Background: Glaucoma is a leading cause of irreversible blindness worldwide. Effective screening and early identification of at-risk individuals are essential to reduce visual morbidity. Population screening programs require efficient screening tests and identification of high-risk groups for targeted case finding.

Objective: To evaluate the performance of a glaucoma screening algorithm combining intraocular pressure (IOP) measurement, optic disc assessment, and visual field screening, estimate the prevalence of suspected glaucoma in an urban adult population, and identify independent risk factors associated with suspected glaucoma.

Methods: A cross-sectional community and outpatient screening program was conducted between January–June 2025. Adults ≥40 years (n = 1,200) were screened using: (1) non-contact tonometry (IOP ≥21 mmHg flagged), (2) optic disc evaluation by trained graders using handheld fundus photography and vertical cup-to-disc ratio (VCDR ≥0.6 flagged), and (3) frequency-doubling technology (FDT) or supra-threshold visual field screening (any defect flagged). Participants with any positive screening test underwent comprehensive ophthalmic examination including Goldmann applanation tonometry, slit-lamp, gonioscopy, dilated stereo-disc evaluation, optical coherence tomography (OCT) RNFL, and standard automated perimetry (SAP). Primary outcomes: prevalence of suspected glaucoma (confirmed by clinical exam: repeatable optic nerve/RNFL and/or corresponding field defect), sensitivity/specificity of individual screening tests and combined algorithm, and multivariable analysis of risk factors (age, family history, myopia, diabetes, hypertension, steroid use, pseudoexfoliation).

Results: Of 1,200 screened participants (mean age 56.2 ± 9.8 years, 55% female), 182 (15.2%) screened positive (≥1 test). After definitive exam, confirmed suspected glaucoma was identified in 74 individuals → community prevalence 6.2% (95% CI 4.9–7.6%). Screening performance: IOP ≥21 mmHg alone — sensitivity 46%, specificity 91%; VCDR ≥0.6 alone — sensitivity 68%, specificity 84%; FDT field defect alone — sensitivity 59%, specificity 88%. Combined algorithm (any positive) improved sensitivity to 88% with specificity 76%. Multivariable logistic regression identified independent risk factors for suspected glaucoma: age per decade (aOR 1.7, 95% CI 1.3–2.2), positive family history of glaucoma (aOR 3.2, 95% CI 1.8–5.7), high myopia (spherical equivalent ≤ −6.0 D; aOR 2.6, 95% CI 1.3–5.1), pseudoexfoliation on exam (aOR 4.5, 95% CI 1.8–11.5) and steroid eye-drop use >4 weeks (aOR 2.9, 95% CI 1.2–7.2). Diabetes and hypertension were not independently associated after adjustment. Number needed to screen (NNS) to detect one suspected glaucoma case = 16.

Conclusion: A combined screening strategy (IOP + optic disc assessment + rapid field screening) yields high sensitivity and acceptable specificity for detecting suspected glaucoma in a community setting. Targeted screening of older adults, those with family history, high myopia, pseudoexfoliation, or long-term topical steroid use will improve yield and cost-effectiveness. Community programs should link positive screens to expedited comprehensive eye care and establish follow-up pathways.