A Survey of Eye Care Needs Among Community Health Patients in Western South Dakota.

INTRODUCTION: Community Health Centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87%) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH. A total of 217 respondents (52%) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51%) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having health insurance such as private insurance, Medicaid, Medicare, State Children's Health Insurance Program (CHIP), Indian Health Services, Military insurance, or other public or government insurance programs (191, 45%) but showed a comparably high likelihood of using an on-site eye clinic when compared to their uninsured counterparts, 90% and 84%, respectively. Finally, 50 (12%) respondents indicated they had been referred to an eye doctor in the past, with affordability as the most cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

Conservative Management of Traumatic Optic Neuropathy Secondary to Lateral Orbital Wall Fracture.

PURPOSE: To inform rural healthcare providers about the early identification and management of traumatic optic neuropathy (TON). Specifically, we seek to legitimize expectant management as a viable approach to such cases. OBSERVATIONS: A 27-year-old female with direct posterior compressive TON with associated visual field and visual acuity deficit was managed expectantly without steroids or surgical intervention. In four months, her visual acuity improved from 20/400 to 20/50. CONCLUSTION AND IMPORTANCE: Although steroids and surgery have been common practice for treatment of TON, there is insufficient evidence to support their use in all cases. Existing research supports expectant management as a viable option. This could prove especially useful in rural settings where resources and surgical subspecialists are limited.