Prevalence of Visual Impairment and Ocular Pathology and Achievability of Examination in a University-Based Eye Clinic for Patients with Disabilities
Sheryl J. Menacker, MD; Alcides Fernandes, MD; Laura Ward, MSPH
Introduction: Individuals with disabilities often have visual/ocular pathology. Examination can be challenging, yet services scarce. Our university-based eye center established a once/month clinic for patients with disabilities. We describe the demographics, types of visual/ocular pathology, and achievability of examination in this dedicated clinic, staffed by one pediatric ophthalmologist.
Methods: Medical records for patients examined January 2014 through December 2016 were reviewed. Descriptive statistics were calculated for demographics, visual acuity, ocular diagnoses (categorized as treatable, possibly treatable, or non-treatable), non-ocular diagnoses, refractive error, and achievable examination data.
Results: 178 patients with disabilities, 5 months to 95 years, were examined at 281 visits. 119 (66.9%) were non-verbal. 36/178 patients (20.2%) had a normal exam, 133 (74.7%) had treatable ocular diagnoses, 2 (1.1%) had possibly treatable diagnoses only, and 7 (3.9%) had non-treatable diagnoses only. 68/135 (50.4%) with treatable/possibly treatable diagnoses were newly diagnosed. 85/178 (47.8%) patients had a significant refractive error.1 72.5% of patients with a treatable refractive error also had another treatable diagnosis. Cooperation precluded slit lamp examination in 1/178 individuals (0.6%), cycloplegic refraction in 3/178 (1.7%), dilated fundus exam in 4/178 (2.2%), and iCare/Goldmann IOP in 28/178 (15.7%).
Discussion: Patients with disabilities have a high prevalence of ocular pathology, often treatable and previously unrecognized. Refractive errors are common, frequently accompanied by other treatable conditions. Trained providers can achieve a complete ophthalmic examination in most patients.
Conclusion: A dedicated eye clinic is an advantageous setting for examination of patients with disabilities. Pediatric ophthalmologists are likely providers because of expertise in examining challenging, often non-verbal patients.
References: 1Based on Donohue SP, Arthur B, Neely DE, et al. Guidelines for automated preschool vision screening: a 10-year evidence-based update. J AAPOS 2013; 17:4-8