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Visual impairment and the prevalence of ocular pathology in homeless children and adults globally: a systematic review

Published:October 21, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.09.023

      Abstract

      Background

      Homelessness is a global issue in developing and developed countries. This article is the first systematic review to explore its impact on visual health globally.

      Methods

      A systematic literature search was conducted on OVID MEDLINE, EMBASE, and Cochrane CENTRAL. Peer-reviewed English-language studies with a focus on homeless children or adults that reported on ocular outcomes were included. Primary outcomes and secondary endpoints were reported via weighted averages. Primary outcomes between homeless children and homeless adults were compared using the Fisher exact test.

      Results

      There were 5774 individuals across 23 full-text articles included in the review. For studies reporting primary outcomes, 36.8% of homeless individuals self-reported dissatisfaction with their vision, 26.8% self-reported a previous ocular pathology, 26.3% had uncorrected refractive error, 25.6% were functionally visually impaired, 9.2% had at least one previous eye surgery or procedure, and 4.0% had nonrefractive visual impairment. Upon screening, 25.1% of homeless individuals had some type of ocular pathology, which included cornea and external eye diseases (13.4%), glaucoma (7.4%), cataracts (6.3%), retinal diseases (5.3%), ocular motility disorders (4.7%), trauma (2.3%), neuro-ophthalmological conditions (1.7%), and oculoplastic conditions (0.7%). Homeless adults had significantly more visual impairment (p < 0.001), uncorrected refractive error (p < 0.001), ocular pathology (p < 0.001), cataracts (p < 0.001), retinal pathology (p < 0.001), and neuro-ophthalmological conditions (p < 0.001) relative to children.

      Conclusions

      Visual impairment in homeless individuals is higher than the general population. Uncorrected refractive error is a leading cause of visual impairment in this population. Additionally, homeless adults have significantly more visual impairment and ocular pathology than homeless children. Future studies should also explore if these differences are consistent in developing countries and investigate ways to increase eye care access for homeless individuals.

      Contexte

      L'itinérance est un enjeu universel qui touche à la fois les pays développés et les pays en voie de développement. Le présent article est la première revue de synthèse systématique à examiner les effets de l'itinérance sur la santé visuelle à l’échelle mondiale.

      Méthodes

      On a réalisé une revue systématique de la littérature médicale dans 3 bases de données : OVID MEDLINE, EMBASE et Cochrane CENTRAL. Ont été incluses les études révisées par des pairs et publiées en anglais qui portaient sur des enfants ou des adultes en situation d'itinérance et qui comprenaient des données sur les résultats visuels. Les valeurs des paramètres principaux et secondaires ont été présentées sous forme de moyennes pondérées. On a eu recours à la méthode exacte de Fisher pour comparer les paramètres principaux relatifs à des enfants en situation d'itinérance à ceux d'adultes dans la même situation.

      Résultats

      On a recensé quelque 5774 sujets provenant de 23 articles intégraux aux fins de la revue de synthèse. Dans les études qui présentaient des paramètres principaux, on note que 36,8 % des sujets en situation d'itinérance ont spontanément signalé une insatisfaction quant à leur vision, que 26,8 % des sujets ont spontanément signalé avoir déjà souffert d'une pathologie oculaire, que 26,3 % des sujets présentaient une erreur de réfraction non corrigée, que 25,6 % des sujets présentaient une déficience visuelle fonctionnelle, que 9,2 % des sujets avaient déjà subi au moins une intervention oculaire (chirurgicale ou non) et que 4,0 % des sujets présentaient une déficience visuelle non réfractive. Après un dépistage, 25,1 % des sujets en situation d'itinérance présentaient une pathologie oculaire, notamment des atteintes de la cornée et des affections oculaires externes (13,4 %), un glaucome (7,4 %), des cataractes (6,3 %), des affections de la rétine (5,3 %), des troubles de la motilité oculaire (4,7 %), des traumatismes (2,3 %), des atteintes neuro-ophtalmologiques (1,7 %) et des affections oculoplastiques (0,7 %). Chez les adultes en situation d'itinérance, on notait significativement plus de troubles visuels (p < 0,001), d'erreurs de réfraction non corrigées (p < 0,001), de pathologies oculaires (p < 0,001), de cataractes (p < 0,001), d'affections de la rétine (p < 0,001) et d'atteintes neuro-ophtalmologiques (p < 0,001) que chez les enfants.

      Conclusions

      La déficience visuelle chez les sujets en situation d'itinérance est plus élevée que dans la population générale. L'erreur de réfraction non corrigée est la cause principale de déficience visuelle au sein de cette population. De plus, les adultes en situation d'itinérance présentent significativement plus de déficience visuelle et de pathologies oculaires que les enfants dans la même situation. Il serait intéressant que les prochaines études vérifient si ces différences sont les mêmes dans les pays en voie de développement, et examinent des façons d'améliorer les soins oculaires pour les personnes en situation d'itinérance.
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