Ophthalmic needs of indigenous adults experiencing homelessness and marginal housing: a serial cross-sectional analysis.

OBJECTIVE: To describe the frequency and causes of visual impairment (VI) among Indigenous adults experiencing homelessness or marginal housing in Toronto and Hamilton, Ontario. DESIGN: Serial cross-sectional study. PARTICIPANTS: Indigenous adults 18 years or older attending 5 ocular screening clinics at Indigenous-led shelters (September 2021 to October 2023) who had not received an eye examination in the previous 12 months and were not currently seeing an ophthalmologist. METHODS: We collected sociodemographic data and medical history and performed presenting and pinhole visual acuity, intraocular pressure measurement, autorefraction, and anterior and posterior examination. VI was defined using the North American threshold (better-eye visual acuity <20/50). World Health Organization VI categories also were recorded. We report categorical variables as counts and percentages and continuous variables as means and SDs. RESULTS: Ninety-seven participants were included. VI was present in 30.9% (n = 30) of participants on the basis of presenting acuity and 9.3% (n = 9) after pinhole. By World Health Organization categories, 25.8% (n = 25) had moderate impairment or blindness at presentation and 6.2% (n = 6) after pinhole. Most participants were dissatisfied with their vision (75.3%, n = 73), and 48.5% (n = 47) currently owned glasses, despite 73.2% (n = 71) having previously owned a pair. Cost was the most commonly reported barrier to eye care (30.9%, n = 30). The mean time since last eye examination was 6.3 years (SD 6.5 years). CONCLUSIONS: Indigenous adults experiencing homelessness or marginal housing had a high burden of correctable VI and long intervals without care. Refractive services with on-site dispensing and facilitated follow-up may reduce vision loss in this population.