Different Models of Ophthalmology Care for People Experiencing Homelessness

Background and Objectives: People experiencing homelessness (PEH) face a disproportionately high burden of vision impairment, most commonly from uncorrected refractive error (RE), and encounter significant barriers to accessing care. Despite these challenges, there is limited knowledge about effective approaches to providing ophthalmic services to this population. This review aims to categorize and evaluate existing models of eye care delivery for PEH in North America. Materials and Methods: A literature search was conducted for publications between 2013 and 2023. Eligible studies included those describing direct ophthalmic interventions for PEH in North America. Identified studies were reviewed and classified into distinct models of care delivery. Results: Four models of care emerged: office-based, shelter-based, mobile/temporary-based, and street medicine-based. Each model demonstrated unique strengths and limitations related to accessibility, continuity of care, and resource intensity. Across models, on-site correction of RE, particularly through provision of eyeglasses at the point of care, led to documented improvement of vision. However, referral completion and follow-up rates to tertiary care centers were low, especially in programs where services were fragmented across multiple locations. Strategies that emphasize same-location diagnosis and treatment for RE increase service delivery rates. Further studies are needed to evaluate referral pathways, long-term outcomes, and policy strategies to reduce vision-related disparities in this underserved population. Conclusions: No single model of care proved universally superior. Instead, hybrid approaches that integrate multiple models tailored to community infrastructure and patient needs appear most effective for expanding access to ophthalmic services among PEH.