Work

Prevalence of Refractive Errors, Myopic Macular Degeneration, and Associated Risk Factors in a Maltese Population-Based Study

Year: 2026

Type: article

Abstract: Purpose: To estimate the prevalence of refractive error and myopic macular degeneration in a nationally representative sample of older adults from Malta, evaluate associations with established risk factors. Patients and Methods: This population-based cross-sectional study included 1,794 participants aged 50– 80 years from Malta, recruited as part of The Malta Eye Study (response rate 44.8%). Demographic, medical, behavioral, and ocular data were collected using structured questionnaires. Standardized ophthalmic examinations were performed, including autorefraction and retinal imaging with optical coherence tomography. Refractive error was classified by spherical equivalent as myopia (< − 0.50 D) and hyperopia (> +0.50 D), while astigmatism was defined as ≤ − 0.75 D. Myopic macular degeneration was graded using the meta-analysis for pathologic myopia classification. Associations were assessed using multivariable logistic regression. Results: Among right phakic, surgically untouched eyes, the prevalence of emmetropia, myopia, and hyperopia was 20.0% (95% CI 18.0– 22.1%), 25.1% (95% CI 23.0– 27.4%), and 54.8% (95% CI 52.3– 57.3%), respectively. Vector-derived average astigmatism prevalence in both eyes was 44.3% (95% CI 41.6– 46.9%), with against-the-rule astigmatism being the most common pattern. Effective refractive error coverage exceeded 90% for both distance and near vision. The prevalence of any myopic degeneration in either eye was 2.6% (95% CI 1.9– 3.4%). Myopia prevalence among individuals aged 50– 59 years was lower than that reported in other European populations, and use of long-acting anti-muscarinic agents was associated with myopic degeneration (OR 25.70, 95% CI 1.55– 426.04, p=0.023). Conclusion: This study reports refractive error and myopic macular degeneration prevalence broadly comparable to other European settings. Lower myopia prevalence among individuals aged 50– 59 years may reflect complex gene–environment–behavior interactions. Further investigation of these interactions, as well as the potential impact of long-acting anti-muscarinic agents on myopic macular degeneration, is warranted, particularly in light of the wide confidence interval. Plain Language Summary: This study explored how common vision problems are among adults aged 50 years and older living in Malta, and which factors may be linked to these problems. The focus was on short-sightedness, long-sightedness, uneven focus, and damage to the retina related to short-sightedness. Why was this study done? Uncorrected vision problems are a leading cause of reduced vision worldwide. In Malta, there are no recent national data on these conditions. Such information is important for planning eye care services and reducing avoidable vision loss. What did the researchers do and find? We examined a large, representative group of older adults in Malta. We measured vision, examined the eyes, and collected information about health and lifestyle. About one in four people had short-sightedness, while over half had long-sightedness. Many also had uneven focus. Most people who needed vision correction had their distance and near vision needs met. Damage related to short-sightedness affected a small proportion of the population. People aged 50 to 59 had lower rates of short-sightedness than those reported in other European countries. We also observed a possible link between the use of certain long-acting inhaled medicines for breathing conditions and short-sightedness-related eye damage, based on small numbers. What do these results mean? Vision problems are common among older adults in Malta, but access to vision correction is generally good. Differences between age groups and the possible medication link need further study. Keywords: myopia, hyperopia, refractive error, astigmatism, anisometropia, myopic macular degeneration, prevalence, risk factors, ageing, population-based study, long-acting anti-muscarinic agents

Source: Clinical Optometry

DOI: 10.2147/opto.s561426