Glaucoma Risk Stratification Questionnaire Demonstrates Strong Discriminative Ability for Community Screening

Researchers at West China Hospital, Sichuan University, have developed and validated the Glaucoma Risk Stratification Questionnaire (GRSQ), establishing that the new instrument achieves an area under the receiver operating characteristic curve of 0.816 for identifying individuals at risk of glaucoma in Chinese communities. Glaucoma represents a leading cause of irreversible blindness, yet timely detection within community settings has been persistently hampered by an absence of accessible, low-cost screening tools. In addressing this gap, the study demonstrated that the questionnaire provides acceptable structural validity, acceptable reliability, and good discriminative ability to help triage individuals who require comprehensive ophthalmic examinations.

Conducted from December 2025 to August 2026, the investigation was structured as a hospital-based cross-sectional study that served as the instrument development and validation phase of a community screening program. The research was carried out within the Department of Ophthalmology at West China Hospital, Sichuan University, located in Chengdu, China.

A total of 413 participants were enrolled in the study across three predefined clinical cohorts. Group A comprised 207 individuals with confirmed glaucoma diagnoses. Group B enrolled 100 glaucoma suspects, and Group C included 106 normal control participants.

The instrument was initially drafted as a broader item pool that underwent systematic refinement through a two-round Delphi process involving 13 glaucoma experts. Following expert consensus, 24 items were retained for formal psychometric evaluation. Subsequent item analysis and exploratory factor analysis established a refined 14-item, three-factor structure that accounted for 46.7% of the total variance.

The finalized 14-item questionnaire is organized into three distinct subscales alongside two independently scored items. The first factor contains six items evaluating ocular symptoms. The second factor comprises three items covering psychological factors and corticosteroid use. The third factor consists of three items assessing systemic disorders. The remaining two items in the instrument are evaluated and scored independently from the three primary latent factors.

Confirmatory factor analysis conducted in an independent sample of 206 participants supported acceptable model fit, yielding a comparative fit index of 0.921, a Tucker-Lewis index of 0.898, and a root mean square error of approximation of 0.060. Total-scale internal consistency was acceptable, with a Cronbach’s alpha of 0.719. Furthermore, one-way analysis of variance demonstrated statistically significant differences in GRSQ scores across the three cohorts (F(2, 410) = 96.23, p < 0.001), with mean scores reaching 9.86 ± 3.97 in Group A, 6.69 ± 4.35 in Group B, and 3.55 ± 3.08 in Group C.

Receiver operating characteristic analysis confirmed an area under the curve of 0.816, with a 95% confidence interval of 0.773 to 0.857 (p < 0.001). At an optimal cutoff score of 6.5, the instrument achieved 82.1% sensitivity and 72.3% specificity. Based on these findings, the authors defined a three-tier risk stratification framework that classifies individuals into low risk (scores 0 to 5), moderate risk (scores 6 to 9), and high risk (scores of 10 or greater), providing a structured method to prioritize ophthalmic referrals while recognizing the hospital-based nature of this validation phase.

The investigative team was led by corresponding author Li Tang, alongside co-investigators Xianjie Yu, Jiaying Zhang, Xiangyu Fu, Vincentius Yonathan Evandrew, Haotian Xiang, Shanming Jiang, Meng Wang, Yutong Liu, and Caizhi Wu.

The peer-reviewed paper was submitted to the journal on August 10, 2026, and officially accepted following editorial review on October 29, 2026. The report appeared in Frontiers in Public Health under the Public Health Education and Promotion section. As an original research article, the full text and findings are distributed under the terms of the Creative Commons Attribution License, permitting open distribution, sharing, and reproduction in other academic forums provided the original authors and the source publication are properly credited.

To ensure empirical validity, the full psychometric testing sequence integrated item analysis, exploratory and confirmatory factor analysis, internal consistency evaluations, one-way analysis of variance, and receiver operating characteristic curve analysis.

Subject of Research: Development and psychometric validation of the Glaucoma Risk Stratification Questionnaire for community screening

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

Article References: Yu, X., Zhang, J., Fu, X., Evandrew, V. Y., Xiang, H., Jiang, S., Wang, M., Liu, Y., Wu, C., & Tang, L. (2026). Development and validation of the Glaucoma Risk Stratification Questionnaire for community screening. Frontiers in Public Health, 14, Article 1963928. https://doi.org/10.3389/fpubh.2026.1963928

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1963928

Keywords: glaucoma, glaucoma screening, risk stratification, Glaucoma Risk Stratification Questionnaire, GRSQ, community screening, ophthalmology, Delphi method, exploratory factor analysis, confirmatory factor analysis, psychometric validation, receiver operating characteristic, ocular symptoms, corticosteroid use, systemic disorders, West China Hospital, cross-sectional study