Introduction: Little is known regarding the extent of visualimpairment amongst pre-school children in Malaysia.Objective: To determine the prevalence of visual impairmentand amblyopia in Malaysian preschool children.Methodology: A cross-sectional, population-based studywas conducted on children aged four to six years from 51participating kindergartens in the district of Segamat, Johor,Malaysia from 20 March 2016 to 6 April 2016. All subjects hadinitial eye screening consisting of LogMar visual acuity,orthoptics examination and Spot vision screenerassessment. Subjects who failed the initial eye screeningwere invited for a formal eye assessment consisting ofcycloplegic refraction and a comprehensive ocularexamination. Definitions of visual impairment and amblyopiawere based on the Multi-Ethnic Pediatric Eye Disease Studycriteria.Results: A total of 1287 children were recruited. Meansubject age was 5.03 (SD:0.77) and males represented 52.3%of subjects. Subjects by ethnicity were Malay (54.8%),Chinese (27.7%), Indian (15.6%) and Orang Asli (1.9%).Formal eye assessment was required for 221 subjects and88.8% required ophthalmic intervention. Refractive error,representing 95.4% of diagnosed ocular disorders,comprised of astigmatism (84%), myopia (9%) andhypermetropia (6.9%). With-the-rule astigmatism waspresent in 93.4% of the subjects with astigmatism. Visualimpairment was present in 12.5% of our subjects, with 61%having bilateral visual impairment. Of the subjects withvisual impairment, 59.1% had moderate visual impairment.The prevalence of amblyopia was 7.53%, and 66% of theamblyopic subjects had bilateral amblyopia.Conclusion: Our study highlights an urgent need forinitiation of preschool vision screening in Malaysia.