Visual Impairment From Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access Among Low-income Adults in Michigan
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Visual Impairment From Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access Among Low-income Adults in Michigan

Public Access Version Available on: March 01, 2025, 12:00 AM
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    Assess rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) program.


    Cross-sectional study.


    Adults ≥ 18 years without acute ocular symptoms.


    MI-SIGHT Program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical shop. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA] ≤20/50, best corrected visual acuity [BCVA] ≥20/40), URE without VI (PVA ≥20/40, had ≥2 lines of improvement to BCVA), and no or adequately corrected RE (PVA ≥20/40, <2 line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared between groups using analysis of variance (ANOVA), Kruskal-Wallis (KW), Chi-square, and Fisher exact testing.

    Main Outcome Measures:

    PVA, BCVA, and presence of VI (defined as PVA ≤20/50)


    Of 1171 participants enrolled in the MI-SIGHT program during the first year, average age was 55.1 years old (SD=14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 (10.3%); 96 had VI from URE (8.2%), 168 (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI from URE reported having a college degree and a larger percentage reported income <$10,000 compared to participants with no or adequately corrected RE (3.2% versus 14.2%, p=0.02; 45.5% versus 21.6%, respectively, p<0.0001. Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (VFQ9 composite score 67.3±19.6 versus 77.0±14.4 versus 82.2±13.3, respectively; p<0.0001). 71.2% (n=830) ordered glasses for an average cost of $36.80±$32.60; 97.7% were satisfied with their glasses.


    URE was the main cause of VI at two clinics serving low-income communities and was associated with reduced vision related quality of life. An online optical shop with lower prices made eyeglasses accessible to low-income patients.

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