Authors: Collier (Shangjun) Jiang, Mirriam Mikhail, Jackie Slomovic, Austin Pereira, Gerald Lebovic, Christopher Noel, Myrna Lichter
Author Disclosure Block: C. Jiang: None. M. Mikhail: None. J. Slomovic: None. A. Pereira: None. G. Lebovic: None. C. Noel: None. M. Lichter: None.

Abstract Body:

Purpose: Homeless and marginally housed (HMH) populations have been shown to have a higher prevalence of visual impairment compared to the general population. This study is the first to conduct a comprehensive ophthalmic examination using portable equipment at various homeless shelter locations in an urban population to identify objective ocular pathologies in a randomized sample.
Study Design: This is a cross-sectional study.
Methods: 10 adult shelters were randomly selected in Toronto, Ontario, Canada. A number of individuals were randomly selected based on their shelter bed numbers at each shelter, in proportion to the shelter’s bed capacity. A total of 143 participants were recruited between August 2017 to April 2018. Participants completed a sociodemographic survey and clinical eye exam. Finally, a dilated ocular exam was performed using a portable slit lamp, autorefractor, tonometer, indirect ophthalmoscope and fundus camera.
Results: The median age of participants was 53.3, with a gender breakdown of 82.5% male and 17.5% female. The age-standardized prevalence of visual impairment was 27.4% (95% CI, 20.6-35.1%) for study participants. Refractive error was present in 48% of participants, 34% with myopia and 11% with hyperopia. 37.8% (95% CI, 32.2-45.9%) of this study population were diagnosed with at least one nonrefractive ocular pathology. Low income and low educational attainment were associated with increased odds of being diagnosed with nonrefractive ocular pathologies.
Conclusions: A clear healthcare gap exists between the ophthalmological disease burden of the HMH population and the amount of resources allocated directed towards their needs. Addressing risk factors such as low income and education, as well as increasing access to free eye examinations and visual aids may be an effective method of attending to this lack of health equity.