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Glaucoma is the leading cause of irreversible blindness worldwide after cataract and accounts for 10% of the world's blind.1 Although patients with acute angle closure glaucoma are symptomatic, those with other forms of glaucoma (at least in the early stages) usually do not experience many symptoms, thereby, resulting in the disease often going unnoticed with possible progression. In some cases, patients with fluctuating levels of intraocular pressure may experience blurred vision and see haloes around lights. The Glaucoma Symptom Scale (GSS) was developed to assess ophthalmic symptoms experienced by patients with glaucoma.2 The GSS comprises 10 ocular symptoms, of which six are non-visual and four are visual. The non-visual symptoms include ‘burning/smarting/stinging’, ‘tearing’, ‘dryness’, ‘itching’, ‘soreness/tiredness’, and ‘feeling of something in the eye’. The visual symptoms include ‘blurry/dim vision’, ‘hard to see in daylight’, ‘hard to see in darkness’, and ‘halos around lights’. The GSS is unique in that it assesses symptoms as compared with visual functioning by other glaucoma-specific questionnaires. Like most questionnaires in ophthalmology, the GSS was also developed using traditional psychometric methods, that is, the classical test theory (CTT).3 The limitations of CTT have been well acknowledged. A major shortcoming of CTT pertains to its scoring assumptions: Likert or summary scoring in which the scores are calculated from …
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