Unmet eye care needs among a homeless youth population



      To assess the rate of visual impairment and quantify the unmet eye care needs within Toronto’s homeless youth community.


      Prospective and cross sectional.


      Ninety randomly selected homeless youth aged 16–24 years.


      From each of 9 participating homeless youth shelters and drop-in centres in Toronto, 10 English-speaking youths between ages 16 and 24 were randomly recruited. Information regarding sociodemographics, medical history, subjective visual acuity, and access to eye care was collected. Comprehensive visual screening and undilated direct fundoscopy were also performed.


      The median age of participants was 21 years (interquartile range = 19–23 years), and 62.2% were male. Most participants were homeless for less than 5 years (90%) and earning less than $500 monthly (57.8%). Despite 51.1% of participants having previously owned corrective lenses, only 20% of participants currently owned them when assessed/at study time. When analyzing the better-seeing eye, presenting visual acuity was 20/50 or worse in 18.9% (95% CI 10.8%–27.0%) of participants. Pinhole occlusion decreased the number to 2.2% (95% CI 0%–5.3%). The most common cause of visual impairment was uncorrected refractive error. Ocular pathology was observed in 8 participants. Compared to adults, youth have similar functional visual impairment (adults 24.0%, youth 18.9%) but less impairment uncorrectable by pinhole occlusion (adults 11.0%, youth 2.2%) and are less dissatisfied with their vision (adults 70.0%, youths 36.7%). Although a higher proportion of homeless youths have visited an eye specialist in the past year (adults 14.0%; youths 17.8%), neither group is visiting as frequently as the Canadian average (41%) (p < 0.01).


      Homeless youth have a high prevalence of visual impairment, even when living within a system of universal health insurance. Ongoing vision-screening programs, readily accessible free eye clinics, and particularly low-cost glasses may help address this need.



      Évaluer le taux de déficience visuelle et quantifier les besoins de soins oculaires non comblés chez les jeunes sans-abri de Toronto.


      Étude transversale prospective.


      90 jeunes sans-abri de 16 à 24 ans choisis au hasard.


      Dans chacun des neuf refuges pour jeunes sans-abri et centres de jour participants de Toronto, 10 jeunes anglophones ayant entre 16 et 24 ans ont été recrutés aléatoirement. Des informations sur le profil sociodémographique, les antécédents médicaux, l’acuité visuelle subjective et l’accès à des soins oculaires ont été recueillies. Un examen visuel complet et une ophtalmoscopie directe sans dilatation ont aussi été réalisés.


      L’âge médian des participants était de 21 ans (écart interquartile = 19−23) et 62,2 % étaient de sexe masculin. La plupart des participants étaient sans abri depuis moins de 5 ans (90 %) et avaient un revenu mensuel de moins de 500 $ (57,8 %). Alors que 51,1 % des participants avaient déjà possédé des verres correcteurs, seuls 20 % en possédaient au moment de l’étude.
      Dans l’analyse du meilleur œil, l’acuité visuelle manifeste était de 20/50 ou pire chez 18,9 % (95 % IC 10,8 %-27,0 %) des participants. La mesure de l’acuité avec le trou sténopéïque a réduit la proportion à 2,2 % (95 % IC 0 %−5,3 %). La cause la plus courante de la déficience visuelle était la non-correction d’une erreur de réfraction. Une pathologie oculaire a été observée chez huit participants.
      Les jeunes ont un taux de déficience visuelle fonctionnelle comparable à celui des adultes (adultes 24,0 %, jeunes 18,9 %), mais une proportion moins forte de déficience non corrigible avec le trou sténopéïque (adultes 11,0 %, jeunes 2,2 %) et sont moins insatisfaits de leur vision (adultes 70,0 %, jeunes 36,7 %). Même si les jeunes sans-abris sont proportionnellement plus nombreux à avoir consulté un spécialiste des yeux au cours de la dernière année (adultes 14,0 %; jeunes 17,8 %), aucun des deux groupes ne consulte aussi fréquemment que la moyenne des Canadiens (41 %) (p<0,01).


      Les jeunes sans-abri ont une forte prévalence de déficience visuelle, même quand ils vivent à un endroit où existe un régime d’assurance maladie universelle. Des programmes permanents d’examen de la vue, des cliniques de soins oculaires gratuites facilement accessibles et surtout des verres abordables pourraient contribuer à répondre à leurs besoins.
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        • Hwang S.W.
        Homelessness and health.
        Can Med Assoc J. 2001; 164: 229-233
        • Hwang S.W.
        • Bugeja A.L.
        Barriers to appropriate diabetes management among homeless people in Toronto.
        Can Med Assoc J. 2000; 163: 161-165
        • Gelberg L.
        • Linn L.S.
        Assessing the physical health of homeless adults.
        JAMA. 1989; 262: 1973-1979
      1. Street Health. The Street Health Report. 2007. Available at: 〈〉. Accessed September, 2015.

        • Perruccio A.V.
        • Badley E.M.
        • Trope G.E.
        A Canadian population-based study of vision problems: assessing the significance of socioeconomic status.
        Can J Ophthalmol. 2010; 45: 477-483
        • Saw S.M.
        A synopsis of the prevalence rates and environmental risk factors for myopia.
        Clin Exp Optom. 2003; 86: 289-294
        • Gall C.
        • Lucklum J.
        • Sabel B.A.
        • Franke G.H.
        Vision-and health-related quality of life in patients with visual field loss after postchiasmatic lesions.
        Invest Ophthalmol Vis Sci. 2009; 50: 2765-2776
        • Jalil A.
        • Yin K.
        • Coyle L.
        • et al.
        Vision-related quality of life and employment status in patients with uveitis of working age: a prospective study.
        Ocul Immunol Inflamm. 2012; 20: 262-265
        • Breslin C.W.
        Our vision of vision health: the National Coalition for Vision Health.
        Can J Ophthalmol. 2007; 42: 790-791
        • Noel C.W.
        • Fung H.
        • Srivastava R.
        • et al.
        Visual impairment and unmet eye care needs among homeless adults in a Canadian City.
        JAMA Ophthalmol. 2015; 133: 455-460
        • Jin Y.-P.
        • Buys Y.M.
        • Xiong J.
        • Trope G.E.
        Government-insured routine eye examinations and prevalence of nonrefractive vision problems among elderly.
        Can J Ophthalmol. 2013; 48: 167-172
        • Vitale S.
        • Cotch M.F.
        • Sperduto R.D.
        Prevalence of visual impairment in the United States.
        JAMA. 2006; 295: 2158-2163
        • Stidwill D.
        Epidemiology of strabismus.
        Ophthalmic Physiol Opt. 1997; 17: 536-539
        • Martinez-Thompson J.M.
        • Diehl N.N.
        • Holmes J.M.
        • Mohney B.G.
        Incidence, types, and lifetime risk of adult-onset strabismus.
        Ophthalmology. 2014; 121: 877-882
        • Gold D.
        • Shaw A.
        • Wolffe K.
        The status of Canadian youth who are blind or visually impaired: a study of lifestyles, quality of life and employment. International Congress Series.
        Elsevier, Toronto, ON2005
        • Huurre T.
        • Aro H.
        Psychosocial development among adolescents with visual impairment.
        Eur Child Adolesc Psychiatry. 1998; 7: 73-78
        • Rosenblum L.P.
        Perceptions of the impact of visual impairment on the lives of adolescents.
        J Vis Impairment Blindness. 2000; 94: 434-445
        • Barnes J.B.
        • Barnes S.S.
        Small CR. Mobile eye screenings for Hawaii’s homeless: results and applications.
        Population. 2010; 9: 10
        • Ho J.H.
        • Chang R.J.
        • Wheeler N.C.
        • Lee D.A.
        Ophthalmic disorders among the homeless and nonhomeless in Los Angeles.
        J Am Optom Assoc. 1997; 68: 567-573
        • Pitz S.
        • Kramann C.
        • Krummenauer F.
        • Pitz A.
        • Trabert G.
        • Pfeiffer N.
        Is homelessness a risk factor for eye disease?.
        Ophthalmologica. 2005; 219: 345-349
        • Maberley D.
        • Hollands H.
        • Chuo J.
        • et al.
        The prevalence of low vision and blindness in Canada.
        Eye. 2005; 20: 341-346
        • Wilson E.B.
        Probable inference, the law of succession, and statistical inference.
        J Am Stat Assoc. 1927; 22: 209-212
        • Newcombe R.G.
        Two-sided confidence intervals for the single proportion: comparison of seven methods.
        Stat Med. 1998; 17: 857-872
        • R Development Core Team
        R: a language and environment for statistical computing.
        the R Foundation for Statistical Computing, Vienna2012
        • Maberley D.
        • Hollands H.
        • Chang A.
        • Adilman S.
        • Chakraborti B.
        • Kliever G.
        The prevalence of low vision and blindness in a Canadian inner city.
        Eye. 2006; 21: 528-533
        • Gelberg L.
        • Andersen R.M.
        • Leake B.D.
        The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people.
        Health Serv Res. 2000; 34: 1273
        • Jin Y.-P.
        • Wong D.T.
        Self-reported visual impairment in elderly Canadians and its impact on healthy living.
        Can J Ophthalmol. 2008; 43: 407-413
        • Dotan G.
        • Truong B.
        • Snitzer M.
        • et al.
        Outcomes of an inner-city vision outreach program: Give Kids Sight Day.
        JAMA Ophthalmol. 2015; 133: 527-532
        • Thompson J.
        • Woodruff G.
        • Hiscox F.A.
        • Strong N.
        • Minshull C.
        The incidence and prevalence of amblyopia detected in childhood.
        Public Health. 1991; 105: 455-462
        • McManus M.
        Mobile eye units in the fight against eye disease in East Africa.
        J Ophthalmic Nurs Technol. 1992; 12: 19-21
        • Hill J.
        Mobile eye-care teams and rural ophthalmology in southern Africa.
        S Afr Med J. 1984; 66: 531-535
        • Leese G.
        • Ahmed S.
        • Newton R.W.
        • et al.
        Use of mobile screening unit for diabetic retinopathy in rural and urban areas.
        BMJ. 1993; 306: 187
        • Ruggeiro C.P.
        • Gloyd S.
        Evaluation of vision services delivered by a mobile eye clinic in Costa Rica.
        Optom Vis Sci. 1995; 72: 241-248