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Seeing the unseen: uncovering health-related social needs through universal screening at an academic ophthalmology practice

Eye volume 39, pages 1501–1507 (2025)Cite this article

Subjects

Abstract

Background

Health-related social needs (HRSN), or unmet conditions that are important to maintain health (such as finances and transportation), contribute to vision health disparities. The purpose of this study is to identify the unmet HRSN of ophthalmology clinic patients.

Methods

This retrospective, cross-sectional study examined HRSN survey results from adult patients who checked in for a clinic visit at a tertiary academic eye centre from April 28, 2022, to March 31, 2023. Demographics and visual acuity were extracted from the electronic health record, and their reported HRSNs were evaluated using binary logistic regression.

Results

Of 1413 patients who completed the survey, 194 (13.7%) screened positive for at least one HRSN. The most frequently reported need was food insecurity (99/1303, 7.6%), followed by transportation (68/1340, 5.1%), housing instability (63/1305, 4.8%), financial insecurity (46/1293, 3.6%), and homelessness (10/1330, 0.8%). Patients with at least one reported HRSN were more likely to be Black compared to White (OR 4.03, 95% CI: 2.71–5.96), female compared to male (OR 1.88, 95% CI: 1.34–2.62), and younger than 65 years of age compared to 65 to 75 years (OR 2.35, 95% CI: 1.68–3.37) or older than 75 years (OR 4.62, 95% CI: 2.54–8.16). Presence of at least one HRSN was associated with visual impairment, with greater odds of best-corrected visual acuity worse than 20/40 in the group with HRSN compared to without HRSN (OR 1.55, 95% CI: 1.09–2.19).

Conclusion

Integrating a screening questionnaire in ophthalmology clinics can uncover unaddressed HRSN, enabling resource allocation to mitigate vision health disparities.

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Fig. 1: Proportion of patients with visual acuity better and worse than 20/40 vs. social need screening status (n = 1142).

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Data availability

The datasets used and analysed during the current study are available from the corresponding author upon reasonable request.

Notes

  1. Consistent with most Likert-scale based questions, there was not a free-text option to capture patient-specific subjective interpretations of Likert scale options (e.g., “sometimes true” for food insecurity is subject to each participant’s individual interpretation). To account for this limitation, we also conducted a sensitivity analysis in which food insecurity was defined more strictly by the top-box selection of “often true” (rather than “often true” or “sometimes true”). The conclusions regarding associations between demographic characteristics and food insecurity were not substantially different when only the “often true” responses were considered a positive screen (n = 79 for “often true” compared to n = 99 for “often true” or “sometimes true”).

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Funding

This work was supported by the National Institutes of Health (NIH) through Grant UL1 TR001857, NIH CORE Grant P30 EY08098, the Henry L. Hillman Foundation, the Eye and Ear Foundation of Pittsburgh, and by an unrestricted grant from Research to Prevent Blindness to the Department of Ophthalmology at the University of Pittsburgh. The funding organizations had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Natasha Mayer, Julie Cassidy, Lauren M. Wasser & Andrew M. Williams

  2. Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel

    Lauren M. Wasser

  3. Department of Business Administration – Marketing and Business Economics Area, Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA, USA

    Peggy J. Liu

Authors
  1. Natasha Mayer
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Contributions

All authors attest that they meet the current ICMJE criteria for Authorship. NM wrote the original draft of the manuscript; JC, LMW, and PJL collected and analysed data; AMW provided supervision and edited the manuscript.

Corresponding author

Correspondence to Andrew M. Williams.

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Competing interests

AMW receives funding from the National Science Foundation, Research to Prevent Blindness, the Chandler-Grant Glaucoma Society, and the American Glaucoma Society. No other contributing authors have competing interests.

Ethics approval

This study was deemed exempt from review by University of Pittsburgh Institutional Review Board. Additionally, this study adheres to the ethical principles for human research established by the Helsinki Declaration and the Belmont Report.

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Mayer, N., Cassidy, J., Wasser, L.M. et al. Seeing the unseen: uncovering health-related social needs through universal screening at an academic ophthalmology practice. Eye 39, 1501–1507 (2025). https://doi.org/10.1038/s41433-025-03690-9

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