{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T13:50:24Z","timestamp":1765374624122,"version":"3.46.0"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/medicina61122178","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:35:51Z","timestamp":1765190151000},"page":"2178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Different Models of Ophthalmology Care for People Experiencing Homelessness"],"prefix":"10.3390","volume":"61","author":[{"given":"Caroline","family":"Campbell","sequence":"first","affiliation":[{"name":"School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1994-9377","authenticated-orcid":false,"given":"Anindya","family":"Samanta","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"},{"name":"Southwest Retina Consultants, PA, 7100 Curie Drive, 3800, El Paso, TX 79902, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Reppa","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1772-3558","authenticated-orcid":false,"given":"Jay","family":"Chhablani","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.2105\/AJPH.2009.180109","article-title":"The Unmet Health Care Needs of Homeless Adults: A National Study","volume":"100","author":"Baggett","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/106286060401900503","article-title":"Improving Health Care Experiences of Persons Who Are Blind or Have Low Vision: Suggestions from Focus Groups","volume":"19","author":"Killeen","year":"2004","journal-title":"Am. J. Med. Qual."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jcjo.2020.09.023","article-title":"Visual Impairment and the Prevalence of Ocular Pathology in Homeless Children and Adults Globally: A Systematic Review","volume":"56","author":"Sayal","year":"2021","journal-title":"Can. J. Ophthalmol."},{"key":"ref_4","first-page":"4460","article-title":"Comparing Eye Care at a Tertiary Eye Care Clinic to a Free Homeless Clinic","volume":"60","author":"Bernhisel","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_5","unstructured":"Kimmel, A., Qin, G., Braun, R., Sucharew, H., Freiermuth, C.E., and Kreitzer, N. (2025). Barriers to Healthcare Access: Insights from a Survey of Persons Experiencing Homelessness. [Master\u2019s Thesis, University of Cincinnati]."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/OPX.0000000000002250","article-title":"Perceptions of Providers and Unhoused Patients on Access to Eye Care in Santa Clara County: A Qualitative Study","volume":"102","author":"Liu","year":"2025","journal-title":"Optom. Vis. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/tvst.12.11.7","article-title":"Eye Disease Prevalence and VF-14 Validation Among Patients Experiencing Homelessness and Presenting for Ophthalmic Examination in Baltimore, Maryland","volume":"12","author":"Vinnett","year":"2023","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2147\/OPTO.S13007","article-title":"Mobile Eye Screenings for Hawaii\u2019s Homeless: Results and Applications","volume":"2010","author":"Barnes","year":"2010","journal-title":"Clin. Optom."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.ajo.2024.07.023","article-title":"The Street Medicine Auto-Refraction Technology Study: A Model for Screening and Treating Refractive Error in Persons Experiencing Homelessness","volume":"270","author":"Samanta","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_10","unstructured":"Campbell, C., Samanta, A., and Reppa, C. (2024, January 9\u201311). Different Models of Ophthalmology Care for Unhoused Patients. Proceedings of the Global Ophthalmology Summit, Oregon, Portland."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/OPX.0000000000001674","article-title":"Visual and Ocular Conditions among a Homeless Adult Population of Boston","volume":"98","author":"Russo","year":"2021","journal-title":"Optom. Vis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.59586\/jsrc.v4i1.58","article-title":"Identifying the Underserved: An Analysis of a Free Eye Clinic\u00e2\u20acTMs Demographics","volume":"4","author":"Nizamuddin","year":"2018","journal-title":"J. Stud.-Run Clin."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ahluwalia, A., Morcos, D., and Koulen, P. (2023). The Impact of Having a Free Community Eye Clinic Located inside a Homeless Shelter: A Retrospective Analysis of Patient Demographics. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1284748"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1055\/s-0041-1726288","article-title":"Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter","volume":"13","author":"Hennein","year":"2021","journal-title":"J. Acad. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1001\/jamaophthalmol.2020.6373","article-title":"Association of a Health Coaching and Transportation Assistance Intervention at a Free Ophthalmology Homeless Shelter Clinic With Follow-up Rates","volume":"139","author":"Hennein","year":"2021","journal-title":"JAMA Ophthalmol."},{"key":"ref_16","first-page":"10","article-title":"Ophthalmology Clinic for the Homeless in San Francisco: Experiences and Findings","volume":"12","author":"Silva","year":"2020","journal-title":"J. Acad. Ophthalmol."},{"key":"ref_17","unstructured":"Linson, E., Zanganeh, T., Korchak, M., and Lustbader, J. (2023, April 07). Georgetown Eye Health Initiative. Available online: https:\/\/studentrunfreeclinics.org\/journalsrc.org\/index.php\/jsrc\/article\/view\/10\/9."},{"key":"ref_18","unstructured":"Tousignant, B. (2018). Eye Care for the Homeless: First Year of Data from a Mobile Teaching Clinic, American Academy of Optometry."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1001\/jamaophthalmol.2014.6113","article-title":"Visual Impairment and Unmet Eye Care Needs among Homeless Adults in a Canadian City","volume":"133","author":"Noel","year":"2015","journal-title":"JAMA Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jcjo.2019.07.006","article-title":"Prevalence and Impact of Eye Disease in an Urban Homeless and Marginally Housed Population","volume":"55","author":"Jiang","year":"2019","journal-title":"Can. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcjo.2022.11.005","article-title":"Ophthalmic Findings in Marginally Housed Women in a Canadian City","volume":"59","author":"Park","year":"2022","journal-title":"Can. J. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.jcjo.2017.12.010","article-title":"Identifying the Ophthalmic Needs of Families Living in Toronto Shelters","volume":"53","author":"Sedarous","year":"2018","journal-title":"Can. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jcjo.2021.08.018","article-title":"Delivering Eye Care to Homeless and Marginally Housed Populations during the COVID-19 Pandemic: A Pilot Study","volume":"58","author":"Slomovic","year":"2023","journal-title":"Can. J. Ophthalmol."},{"key":"ref_24","unstructured":"Miller, J., Samanta, A., Nelson, P., Bhatia, S., and Jacobs, M. (2023, January 17). The SMART Study [The Street Medicine Auto-Refractive Technology Study]. Proceedings of the National Health Care for the Homeless Conference, Baltimore, MD, USA."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1002\/emp2.12054","article-title":"Dedicated Homeless Clinics Reduce Inappropriate Emergency Department Utilization","volume":"1","author":"Holmes","year":"2020","journal-title":"JACEP Open"},{"key":"ref_26","unstructured":"(2025, July 20). Care Locations\u2014Healthcare for the Homeless\u2014Houston. Available online: https:\/\/www.homeless-healthcare.org\/care-locations."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s12939-019-1004-4","article-title":"Experience of Healthcare among the Homeless and Vulnerably Housed a Qualitative Study: Opportunities for Equity-Oriented Health Care","volume":"18","author":"Purkey","year":"2019","journal-title":"Int. J. Equity Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1007\/s11606-007-0183-7","article-title":"Homeless People\u2019s Perceptions of Welcomeness and Unwelcomeness in Healthcare Encounters","volume":"22","author":"Wen","year":"2007","journal-title":"J. Gen. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1055\/s-0040-1705086","article-title":"Methods to Develop a Sustainable Free Eye Clinic at a Homeless Shelter","volume":"12","author":"Hennein","year":"2020","journal-title":"J. Acad. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1007\/s11013-022-09807-z","article-title":"Harm Reduction Principles in a Street Medicine Program: A Qualitative Study","volume":"47","author":"Frankeberger","year":"2022","journal-title":"Cult. Med. Psychiatry"},{"key":"ref_31","first-page":"3045","article-title":"The Street Medicine Auto-Refraction Technology (SMART) Study: A Model for Screening and Treating Refractive Error in Unsheltered People","volume":"64","author":"Samanta","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_32","first-page":"2076","article-title":"Visual Impairment and Unmet Eye Care Needs In a Marginalized Community at a Chicago Vision Screening","volume":"66","author":"Randolph","year":"2025","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3999","DOI":"10.1007\/s11606-022-07689-w","article-title":"The Case for Mobile \u201cStreet Medicine\u201d for Patients Experiencing Homelessness","volume":"37","author":"Lynch","year":"2022","journal-title":"J. Gen. Intern. Med."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kaufman, R.A., Mallick, M., Louis, J.T., Williams, M., and Oriol, N. (2024). The Role of Street Medicine and Mobile Clinics for Persons Experiencing Homelessness: A Scoping Review. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21060760"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101354","DOI":"10.1016\/j.eclinm.2022.101354","article-title":"The Economics of Vision Impairment and Its Leading Causes: A Systematic Review","volume":"46","author":"Marques","year":"2022","journal-title":"eClinicalMedicine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1177\/1357633X20940140","article-title":"Better One or Two? A Systematic Review of Portable Automated Refractors","volume":"28","author":"Samanta","year":"2022","journal-title":"J. Telemed. Telecare"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Devine, B.C., Dogan, A.B., and Sobol, W.M. (2025). Recent Optical Coherence Tomography (OCT) Innovations for Increased Accessibility and Remote Surveillance. Bioengineering, 12.","DOI":"10.3390\/bioengineering12050441"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s10792-024-02975-4","article-title":"Clinical Utility of Handheld Fundus and Smartphone-Based Camera for Monitoring Diabetic Retinal Diseases: A Review Study","volume":"44","author":"Naz","year":"2024","journal-title":"Int. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/IJG.0000000000002463","article-title":"Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program","volume":"34","author":"Ramachandran","year":"2024","journal-title":"J. Glaucoma"},{"key":"ref_40","unstructured":"(2025, August 03). HCHD Foundation Focus on Healthcare for the Homeless and Dr. Matthew, W. Plummer, Jr. Available online: https:\/\/hchdfoundation.org\/homeless-dental-program-van\/."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:59:59Z","timestamp":1765371599000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/12\/2178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["medicina61122178"],"URL":"https:\/\/doi.org\/10.3390\/medicina61122178","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}