Incarcerated individuals and those in immigration detention centres have higher rates of health care disparities and are disproportionately burdened by chronic disease: obesity, type II diabetes mellitus, hypertension, human immunodeficiency virus, substance use disorders, and mental illness [1]. Ophthalmic care for patients in these vulnerable populations can be especially difficult; logistical, communication, and bureaucratic barriers exist in the carceral system, preventing timely and appropriate management of the aforementioned and ophthalmic conditions [2]. A paucity of literature exists pertaining to ophthalmic care for patients in immigration detention centres. This is increasingly important given the changing political landscape in the United States, with higher numbers of migrants being placed in detention centres operated by privatized, for-profit organizations. Furthermore, recently policy changes favour prolonged detention periods and standardized health care implementation and oversight is lacking [3]. In the October 2025 issue of Eye, Wedekind et al explore the state of ophthalmic care for incarcerated patients and those in immigration detention centres presenting to an academic ophthalmology department in southern California [4]. Their findings reveal both a significant delay in follow-up for those that attended appointments and a majority of included patients being lost to follow-up. Furthermore, use of ancillary testing was low for these populations, though this may primarily be attributed to these tests needing to be performed at a separate appointment, as the authors noted. Interestingly, subspecialty appointments such as neuro-ophthalmology and oculoplastics had significantly decreased attendance rates compared to comprehensive visits. These results underscore the significant disparity of ophthalmic healthcare for incarcerated patients and those in immigration detention centres. The authors should be commended for their work and investigation into these susceptible populations.

A Problem at the Human Level

Incarcerated individuals have a constitutional right for a minimum standard of health care under the Eighth Amendment of the United States Constitution. Immigration detainees also have a right to adequate medical care for serious medical needs according to the Due Process Clause of the Fifth and Fourteenth Amendments, which may be interpreted as ensuring detained individuals be pardoned from conditions that amount to punishment and that they receive care at least equivalent to that of incarcerated individuals under the Eighth Amendment [3, 5]. Although immigration detention is a civil matter, indifference to acute and chronic medical needs, including acute and chronic ophthalmic care, is prohibited and facilities should provide access to care. This article by Wedekind et al and others [3, 4, 6] highlights the delays in proper treatment and inadequate management of ophthalmic conditions. Though standards exist from organizations such as the National Commission on Correctional Health Care and the American Correctional Association, these standards are poorly implemented and enforced. Accreditation is voluntary, leading to variability in care and minimal accountability [1, 7]. The scarcity of oversight for carceral system care needs to be rectified.

A Problem at the System Level

Logistically, implementing these rights has been difficult. On-site specialty care is limited at jails, prisons, and detention centres, and thus off-site medical care is conducted through contracts with community or academic health care systems, leading to inevitable transportation and communication obstacles [1, 2, 8]. Partnering healthcare systems may be already overburdened and ill-prepared to handle an influx of patients without additional resources to coordinate care.

Geographically, distance alone can be an issue, as Wedekind et al noted that the average distance travelled for carceral patients was just over 40 miles [4]. Transportation between sites is also subject to cancellation or delay due to resource costs and staffing issues. Current security restrictions also lead to disruption of the patient-physician relationship with third-party carceral staff members acting as intermediaries to facilitate scheduling between providers and patients themselves [2, 8]. Language and cultural barriers further represent a significant barrier in this population. Demographics of jails, prisons, and immigration detention centres show increased prevalence of minority racial and ethnic groups, with these groups experiencing higher rates of disease burden [1]. Compounded with logistical scheduling issues and third-party involvement, the added language and cultural barriers further exacerbate delays in treatment or management for acute and chronic ophthalmic conditions. Additionally, patients in the carceral system are at risk for broken continuity of care from inter-facility transfer, release, or deportation without system-wide oversight.

All these barriers likely contribute to increased delay in ophthalmic care and higher risk for vision loss, especially for conditions such as glaucoma which may be asymptomatic for early stages of the disease [2]. In short, with the expanding number of detainees in immigration detention centres, awareness and implementation of comprehensive, consistent standards for ophthalmic conditions must be implemented.

Embracing the Challenge

Telemedicine and other virtual consult services can alleviate the burden of off-site transport and provide timely access to ophthalmic care. Teleophthalmology is an evidence-based tool that has been used in the carceral population [9,10,11]. This cost-effective service may be used for initial screenings, triage, and diagnosis without the logistical burden of physical transportation. Standardized vision screening standards at intake should also be implemented. The National Commission on Correctional Health Care recommends a comprehensive health assessment within 1 week from the date of intake to a facility for justice-involved youth [12]. Similar standards should be applied to the adult population including vision care, with ocular health assessments being performed within 14 days of admission. This may be done in conjunction with teleophthalmology. Additionally, onsite medical staff should be trained in standardized vision screening, intraocular pressure measurement and non-mydriatic fundus photography.

Most importantly, these standards should be implemented and upheld in accordance with human and Constitutional rights for incarcerated persons and individuals in immigration detention centres. Current Immigration and Customs Enforcement (ICE) standards include a comprehensive health assessment within 14 days, but a disparity exists in overall health outcomes and medical management [13,14,15]. Accountability should be expanded from annual inspections and formal grievances to include random audits and detainee feedback especially in ICE detention facilities [13,14,15]. Continuity protocols and a central referral management system need also be emphasized to promote effective medical and ophthalmic care apart from an initial screening. Lastly, partnership with vocational programs that provide glasses can ease financial burdens for patients in the carceral and detainment systems.