The Study Design and Methodology of the Malta Eye Study (TMES), an Ophthalmic Epidemiology Study


  • David Agius Department of Surgery, University of Malta, Msida, Malta
  • Julian Mamo Department of Public Health, University of Malta, Msida, Malta
  • Christopher Hammond King’s College, London, United Kingdom
  • Neville Calleja Department of Public Health, University of Malta, Msida, Malta
  • Francis Carbonaro King’s College, London, United Kingdom


Visual Impairment, Prevalence, Malta, Glaucoma, ARMD, Cataract, Diabetic retinopathy


Purpose: The Malta Eye Study (TMES) is a cross-sectional study of the adult Maltese population to determine the prevalence of visual impairment and the respective causative pathologies. The study's design and methods are discussed in this paper.

Methods: A random sample of 5000 Maltese individuals aged 50–80 years, stratified by age, sex, and locality, are being invited for an ophthalmic assessment between September 2021 and May 2024. The validated tools of measurement include the National Eye Institute Visual Function Questionnaire, the EQ-5D-5L, the Ocular Surface Disease Index, and the Quick Mild Cognitive Impairment Score for assessments of visual function, quality of life, dry eye symptoms, and cognitive impairment, respectively. Other tools of measurement involve anthropometrics, visual acuity, autorefraction, keratometry, air-puff tonometry, Goldmann tonometry, slit lamp examination, fundus photography, swept-source optical coherence tomography (SSOCT) scanning of the macula and disc, as well as SSOCT angiography. A saliva sample is also collected for genetic analysis.

Results: The data collection has assessed 1600 individuals up until the end of November 2023. Data from the first year of data collection has shown that the sample was representative in terms of age and gender.

Conclusions: TMES uses up-to-date technology and tools to provide epidemiologic data on visual impairment, eye conditions, risk factors, and genetic associations. Knowledge of the local situation will help determine policymaking in terms of screening and primary and tertiary health care planning. TMES is also compiling a SSOCT angiography portfolio for the assessed participants.

Financial Support: Research, Innovation and Development Trust of the University of Malta; Prohealth Ltd; Class Optical

Conflict of Interest: None of the authors have any proprietary interests or conflicts of interest related to this submission.

Acknowledgements: Dr John Cachia gave advice based on his previous Maltese ophthalmic epidemiological study. Dr George Farrugia, from the Department of Maltese, assisted in obtaining accurate back translations of the questionnaires into Maltese.  Mr Nicolai Schembri and Mr Christian Attard (University of Malta IT department) and Mr Stefan Attard (Department of Health Promotion) provided IT support. The staff and management of Mater Dei Hospital and the Department of Ophthalmology enabled the smooth running of this study.





How to Cite

Agius, D., Mamo, J., Hammond, C., Calleja, N., & Carbonaro, F. (2024). The Study Design and Methodology of the Malta Eye Study (TMES), an Ophthalmic Epidemiology Study. South Eastern European Journal of Public Health, 188–200. Retrieved from