The population characteristics and prevalence of visual impairment in a Southern European population

Purpose To describe the population characteristics, prevalence, and causes of visual impairment in Maltese adults aged 50–80 years. Methods The Malta Eye Study invited 4,006 random adults aged 50–80 for eye exams and interviews at the Malta and Gozo state hospitals (September 2021–July 2024). Tests included visual acuity, refraction, anthropometry, clinical measurements, tonometry, slit-lamp and dilated fundus exams, retinal imaging, and cognitive screening. Interviews covered sociodemographic, medical, ocular, and medication histories. Results A representative sample of 1,794 individuals (44.8% turnout) were assessed. Visual impairment in either eye was found in 23.9% (95%CI 21.9%–25.9%), and bilateral impairment in 6.0% (95%CI 4.9%–7.2%). The most common causes in either eye were uncorrected/undercorrected refractive error (12.3%), amblyopia (5.0%), cataract (3.8%), pathological myopia (1.3%), diabetic retinopathy (0.8%), age-related macular degeneration (0.6%), and glaucoma (0.4%). Predictors of visual impairment included older age, lower education, diabetes requiring insulin and tablets, and dementia. Protective factors were sunglasses use and angiotensin receptor blocker therapy. Conclusions Although overall visual impairment rates are favourable, this study highlights the need to strengthen screening and treatment services for avoidable causes, particularly by improving public optometry access, among older adults, socioeconomically vulnerable groups, and those with poorly controlled diabetes.