Development and validation of the Glaucoma Risk Stratification Questionnaire for community screening

Purpose Glaucoma is a leading cause of irreversible blindness, and community detection is hampered by the lack of accessible, low-cost screening tools. We developed and validated the Glaucoma Risk Stratification Questionnaire (GRSQ), a questionnaire-based instrument for identifying individuals at risk of glaucoma in Chinese communities. Methods This hospital-based cross-sectional study, constituting the instrument development and validation phase of a community screening program, was conducted at West China Hospital, Sichuan University, from December 2025 to August 2026. In total, 413 participants were enrolled: 207 with confirmed glaucoma (Group A), 100 glaucoma suspects (Group B) and 106 normal controls (Group C). The item pool was refined by a two-round Delphi process with 13 glaucoma experts, and psychometric properties were evaluated by item analysis, exploratory and confirmatory factor analysis (EFA, CFA), internal consistency, one-way ANOVA and ROC curve analysis. Results The Delphi process retained 24 items, from which a 14-item, three-factor structure was established after item analysis and EFA (46.7% of variance): ocular symptoms (6 items), psychological factor and corticosteroid use (3 items) and systemic disorders (3 items), with two items scored independently. CFA in an independent sample ( n = 206) showed acceptable fit (CFI = 0.921, TLI = 0.898, RMSEA = 0.060), and the total-scale Cronbach’s alpha was 0.719. GRSQ scores differed significantly among the three groups ( F (2,410) = 96.23, p < 0.001): 9.86 ± 3.97, 6.69 ± 4.35 and 3.55 ± 3.08 in Groups A, B and C. The area under the ROC curve (AUC) was 0.816 (95% CI, 0.773–0.857; p < 0.001), with 82.1% sensitivity and 72.3% specificity at the optimal cutoff of 6.5. A three-tier risk stratification system was established: low (0–5), moderate (6–9) and high risk (≥ 10). Conclusion GRSQ demonstrated acceptable structural validity, acceptable reliability at the total-scale level and good discriminative ability, representing a practical and accessible tool for identifying individuals at risk of glaucoma who may benefit from comprehensive ophthalmic examinations in resource-limited community settings.