Barrier or facilitator	Quote	Number of participants expressing barrier (% of patients expressing barrier)	Number of times referenced
Barriers to eyeglass correction
Cost	I don’t have cash. Mine are extremely expensive. Each lens is different and each bifocal is different. So that’s four lenses I have to pay for. The last time I bought glasses they were $670. I can’t imagine five years later what they are going to be now.	29 (97)	312
	Even if I got just the basic frame, the basic frames are like $60, $70. Then the lenses. It’s the lenses that cost—so infuriating.
	I didn’t get [glasses] as often as I needed them because I can’t afford them.
	My insurance helped me pay for the eye doctor but not with the glasses. So I have to pay for them myself. So sometimes I waited [to get glasses].
	Even at America’s Best: two pairs for $65 with an eye exam. $65 is a lot for somebody that doesn’t have a substantial income to take out at one time, when you say I could pay half on a cable bill or I could eat, or pay the light bill, you know. Glasses are expensive. And it’s hard, but it’s kind of like choosing between eating and seeing.
	You got more bills. You got to keep a roof over your head. You got to have food to eat and things for your kids and things. The glasses will have to wait. Take care of the primary things first. Self-preservation is the law of the land. You got to have a roof over your head you got to have food to eat. You got to put clothes on your kids backs. You got to have some money and then you take care of [glasses].
	Rent’s coming up again. I can never even set $5 aside, that’s how tight things are.
	When you don’t have very much money, you got to go to what’s important. And sometimes it seems like getting glasses is not as important as paying the rent or the utility, because they wouldn’t put you out on the street if you don’t have glasses, but they will if you don’t pay your utilities.
	Glasses, eating; easy choice. Glasses, paying the utility bills; easy choice.
	I got to raise my daughter. She is four months old. I can forget glasses. I got to make sure she eats. If it comes down to my daughter, that’s who is going to eat, that’s what I’m going to take care of. I would go blind for her.
	I have a lot of health issues. I already pay for a lot of medications. Some things come before glasses.
	Glasses are expensive. And it’s hard, it’s kind of like choosing between eating and seeing.
Negative experiences	My glasses are humongous. They’re heavy and they’re not comfortable at all. They’re always falling and they’re just not comfortable. I’m always pushing them up.	29 (97)	263
	[Glasses are] uncomfortable. If it’s just too much pressure on my nose, it gives me a headache.
	It seems like every time I get them, I lose them.
	Most affordable glasses make people look ugly like coke bottles. Because of the frames, big lenses, who wants to wear big lenses like that?
	Several times I got a pair that the arms has broke off of it.
Lack of access	I am looking into programs such as clinics or churches or other places that might be able to assist [with glasses]. I know there are programs available but their waiting lists are extremely long.	27 (90)	175
	I need a new pair [of glasses] really bad. And I’ve been calling around, calling around, just starting at the top of the list literally and going down through the phone book. Trying to find one that will take my combination of insurance because it’s a Medicare with Medicaid backup. So one has to compliment the other, it just won’t take the one or the other. For some reason the systems won’t process it.
	Where I live, there’s [an optical shop nearby]. There’s one about two miles from where I live, but they don’t accept my insurance.
	Well, you’ve got certain doctors that won’t take Medicaid, you’ve got certain doctors won’t take Medicare.
	I’ve called my insurance company and they told me that we don’t cover eyeglass wear. And I was like they don’t cover anything at all. They were like we don’t cover eyeglasses or doctor’s visits.
Misperceptions	It can actually make your vision worse, if you wear the wrong prescription. It’s a muscle weakness of the muscle, that’s why the eyes keep getting worse.	19 (63)	45
	I haven’t tried to pay for glasses out of pocket, but I don’t think you can. They mostly want insurance. So I haven’t tried that.
	The wrong prescription can do more harm than good.
Lack of trust in healthcare system	[My primary care physician] says I don’t know where you can go. That’s the story I get from my PCP. They don’t know where to send you.	15 (50)	53
	I feel comfortable talking to my [primary care doctor]. My eye doctor not so much, he don’t care, he’s there just to do the exam and get a paycheck.
	I understand the whole concept of having to cover the lights in the building. But I think the markup [on glasses] is just extremely high.
	[My eye doctor] is just there to get a check. I mean, he is getting paid, he don’t care.
	I feel we are literally being gouged financially for a medical device, which you need.
Lack of transportation	Many people don’t have transportation, so how are they going to get there? It’s only certain places you can go, might be halfway down in Detroit somewhere. Who got the money to go down there?	9 (30)	29
	I don’t have any transportation and I am on that public bus. It takes me two buses and also to get to my doctor’s office. So I have to get on two buses to get there. So that’s probably about an hour. But if I was in a car it took me maybe 15 minutes.
	I’d have to walk or ride a bike [to the eye doctor]. I can’t drive.
Facilitators to eyeglass correction
Positive experiences	Well I have glasses and my life has been changed tremendously, I can read and see better so no more squinting.	29 (97)	230
	[I feel] safer [with glasses] because I could maybe have seen some things in my community, [like] abandoned houses that I didn’t notice before wearing my glasses that need to be taken down or boarded up.
	Honestly, I look sexy with glasses on and my glasses real nice, real nice and I got good taste.
	[People with glasses] are more likely to get a job, the one who can’t see can’t get no job because they can’t do the job [without good vision].
	Wearing glasses affects my life in terms of my overall functionality. I can drive a car, I can walk, I can see, I can recognize people and things. It’s allowed me to become a part of the general public and population.
	The last place I lived was not a safe environment. When you are not in a safe environment, you need to be able to see around you. And without glasses you won’t be able to see it well.
Easy access	Walmart sells glasses. A lot of the major chains: Meyers, Walmart, I don’t know if Kroger’s got them. But there’re a lot of places that have little shops in there where you can get glasses.	27 (90)	143
	The Gift of Sight helped me get [my glasses]. I couldn’t afford them without the Gift of Sight. That’s an organization that helps people get glasses.
	[If I needed glasses] I would go through my case manager through Community Mental Health and let them work for me. Because I have mental issues so my case manager through Community Mental Health takes care of all that stuff for me.
	I get my eye exams with the help of State Insurance, so I’m happy about that. No issues. My insurance takes care of that.
	How easy and hard is it to get glasses? It’s not hard for me because I have insurance. It’s hard for the people that don’t have insurance.
	I can get [glasses] every two years on my insurance, so it’s not hard.
Convenient transportation	I think if your eyes is bad enough, you’re going to find a way to get to the eye doctor, be it cab, bus, or with Medicaid. Yeah, with Medicaid they have a number that you can call that will get you to whatever appointments you need to be with.	27 (90)	65
	Ask someone for a ride. Everybody knows somebody who has a vehicle. And there’s always the bus system.
	I have transportation [to go to the eye doctor]. I have transportation to get there, and if my transportation is bad I call a family member to come take me.
Trust in healthcare system	I have had no [problems getting glasses]. I guess I have a good team of doctors around me making sure everything is easy for me. My doctor is very cooperative and she checked my eyes very carefully.	17 (56)	62
	It depends on where you go because some [clinics], you walk in and it is like, the people look and say like “what are you doing here, this is not for you.” And some places when you walk in they are happy and they treat you like you’re family, they greet you and they will make sure you are well taken care of. So it depends on where you go.
Low cost	At Eyeglass World, $69.99, you get two pair of eyeglasses and your eye exam is free. I think anybody can come up with $70 to go up here and take care of that.	12 (40)	18
	Nowadays you can get a fairly cheap pair of glasses. Unless you just wanna be fashionable.
	I think it is the website of zenny.com. These are what is called designer eye glasses for like $6.99, $9.89. You just put the number in the way you wear the eye glasses and then they ship it to you. If everybody was informed about that, then it will be helpful for people who didn’t have any money.