This study compared urban and rural referrals from a community-based eye health screening program named 'Jom Check Mata Malaysia (JCMM)'. The program was carried out in nine different states in Peninsular Malaysia—a total of 18 screening locations with a mix of urban and rural. Two mobile eye clinics were mobilised for community-based eye health screenings. This study involved 3,139 participants (1,158 and 1,981 participants from rural and urban, respectively). Visual complaints were collected via interviews using an ocular symptom checklist. The visual acuity was screened using a Snellen Chart. Ocular health screening, including anterior and posterior eye segments, was screened using slit-lamp bio-microscopy and fundus camera. Overall referrals were 2,139 (68%), 846 (27%) and 362 (12%) based on visual complaints, visual acuity and ocular health screening, respectively. Rural locations had significantly higher referral rates for visual complaint screening (χ2 = 422.53, p<0.05), visual acuity screening (χ2 = 20.20, p<0.05) as well as ocular health screening (χ2 = 64.70, p<0.05) compared to the urban locations. There was a consistent pattern of higher rural referrals for all types of vision screening. Information from our three-category screening analysis could help to design a vision screening for our rural and urban populations. 

Keywords: eye health; vision screening; visual complaint; visual acuity; ocular health; rural; urban

References

Abdolalizadeh, P., & Ghasemi Falavarjani, K. (2022). Correlation between global prevalence of vision impairment and depressive disorders. European Journal of Ophthalmology, 32(6), 3227–3236. https://doi.org/10.1177/11206721221086152

Abdulhussein, D., & Abdul Hussein, M. (2023). WHO Vision 2020: Have we done it? Ophthalmic Epidemiology, 30(4), 331–339. https://doi.org/10.1080/09286586.2022.2127784

Ackland, P. (2012). The accomplishments of the global initiative VISION 2020: The Right to Sight and the focus for the next 8 years of the campaign. Indian Journal of Ophthalmology, 60(5), 380–386. https://doi.org/10.4103/0301-4738.100531

Ackland, P., Resnikoff, S., & Bourne, R. (2017). World blindness and visual impairment: Despite many successes, the problem is growing. Community Eye Health, 30(100), 71–73.

Alemayehu, A. M., Belete, G. T., & Adimassu, N. F. (2018). Knowledge, attitude and associated factors among primary school teachers regarding refractive error in school children in Gondar city, Northwest Ethiopia. PloS One, 13(2), e0191199. https://doi.org/10.1371/journal.pone.0191199

Al-Nuaim, A. A., Al-Nakeeb, Y., Lyons, M., Al-Hazzaa, H. M., Nevill, A., Collins, P., & Duncan, M. J. (2012). The prevalence of physical activity and sedentary behaviours relative to obesity among adolescents from Al-Ahsa, Saudi Arabia: Rural versus urban variations. Journal of Nutrition and Metabolism, 2012, 417589.

Alvi, R. A., Justason, L., Liotta, C., Martinez-Helfman, S., Dennis, K., Croker, S. P., Leiby, B. E., & Levin, A. V. (2015). The Eagles Eye Mobile: Assessing its ability to deliver eye care in a high-risk community. Journal of Pediatric Ophthalmology and Strabismus, 52(2), 98–105. https://doi.org/10.3928/01913913-20150216-02

Aniza, I., Mn, A., Jamsiah, M., Bi, I., & Cb, M. L. (2012). Prevalence of visual acuity impairment and its associated factors among secondary school students in Beranang, Selangor. Malaysian Journal of Public Health Medicine, 12(1), 39–44.

Bakar, N. F. A., Chen, A. H., Rahim, M. N. A., & Goh, P. P. (2012). Pilot study: A review of personnel involved in school vision screening and the training module in Betong, Malaysia. The International Medical Journal of Malaysia, 11(2).

Bakar, N. F. A., Chen, A.-H., Noor, A. R. M., & Goh, P.-P. (2012). Comparison of refractive error and visual impairment between Native Iban and Malay in a formal government school vision loss prevention programme. The Malaysian Journal of Medical Sciences: MJMS, 19(2), 48–55.

Burton, M. J., Ramke, J., Marques, A. P., Bourne, R. R. A., Congdon, N., Jones, I., Ah Tong, B. A. M., Arunga, S., Bachani, D., Bascaran, C., Bastawrous, A., Blanchet, K., Braithwaite, T., Buchan, J. C., Cairns, J., Cama, A., Chagunda, M., Chuluunkhuu, C., Cooper, A., … Faal, H. B. (2021). The Lancet global health commission on global eye health: Vision beyond 2020. The Lancet Global Health, 9(4), e489–e551. https://doi.org/10.1016/S2214-109X(20)30488-5

Chen, A. H., & Rosli, S. (2022). Electronic display devices: A study on screen display towards the health issues among Malaysian university students. Journal of ICT in Education, 9(1). https://doi.org/10.37134/jictie.vol9.1.1.2022

Chen, A. H., Rosli, S. A., & Hovis, J. K. (2020). A survey on daily activity inclination and health complaints among urban youth in Malaysia. Journal of Environmental and Public Health, 2020, 9793425. https://doi.org/10.1155/2020/9793425

Cheng, M.-L., Henderson, C., Sinclair, A., & Sanders, R. (2015). Visual health awareness, the Scottish community optometry service and Eyecare Integration Project: Breaking barriers in preventing visual impairment. British Journal of Visual Impairment, 33(3), 220–226. https://doi.org/10.1177/0264619615600009

Clinical Practice Guidelines (CPG) Screening of Diabetic Retinopathy: Vol. June (2011th ed.). (2011).

Dandona, R., Dandona, L., Srinivas, M., Sahare, P., Narsaiah, S., Munoz, S. R., Pokharel, G. P., & Ellwein, L. B. (2002). Refractive error in children in a rural population in India. Investigative Ophthalmology & Visual Science, 43(3), 615–622.

Dhungel, D., & Shrestha, G. S. (2017). Visual symptoms associated with refractive errors among Thangka artists of Kathmandu valley. BMC Ophthalmology, 17(1), 258. https://doi.org/10.1186/s12886-017-0659-0
Ebeigbe, J. A., & Emedike, C. M. (2017). Parents’ awareness and perception of children’s eye diseases in Nigeria. Journal of Optometry, 10(2), 104–110. https://doi.org/10.1016/j.optom.2016.06.001

Edwards, P. (2010). Questionnaires in clinical trials: Guidelines for optimal design and administration. Trials, 11, 2. https://doi.org/10.1186/1745-6215-11-2

Foreman, J., Salim, A. T., Praveen, A., Fonseka, D., Ting, D. S. W., Guang He, M., Bourne, R. R. A., Crowston, J., Wong, T. Y., & Dirani, M. (2021). Association between digital smart device use and myopia: A systematic review and meta-analysis. The Lancet Digital Health, 3(12), e806–e818. https://doi.org/10.1016/S2589-7500(21)00135-7

Fricke, T. R., Tahhan, N., Resnikoff, S., Papas, E., Burnett, A., Ho, S. M., Naduvilath, T., & Naidoo, K. S. (2018). Global prevalence of presbyopia and vision impairment from uncorrected presbyopia: Systematic review, meta-analysis, and modelling. Ophthalmology, 125(10), 1492–1499. https://doi.org/10.1016/j.ophtha.2018.04.013

Goh, P.-P., Abqariyah, Y., Pokharel, G. P., & Ellwein, L. B. (2005). Refractive error and visual impairment in school-age children in Gombak District, Malaysia. Ophthalmology, 112(4), 678–685.

Gomes, J. A. P., & Santo, R. M. (2019). The impact of dry eye disease treatment on patient satisfaction and quality of life: A review. The Ocular Surface, 17(1), 9–19. https://doi.org/10.1016/j.jtos.2018.11.003

Hashim, S., & Tan, H. (2008). Prevalence of refractive error in Malay primary school children in suburban area of Kota Bharu, Kelantan, Malaysia. Annals of the Academy of Medicine, Singapore, 37(11), 940–946.

Hendricks, T. J., De Brabander, J., Van der Horst, F. G., Hendrikse, F., & Knottnerus, J. A. (2007). Relationship between habitual refractive errors and headache complaints in schoolchildren. Optometry and Vision Science, 84(2), 137–143.

Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., Wong, T. Y., Naduvilath, T. J., & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 123(5), 1036–1042.

Hopkins, S., Sampson, G. P., Hendicott, P., & Wood, J. M. (2013). Review of guidelines for children’s vision screenings. Clinical and Experimental Optometry, 96(5), 443–449.

Ismail, A., Nawi, A. M., Mustafa, J., Idris, I. B., & Bastion, M.-L. C. (2012). Prevalence of visual acuity impairment and its associated factors among secondary school students in Beranang, Selangor. Malaysian Journal of Public Health Medicine, 12(1), 39–44.

Jaiswal, S., Asper, L., Long, J., Lee, A., Harrison, K., & Golebiowski, B. (2019). Ocular and visual discomfort associated with smartphones, tablets and computers: What we do and do not know. Clinical & experimental optometry, 102(5), 463–477. https://doi.org/10.1111/cxo.12851

Jin, P., Zhu, J., Zou, H., Lu, L., Zhao, H., & Li, Q. (2015). Screening for significant refractive error using a combination of distance visual acuity and near visual acuity. PloS One, 10(2), 1–10. https://doi.org/10.1371/journal.pone.0117399

Karande, S., & Kulkarni, M. (2005). Poor school performance. The Indian Journal of Pediatrics, 72(11), 961–967. https://doi.org/10.1007/BF02731673

Kvarnström, G., Jakobsson, P., & Lennerstrand, G. (2001). Visual screening of Swedish children: An ophthalmological evaluation. Acta Ophthalmologica Scandinavica, 79(3), 240–244. https://doi.org/10.1034/j.1600-0420.2001.790306.x

Lam, C. S.-Y., Lam, C.-H., Cheng, S. C.-K., & Chan, L. Y.-L. (2012). Prevalence of myopia among Hong Kong Chinese schoolchildren: Changes over two decades. Ophthalmic & Physiological Optics: The Journal of the British College of Ophthalmic Opticians (Optometrists), 32(1), 17–24. https://doi.org/10.1111/j.1475-1313.2011.00886.x

Langeslag-Smith, M. A., Vandal, A. C., Briane, V., Thompson, B., & Anstice, N. S. (2015). Preschool children’s vision screening in New Zealand: A retrospective evaluation of referral accuracy. BMJ Open, 5(11), e009207.

Marsden, J., Stevens, S., & Ebri, A. (2014). How to measure distance visual acuity. Community Eye Health, 27(85), 16.

Marshall, E. C., Meetz, R. E., & L’erin, L. H. (2010). Through our children’s eyes—The public health impact of the vision screening requirements for Indiana school children. Optometry-Journal of the American Optometric Association, 81(2), 71–82.

Masron, T., Yaakob, U., Ayob, N. M., & Mokhtar, A. S. (2017). Population and spatial distribution of urbanisation in Peninsular Malaysia 1957-2000. Geografia: Malaysian Journal of Society and Space, 8(2).

Michaud, L., & Forcier, P. (2014). Prevalence of asymptomatic ocular conditions in subjects with refractive-based symptoms. Journal of Optometry, 7(3), 153–160. PubMed. https://doi.org/10.1016/j.optom.2013.08.003

Pierścionek, B. K., & Weale, R. A. (1995). Presbyopia—A maverick of human aging. Archives of Gerontology and Geriatrics, 20(3), 229–240. https://doi.org/10.1016/0167-4943(94)00617-G

Pizzarello, L., Abiose, A., Ffytche, T., Duerksen, R., Thulasiraj, R., Taylor, H., Faal, H., Rao, G., Kocur, I., & Resnikoff, S. (2004). Vision 2020: The Right to Sight: A global initiative to eliminate avoidable blindness. JAMA Ophthalmology, 122(4), 615–620. https://doi.org/10.1001/archopht.122.4.615

Portello, J. K., Rosenfield, M., Bababekova, Y., Estrada, J. M., & Leon, A. (2012). Computer‐related visual symptoms in office workers. Ophthalmic and Physiological Optics, 32(5), 375–382.

Premsenthil, M., Manju, R., Thanaraj, A., Rahman, S. A. S. A., & Kah, T. A. (2013). The screening of visual impairment among preschool children in an urban population in Malaysia; the Kuching pediatric eye study: A cross sectional study. BMC Ophthalmology, 13(1), 1.

Saw, S. M., Goh, P. P., Cheng, A., Shankar, A., Tan, D. T., & Ellwein, L. B. (2006). Ethnicity-specific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore. The British journal of ophthalmology, 90(10), 1230–1235. https://doi.org/10.1136/bjo.2006.093450

Shah, S. P., Jadoon, M. Z., Dineen, B., Bourne, R. R. A., Johnson, G. J., Gilbert, C. E., & Khan, M. D. (2008). Refractive errors in the adult Pakistani population: The national blindness and visual impairment survey. Ophthalmic Epidemiology, 15(3), 183–190. https://doi.org/10.1080/09286580802105822

Singh, S., Pardhan, S., Kulothungan, V., Swaminathan, G., Ravichandran, J. S., Ganesan, S., Sharma, T., & Raman, R. (2019). The prevalence and risk factors for cataract in rural and urban India. Indian Journal of Ophthalmology, 67(4), 477–483. PubMed. https://doi.org/10.4103/ijo.IJO_1127_17

Speechley, M., Kunnilathu, A., Aluckal, E., Balakrishna, M., Mathew, B., & George, E. K. (2017). Screening in public health and clinical care: Similarities and differences in definitions, types, and aims–a systematic review. Journal of Clinical and Diagnostic Research: JCDR, 11(3), LE01.

Talens-Estarelles, C., Cerviño, A., García-Lázaro, S., Fogelton, A., Sheppard, A., & Wolffsohn, J. S. (2023). The effects of breaks on digital eye strain, dry eye and binocular vision: Testing the 20-20-20 rule. Contact Lens and Anterior Eye, 46(2), 101744. https://doi.org/10.1016/j.clae.2022.101744

Taylor, H. R. (2008). Eye health in the future: What are the challenges for the next twenty years? Community Eye Health, 21(67), 48–49. PubMed.

Thomas, R., Paul, P., Rao, G. N., Muliyil, J. P., & Mathai, A. (2005). Present status of eye care in India. Survey of Ophthalmology, 50(1), 85–101. https://doi.org/10.1016/j.survophthal.2004.10.008

WHO. (2007). Global initiative for the elimination of avoidable blindness: Action plan 2006-2011. (p. 97).

WHO. (2013). Universal eye health: A global action plan 2014-2019. (p. 28). https://www.who.int/blindness/AP2014_19_English.pdf?ua=1

Wilson, J. M. G., & Jungner, G. (1968). Principles and practice of screening for disease. Principles and Practice of Screening for Disease., 34.

Wu, L., Leung, H., Jiang, H., Zheng, H., & Ma, L. (2016). Incorporating human movement behavior into the analysis of spatially distributed infrastructure. PloS One, 11(1), e0147216.

Zainal, M., Masran, L., & Ropilah, A. R. (1998). Blindness and visual impairment amongst rural Malays in Kuala Selangor, Selangor. The Medical Journal of Malaysia, 53(1), 46–50.