How an eye exam can detect other health risks and what a Miami clinic is doing to help

Eye exams can tell doctors a lot about your health.

“The eyes are a mirror to the inside of your body,” said Dr. Almas Khan, an optometrist at UHI CommunityCare Clinic in Opa-locka.

Eye exams can detect early signs of diabetes, heart disease, high blood pressure, cancer and other health issues. But eye care and eyeglasses aren’t cheap.

For people without insurance, an exam can cost $50 to $200. Eyeglasses with prescription lenses, contacts, cataract surgery removal and other common procedures and treatments for eye conditions can run into the hundreds.

UHI, a nonprofit community clinic, offers free exams and glasses for those in need. That is one of many services offered by the clinic, which was founded and is supported and led by South Florida’s Muslim community and is open to anyone in need. The Coalition of South Florida Muslim Organizations, known as COSMOS, is a partner.

Cost is why Jose Villatoro, 33, didn’t think he could get a new pair of glasses. The nearsighted construction worker, who doesn’t have vision insurance, said it’s been hard to find work recently and he’s had to prioritize other expenses. He previously spent $400 for two eyeglasses a few years ago, and he can’t afford that again.

A friend told him about UHI in Opa-locka, which provides free eyeglasses to people who don’t have health insurance or have a monthly household income less than 300% below the federal poverty line.

Eligible patients can get free comprehensive eye exams and free glasses with prescription lenses at the clinic at 870 Fisherman St.

While basic eye exams focus on how well a person can see, comprehensive eye exams are more robust. Doctors will check a person’s vision and also check for glaucoma, cataracts and signs of other health conditions such as diabetes.

During his recent visit to the clinic, Villatoro’s eyes underwent a variety of tests. He then selected a free pair of glasses from more than a dozen options. During his visit, the Opa-locka man told the Miami Herald in Spanish that he feels grateful for the clinic and that they “help people like this because maybe we don’t have money” to seek care.

Visual impairment in the country

More people aren’t seeing the way they should. The number of people with visual impairment or blindness in the U.S. is expected to double to more than 8 million by 2050, according to projections based on recent Census data and studies funded by the National Eye Institute, part of the National Institutes of Health. Millions more are expected to experience worsening vision due to myopia (nearsightedness) or hyperopia (farsightedness), conditions that can be fixed with glasses, contacts or surgery.

And Florida has some of the highest rates of vision loss or blindness in the country. About 3% of Floridians have vision loss that can’t be corrected with glasses or contacts, according to estimates from the U.S. Centers for Disease Control and Prevention.

Vision loss is often caused by age-related eye diseases including cataracts, diabetic retinopathy, glaucoma and age-related macular degeneration, according to the CDC. The U.S. population is older than it has ever been, with the country’s 65+ population expected to balloon to 82 million by 2050. But age is not the only reason why more people have eye issues.

Long screen time on phones, computers and tablets that emit blue light can strain your eyes.

Food insecurity, access to insurance and other economic and social factors can also affect eye health, according to Dr. Zubair Ansari, director of medical outreach at the University of Miami’s Bascom Palmer Eye Institute, the top hospital in the nation for opthalmology.

In Miami-Dade County, for example, the prevalence of cataracts — a common eye condition that can cause vision loss in older adults — is two to three times higher in patients who live in lower socioeconomic areas, according to Ansari. Cataract surgery, a 10- to 20-minute procedure, is typically covered by most health insurance plans, including Medicare and Medicaid. Depending on the type of cataract surgery that a patient needs to clear clouding over the lens of the eye, the procedure could cost $3,000 to $6,000 per eye without insurance, according to UCF Health.

Black and Hispanic people, who have higher rates of chronic diseases and are more likely to be uninsured, are also known to experience a higher prevalence of glaucoma, a disease that damages the optic nerve and is the leading cause of irreversible blindness. While there is no cure for glaucoma, early detection and treatment might prevent or delay permanent vision loss.

“Ophthalmologists are sometimes the point of contact for a lot of patients that may not know that they have other health conditions,” said Ansari, noting doctors can see swelling or changes in the eyes that might indicate cardiovascular, neurological or other health problems.

“Ophthalmology and eye care can certainly not only save someone’s vision,” Ansari said, “but also save someone’s life in many cases.”

In 2017, about 93 million American adults 18 years or older, or about 4 in 10, were at high risk for vision loss, according to a study published in JAMA Ophthalmology. Among adults at high risk for vision loss, about 40% did not see an eye doctor or get an eye exam in the last year. Of adults who reported needing eyeglasses, more than 8 million, said they could not afford them.

At the UHI clinic, many of Khan’s patients need glasses or treatment for cataracts, glaucoma, dry eyes, keratoconus, diabetes-related eye issues and other eye conditions. Depending on what type of treatment patients need, the doctor sometimes has to refer them elsewhere for further care. But without insurance, that can be a challenge.

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Patients who need specialized testing, long-term care for certain conditions or specialized custom-designed contact lenses, for example, are usually referred to Nova Southeastern University’s Optometry Clinic, which offers treatment at reduced costs, said Khan, who works as an adjunct professor at the Davie university. Children with autism or other neurological conditions are similarly referred to the university’s pediatric clinic. But it’s more difficult to find affordable alternatives for other eye conditions such as cataracts. The doctor is searching for a cataract surgeon or program that could help provide free or discounted cataract surgeries to UHI patients.

“Patients with dense cataracts can barely walk or drive or do things. They cannot read anymore,” Khan said. “But giving them, helping them get a cataract surgery can give them the quality of life that they need.

“Eyes are kind of like your independence. So good vision brings independence into your life,” she added. “It brings confidence for patients. It brings a peace of mind.”

Improving access to care

The cost of care isn’t the only barrier to improving health. Lack of transportation, affordable housing and medical mistrust can also play a role in patients showing up for treatment.

Besides eye care, the clinic, which earlier this year relocated from Miami Gardens, also offers a variety of other non-emergency primary, pediatric, telehealth and specialty care. Patients can go to the clinic for routine check-ups, vaccinations, podiatry and psychiatric services, lab tests and help with medication and chronic conditions such as diabetes and hypertension. Some of its community partners include the Islamic Foundation of South Florida, Jewish Community Services of South Florida, Jackson Health System, Herbert Wertheim College of Medicine and College of Nursing and Health Sciences at Florida International University, the University of Miami Miller School of Medicine and the Amazon Foundation.

Treating patients means “looking at the patient beyond just a list of diseases and medications and just really getting to know why they are where they are and what else we can do to help them out,” said Naya Caldes, who was recently accepted into three medical schools and has worked at the clinic for several years, first as a volunteer and now as a medical assistant and assistant office manager.

Founded more than 90 years ago by aviation pioneer Glenn Curtiss, the four-square-mile city of Opa-locka is home to many who need help. Nearly a third of the population of 15,700 lives at or below the poverty line, according to the most recent Census data.

Within the city’s boundaries you’ll find homes, parks, an Amazon warehouse and Miami Opa-locka Executive Airport. There are some restaurants and convenience stores, but there are no major grocery stores.

Many diseases “could be managed well if you are able to eat well and able to afford good food,” said Tehsin Siddiqui, a certified physician assistant at UHI.

Clinic staff describe the area as a “food desert” and say they frequently refer patients to nearby food pantries and are always searching for opportunities to participate in food drives and other community events, including dietitian-led nutrition classes to help teach people how to eat healthy on a budget.

“Patients say healthy eating cost a lot of money ... sometimes they think that they need more portions then they need for a healthy plate so our dietitian actually teaches them how to substitute whatever things that you need with the more cheaper options,” said Husna Oleed, adult nurse practitioner.

South Florida healthcare systems, nonprofits and community health centers are also continuing to brainstorm ways to reduce barriers to healthy living. Some have launched mobile health clinics to try and bring primary care and other health services to those who need it most. Bascom Palmer, for example, has a mobile opthalmology clinic that provides comprehensive eye exams to patients who live in underserved areas. The mobile clinic, known as the Vision Van, has provided care around downtown Miami, Allapattah and Little Haiti and has also traveled to the Keys, Naples, and into pockets of Broward and Palm Beach counties. Plans are in the works to expand into Homestead.

Miami-Dade County residents who don’t have medical insurance may also be eligible to apply for the Jackson Prime Card, a program that offers free or reduced-cost care at Jackson Health System using a sliding fee scale based on income and current federal poverty guidelines.

“Our goal is actually just to make the community better overall,” Oleed said. “When the person is mentally and physically healthy, that’s a necessity to have a healthy community.”

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