Purpose: Uncorrected refractive error and ocular disease are the main causes of visual impairment
worldwide. There are few studies of the causes of visual impairment in underserved
areas of the Caribbean region. This is the first study of the prevalence of refractive
error, systemic and ocular diseases in a clinical population in a town at the border
between the Dominican Republic and Haiti.
Methods: The sample included 473 patients (ages 3 to 95. Mean = 46.8 ± 20.1 years) from Pedernales
(Dominican Republic) who responded to an open invitation to a free eye care town clinic
in March 2015. They were examined by optometrists and supervised student clinicians
from the Inter American University of Puerto Rico School of Optometry using a uniform
protocol for each patient. Every patient was consented, had a case history and tested
for blood pressure, visual acuities, cover test, objective and subjective refraction,
external and internal ocular health
Results: 41.2% of all patients never had an ocular examination. Hypertension (36.44%),
diabetes (3.93%), cataracts (8.75%), pterygium (5.84%) and glaucoma (2.39%) were the
most commonly reported systemic and ocular diseases. Our testing revealed that 82.4%
of the patients were hypertensive (44.9% Stage 1 and 37.5% Stage 2 hypertension).
The most common ocular abnormalities found were pinguecula (25.6%), pterygia (21.1%)
and cataracts (25.6%). 48.2% of the patients were visually impaired (presenting distance
visual acuity less than 20/40) out of which 6.5% were blind. Visual impairment was
reduced to 15.8% after refractive correction. The mean spherical equivalent of the
refractive error was 0.06 ± 2.54 D, Range -14.5 D to +5.00 D. The spherical equivalent
of the refractive error was statistically different between age groups (F (7,400)
= 4.65, p <0.01). Post-hoc testing revealed that the mean spherical equivalent
for the 11-20-year-old group was significantly more myopic than most other age groups.
Conclusion: The prevalence of hypertension, ocular diseases and presenting visual impairment in
this clinical population of Pedernales is the highest reported for any Caribbean group
of patients. The main cause of visual impairment was uncorrected refractive error.
Improved access to optometric care, ultraviolet protection, and patient clinical education
can significantly improve the ocular health of this population.