Daniel W. Cordova, Laura A. Syniuta, Fei Yu, Matthew C. Daly, Anne L. Coleman, Gary N. Holland
Ophthalmic Problems among Homeless Individuals in Los Angeles County, California
Purpose: To describe ophthalmic problems among individuals attending a clinic for the homeless in Los Angeles County (LAC), California.
Study Design: Cross-sectional study.
Methods: We reviewed screening records for all homeless individuals evaluated at a monthly free clinic in West Hollywood, CA from August 2015 through February 2020. Demographics, medical history, and examination findings had been recorded on a standard form. Individuals with reduced visual acuity underwent manifest refraction. Ophthalmologists performed slit lamp biomicroscopy and dilated fundoscopy.
Results: A total of 272 homeless individuals were examined during the study period. Median age was 50.5 years (range 18.5-90.3 years). The majority were male (n=179 [66.1%]); 63 (26.4%) were African-American, which differed substantially from the general LAC population (9%). Uncorrected refractive errors were present in 117 (44.8%) of 261 individuals. Visual acuity in the better eye improved with refraction to 20/40 or better in 244 (94.6%) of 258 individuals. Glaucoma was suspected in 14 (5.2%) of 267 individuals. Diabetic retinopathy (DR) was identified in 7 (28.0%) of 25 diabetics.
Conclusions: Prevalence of DR among homeless diabetics was comparable to estimates for the general US population, while suspected glaucoma was more than double the prevalence reported for the general US population. There is a substantial burden of refractive errors, glaucoma, and DR among homeless individuals. Community outreach strategies are needed to improve access of homeless populations to evaluation and treatment of ophthalmic problems. The chronic nature of glaucoma and DR highlight the need for strategies to ensure adequate follow-up care for these individuals.