspectives on intrinsic barriers to accessing eye care diverge. In total, 73% of providers stated that limited health literacy contributed to lower utilization of routine vision care, while 47% of patients cited limited empathy from providers as responsible for their negative experiences and dissatisfaction with care.

Conclusions: In Santa Clara County, patients with low income and their providers both identify similar external barriers to basic vision care: high costs, inadequate insurance coverage, and limited services. However, patients and providers may disagree on intrinsic barriers to accessing care. Suggestions for improving access to vision care include more help from healthcare coordinators, better information about affordable services, improved vision insurance, and mobile healthcare options.