Prevalence of refractive error, visual impairment and access to eyecare for the homeless in Wales, United Kingdom.

BACKGROUND/AIMS: To investigate visual impairment and disability, refractive error, and barriers to eye care in the homeless in Cardiff, United Kingdom. METHODS: Prospective cross-sectional study carried out on participants in homeless shelters in Cardiff. We collected participants socio-demographic profile, ocular history and access to eyecare services. Quantitative data included near and distance visual acuity and a non-cycloplegic refraction. RESULTS: A total of 100 participants were studied in this study. Prevalence of myopia was 19% and hyperopia 17%. Mean SE (Spherical Equivalent) for myopia -2.42D (95% CI: -1.65 to -3.19 D), for hyperopia this was +2.22D (95% CI: + 1.66 to +2.79). The prevalence of astigmatism was 36% (mean: 1.67 D, 95% CI: -0.88 to 0.94, n = 100). The number of participants with visual acuity (VA) worse than 6/12 was 11% in comparison to 0.89% and 1.1% in the general Cardiff and Welsh population respectively (p < 0.05). Additionally, 1% of the homeless subjects were registerable as blind (visual acuity worse than 3/60 in the better eye). Barriers to eyecare services were high, with 50% not seen by an optometrist within the last 5 years. CONCLUSIONS: These findings indicate a significant disparity in ocular health, visual acuity and refractive error amongst the homeless in comparison with the general population.

The Long-term Outcomes of Glaucoma Drainage Device in Pediatric Glaucoma.

PURPOSE: To evaluate the long-term outcomes and safety of glaucoma drainage device (GDD) in pediatric patients. METHODS: Retrospective, noncomparative study including all patients below 18 years old who underwent Baerveldt or Molteno GDD implantation by a single surgeon. Mitomycin-C was used in most cases. Success was defined as postoperative intraocular pressure (IOP) between 6 and 22 mm Hg and a 20% reduction in IOP. RESULTS: Sixty-nine eyes of 52 patients were analyzed. Mean follow-up length was 45.7±25.2 months (range, 6 to 101 mo). At last postoperative visit, mean IOP and median number of antiglaucoma medications had been significantly reduced from baseline. Cumulative probability of qualified success was 95.6% at 1 year and declined to 71.3% at 5 years and 39.7% at 8 years. Multivariate analysis showed that non-white patients and previous history of cyclophotocoagulation had higher risks of failure at 5 years. Hypotony was the most common complication (39.1%) in the first 6 months postoperatively. Bleb encapsulation occurred in 16.4% of patients. Endophthalmitis occurred in 5.8% of cases and necessitated removal of the GDD. CONCLUSIONS: GDD surgery can work adequately in children in the long term. A relatively high complications rate should be expected, but in most cases these can be managed successfully. Early recognition of complications is necessary to ensure a good outcome.