Visual and Ocular Conditions among a Homeless Adult Population of Boston.

SIGNIFICANCE: The eye care needs of the homeless population in the United States are not well known. This study elucidates those needs for health care for the homeless programs and eye care practitioners. This information could result in an increase in the provision of necessary eye care services. PURPOSE: The purpose of this study was to assess the extent of visual and ocular conditions, the frequency of eyeglass orders and receipt of eyeglasses, and the frequency of ophthalmology referrals and receipt of ophthalmological care in an adult homeless population in Boston. METHODS: A cross-sectional retrospective chart review was conducted for patients of the Boston Health Care for the Homeless Program's Pine Street Inn eye clinic from September 26, 2016, to December 31, 2017. Data on sociodemographics, medical history, comprehensive eye examination findings, glasses orders and receipt, and ophthalmology referrals and receipt of care were collected and analyzed. RESULTS: A total of 424 patients were included in the study. The mean age of the study population was 52.7 (interquartile range, 46 to 60), and the majority were male (74%). The most common systemic conditions were hypertension (40.6%) and diabetes (23.8%). The most common refractive error was presbyopia (67.7%), followed by astigmatism (38.9%), hyperopia (34.0%), and myopia (30.7%). The most common ocular conditions were dry eye (28.6%), visually or clinically significant cataract (20%), and glaucoma/glaucoma suspicion (13.9%). Refractive correction was indicated for 356 patients (84%), but 82 (29%) did not receive ordered eyeglasses. Ophthalmology referrals were placed for 61 patients (14.4%), yet only 20 (32.8%) of those referrals were completed. CONCLUSIONS: A significant need for refractive correction and a large gap for ophthalmological care were found among the study population. Health care for the homeless programs and eye care practitioners should be aware of the visual and ocular needs of this patient population so as to better meet their needs.

Monitoring DNA Damage and Repair in Peripheral Blood Mononuclear Cells of Lung Cancer Radiotherapy Patients.

Thoracic radiotherapy (RT) is required for the curative management of inoperable lung cancer, however, treatment delivery is limited by normal tissue toxicity. Prior studies suggest that using radiation-induced DNA damage response (DDR) in peripheral blood mononuclear cells (PBMC) has potential to predict RT-associated toxicities. We collected PBMC from 38 patients enrolled on a prospective clinical trial who received definitive fractionated RT for non-small cell lung cancer. DDR was measured by automated counting of nuclear γ-H2AX foci in immunofluorescence images. Analysis of samples collected before, during and after RT demonstrated the induction of DNA damage in PBMC collected shortly after RT commenced, however, this damage repaired later. Radiation dose to the tumour and lung contributed to the in vivo induction of γ-H2AX foci. Aliquots of PBMC collected before treatment were also irradiated ex vivo, and γ-H2AX kinetics were analyzed. A trend for increasing of fraction of irreparable DNA damage in patients with higher toxicity grades was revealed. Slow DNA repair in three patients was associated with a combined dysphagia/cough toxicity and was confirmed by elevated in vivo RT-generated irreparable DNA damage. These results warrant inclusion of an assessment of DDR in PBMC in a panel of predictive biomarkers that would identify patients at a higher risk of toxicity.

Validity of the Spot Vision Screener in detecting vision disorders in children 6 months to 36 months of age.

PURPOSE: To evaluate the Spot Vision Screener in detecting targeted vision disorders compared to cycloplegic retinoscopy in children <3 years of age. METHODS: Children, ages 6 months to 36 months underwent vision screening using the Spot Vision Screener. Results were compared to results of comprehensive eye examinations. Validity of the Spot was evaluated by calculating the area under the curve (AUC); the receiver operating characteristics (ROC) were used to determine optimal sensitivity and specificity for detection of targeted vision disorders. RESULTS: A total of 249 children were included. The AUC for detecting targeted vision disorders as defined by the study specific criteria using the Spot was 0.790. Compared to cycloplegic retinoscopy, the Spot underestimated hyperopia by 1.02 D (95% CI, 0.86-1.17 D). For hyperopia ≥4.5 D spherical equivalent (n = 10), the mean difference between the Spot and cycloplegic retinoscopy was 3.46 D (95% CI, 1.95-4.98 D). In contrast, the Spot overestimated astigmatism compared to cycloplegic retinoscopy (-1.00 D vs -0.48 D; P < 0.001) by -0.52 D (95% CI, 0.43-0.62 D). CONCLUSIONS: The Spot Vision Screener showed good overall validity in detecting targeted vision disorders. It was within 0.5 D and 1 D of cycloplegic retinoscopy with regard to low hyperopia and astigmatism. Higher hyperopic spherical equivalent refractive errors showed larger differences in mean values between the Spot and cycloplegic retinoscopy.