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Abstract Body: 

Purpose: There is a lack of data on vision problems in an adult refugee population in Canada. Given the  recent arrival of 40,000 Syrian refugees, we performed a cross-sectional, descriptive study to assess the prevalence of visual impairment and unmet eye care needs of adult Syrian refugees in Toronto. 

Study Design: Five single-day clinics were organized. Enrolment was offered to Syrian refugees  registered with resettlement agencies, not for profit organizations, and/or private sponsorship groups. 

Methods: Through a structured interview, socio-demographics, medical history, subjective visual acuity,  and access to eye care information was collected. Comprehensive visual screening, slit-lamp, dilated direct funduscopy, and refractions were performed. Visual acuity data was compared to Canadian prevalence data. χ2 tests were used for statistical analysis. 

Results: 526 (65.8%) out of the 800 adults and children offered enrollment participated in the study. 248  adult patients were examined. The median age was 36 years (interquartile range (IQR)= 30-35) and 53% were females. Most patients lived outside Syria as refugees for 1 to 5 years (69.4%) and earn less than $1000 monthly (49.6%). The prevalence of reported uncorrected vision problems was 22.2% for distance vision, 6.5% for near vision, and 5.6% for distance and near vision, including loss of vision. When compared to the general Canadian population, Syrian adult refugees were 19 times more likely to report uncorrected vision problems (34.4% v. 1.8%, p < 0.01). A majority had not visited an eye specialist in the past year (95.2%) and 60.5% were dissatisfied with their vision. The presenting visual acuity in the better-seeing eye was 20/50 or worse in 19.4% (95% CI, 14.6%-24.8%). By using pin-hole correction, this improved to 12.5% (95% CI, 8.7%-17.3%). Compared to the Canadian population (0.95%), Syrian adult refugees were 13 times more likely to have 20/50 vision or worse (p < 0.01). The most common finding was refractive error in 46.0% (95% CI, 39.6%-52.4%) followed by nonrefractive error in 15.3% (95% CI, 11.1%-20.4%). The most frequent non-refractive errors were cataracts (4.0%), glaucoma (2.8%), traumatic injuries (2.4%), dry age related macular degeneration (2.0%), diabetic retinopathy (2.0%), and retinitis pigmentosa (1.6%). 

Conclusions: This is the first study to assess ocular health in a refugee population in Canada. Syrian adult refugees have a high prevalence of visual impairment, even when living within a system of universal healthcare. Ongoing vision-screening programs and accessible eye clinics may address this need.