Different Models of Ophthalmology Care for People Experiencing Homelessness

Area of Science:

• Ophthalmology
• Public Health
• Health Services Research

Background:

• People experiencing homelessness (PEH) have a high burden of vision impairment, primarily from uncorrected refractive error (RE).
• Significant barriers hinder access to eye care for PEH, with limited understanding of effective service delivery models.
• This review addresses the need to categorize and evaluate existing ophthalmic care models for PEH in North America.

Purpose of the Study:

• To categorize and evaluate current models of eye care delivery for people experiencing homelessness (PEH) in North America.
• To identify strengths and limitations of different care delivery models for this underserved population.

Main Methods:

• Conducted a literature search for publications between 2013 and 2023 focusing on ophthalmic interventions for PEH in North America.
• Classified eligible studies into distinct models of eye care delivery.
• Reviewed and analyzed the accessibility, continuity, and resource intensity of each model.

Main Results:

• Identified four models: office-based, shelter-based, mobile/temporary-based, and street medicine-based.
• On-site correction of refractive error (RE), especially eyeglasses, improved vision, but referral completion to tertiary care was low.
• Models emphasizing same-location diagnosis and treatment for RE showed higher service delivery rates.

Conclusions:

• No single eye care model is universally superior for people experiencing homelessness (PEH).
• Hybrid approaches integrating multiple models, tailored to community needs and infrastructure, are most effective for expanding access.
• Further research is needed on referral pathways, long-term outcomes, and policy strategies to reduce vision disparities.