The homelessness in Ribeirão Preto Eye Study (HOPES): design, methods, and demographic profile

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Objective We describe the design, field procedures, and core ophthalmic examination protocol of the Homelessness in Ribeirão Preto Eye Study (HOPES), report baseline participant characteristics and examination completion, and highlight key methodological differences relative to ophthalmic surveys conducted in general-population settings and in prior studies of people experiencing homelessness. We also provide practical suggestions for future research and for service-oriented activities tailored to this population. Design Cross-sectional design/methods study Subjects Adults experiencing homelessness in Ribeirão Preto, São Paulo, Brazil. Methods From April 2023 to June 2024, participants were recruited during scheduled visits to municipal support centers. The protocol combined standardized interviews with portable ophthalmic assessments, including uncorrected and presenting visual acuity, refraction, intraocular pressure measurement, anterior segment examination, and posterior segment evaluation (with documentation via fundus examination/photography when feasible). Data elements were collected to support WHO-recommended service coverage indicators (effective refractive error coverage [eREC] and effective cataract surgery coverage [eCSC]) in subsequent outcome-focused analyses. Results Of 518 individuals invited, 491 (94.8%) consented, and 461 (89.0%) completed the full ophthalmological examination. Participants were predominantly men (84.8%) and aged 40-59 years old (51.0%). Self-reported skin color was most commonly Brown (52.7%), followed by White (29.5%) and Black (16.3%). Nearly half reported homelessness for ≤1 year (47.5%), and 55.7% had ≤8 years of schooling. One-third had never had an eye examination (33.8%), and 33.2% reported their last examination >5 years earlier. Conclusions HOPES provides a replicable protocol and operational approach for implementing standardized ophthalmic assessments among adults experiencing homelessness in a Brazilian urban setting. Given the younger age structure of this population, inclusion criteria should not be restricted to older age groups (e.g., ≥50 years). In addition, the protocol supports immediate, low-complexity benefit through the provision of free spectacles, ideally using ready-made options when appropriate to maximize same-day correction. Finally, based on the study team’s field experience, individuals who received spectacles frequently sought replacement at subsequent visits, reinforcing that sustainable, ongoing services are likely to be more appropriate than episodic campaigns for meeting recurrent refractive needs in this population.

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