Visual impairment and unmet eye care needs among a Syrian adult refugee population in a Canadian city.

OBJECTIVE: To assess the prevalence of visual impairment and unmet eye care needs of the Syrian adult refugee population in Canada. DESIGN: Cross-sectional descriptive study. PARTICIPANTS: Enrolment was offered to all Syrian refugees 18 years or older, with 248 patients enrolled. METHODS: Five clinics were organized from July 2016 to November 2017 in Toronto, Ontario. A vision screening and dilated retinal examination was performed on all participants. Prevalence of visual impairment and nonrefractive pathologies as well as information on sociodemographics and subjective visual acuity were obtained. RESULTS: The mean age of participants was 36 years (interquartile range, 30-35) and 53% were females. The prevalence of reported uncorrected vision problems was 22.2% for distance vision, 6.5% for near vision, and 5.6% for both distance and near vision, including loss of vision. Compared with the Canadian population, Syrian adult refugees were 19.04 times more likely to report uncorrected vision problems (34.4% vs 1.8%, p < 0.01). The presenting visual acuity in the better-seeing eye was 20/50 or worse in 19.4%. Pinhole improved this to 12.5% (95% confidence interval [CI], 8.7%-17.3%). Compared with the Canadian population (0.95%), Syrian adult refugees were 13 times more likely to have 20/50 vision or worse (p < 0.01). The most common finding was refractive error in 46.0% (95% CI, 39.6%-52.4%) followed by nonrefractive error in 30.2% (95% CI, 24.9%-36.2%). CONCLUSIONS: This is the first study to assess ocular health in a refugee population in Canada. Syrian adult refugees have a high prevalence of visual impairment, even when living within a system of universal health care.

Prevalence and impact of eye disease in an urban homeless and marginally housed population.

OBJECTIVE: Homeless and marginally housed (HMH) populations have a higher prevalence of visual impairment than the general population. This study is the first to conduct a comprehensive ophthalmic examination using portable equipment at various homeless shelter locations in an urban population to identify objective ocular pathologies in a randomly selected sample. METHODS: Ten adult shelters were randomly selected in Toronto, Ontario, Canada, and 143 individuals were randomly selected based on their shelter bed numbers at each shelter, in proportion to the shelter's bed capacity. Participants completed a sociodemographic survey and clinical eye examination. Finally, a dilated ocular examination was performed using a portable slit lamp, autorefractor, tonometer, indirect ophthalmoscope, and fundus camera. RESULTS: The median age of participants was 53.3 years; 82.5% were male and 17.5% female. The age-standardized prevalence of visual impairment was 27.4% (95% confidence interval [CI], 20.6-35.1) for study participants. Refractive error was present in 48% of participants, 34% with myopia and 11% with hyperopia, and 37.8% (95% CI, 32.2-45.9) of this study population were diagnosed with at least one nonrefractive ocular pathology. Low income and low educational attainment were associated with increased odds of being diagnosed with nonrefractive ocular pathologies. CONCLUSIONS: A clear health care gap exists between the ophthalmological disease burden of the HMH population and the amount of resources allocated directed toward their needs. Addressing risk factors such as low income and education, as well as increasing access to free eye examinations and visual aids, may be an effective method of attending to this lack of health equity.