People Without Homes Commonly Require Refractive Care

BOSTON, MA – FEBRUARY 11: A long line of marchers crosses the Boston Common as they take part in the second annual Winter Walk to end homelessness in Boston on Feb. 11, 2018. (Photo by Jessica Rinaldi/The Boston Globe via Getty Images)
A study shows widespread presbyopia in Boston’s Health Care for the Homeless program.

The most common ocular need of people without homes who visited a clinic in Boston was refractive correction, and the most common refractive error was presbyopia, researchers found in a study published in Optometry and Vision Science.

This is the first study to explicitly report the prevalence of presbyopia within this cohort.

Researchers examined health records of the 424 patients who received services at the Boston Health Care for the Homeless Program’s Pine Street eye clinic between September 2016 and December 2017.  The population had a mean age of 52.7 years (range: 18 to 84 years) and 74% were men.

They found that the most common ocular conditions were dry eye syndrome (28.6%), visually or clinically significant cataract (20%), and glaucoma or glaucoma suspicion (13.9%). The investigation notes these rates are higher than in the general patient population, according to prior research.

The most common refractive errors were presbyopia (67.7%), astigmatism (38.9%), hyperopia (34.0%), and myopia (30.7%). About 85% of the patients (n=356) needed refractive correction, and 77% (274) of them received glasses. Most glasses recipients received at the time of the visit (62%) or received over-the-counter reading glasses at the time of the visit (17%). Of the patients who placed an order for eyeglasses, 200 (70%) received them. Another 20 of the 61 patients who were referred to ophthalmology attended those visits.

“Ophthalmological referrals were needed for 14% of the patient population, yet approximately 68% did not attend those referral visits. This represents a significant gap in ocular health needs for this patient population. Although lack of health insurance may pose a common barrier to care, nearly 98% of this patient population was insured. This high level of insured participants is likely due to universal health care efforts via Massachusetts legislation in 2006, combined with the Affordable Care Act of 2010,” investigators explain.

The most common systemic conditions found included hypertension (40.6%), diabetes (23.8%), hepatitis A, B, or C (22.2%), hyperlipidemia (19.8%), arthritis (9%), HIV (8%), prediabetes (6.4%), and stroke (3.5%).

Limitations of the study included sampling bias of the study population due to the patients receiving referral or seeking care, the inclusion of solely 1 outpatient location in 1 city, the reliance on documented diagnoses instead of standard criterion, and lack of collection of data on mental health and substance use disorders.

“This study’s findings indicate a high need of refractive correction and ocular health care for homeless individuals,” according to investigators. “Although the Boston Health Care for the Homeless Program is a health care program specifically for the homeless, other public or private health care facilities likely to be examining homeless individuals will need to understand the unique eye care needs for this population. To better meet the needs of these individuals, a program can anticipate refractive and potential ocular disease and/or ophthalmological service needs.”


Russo D, Bass O. Visual and ocular conditions among a homeless population of Boston. Optom Vis Sci. 2021;98(4):362-366. doi:10.1097/OPX.0000000000001674