Implementation and Clinical Application of 24-Hour Intraocular Pressure Monitoring in China: A Nationwide Survey

Mengyuan Hu,1– 4 Tong Liu,1– 4 Ke Yao,1– 4 Zongrong Wang,5,6 Min Chen,1– 4 Kaijun Wang1– 4 1Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China; 2Provincial Key Laboratory of Ophthalmology, Hangzhou, Zhejiang, People’s Republic of China; 3Zhejiang Provincial Clinical Research Center for Eye Diseases, Hangzhou, Zhejiang, People’s Republic of China; 4Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, People’s Republic of China; 5Huanjiang Laboratory, State Key Laboratory of Silicon and Advanced Semiconductor Materials, Zhejiang University School of Aeronautics and Astronautics, Hangzhou, People’s Republic of China; 6Key Laboratory of Soft Machines and Smart Devices of Zhejiang Province, Hangzhou, People’s Republic of ChinaCorrespondence: Kaijun Wang, Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Avenue, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-571-87783907, Email [email protected] Min Chen, Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Avenue, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-571-87783907, Email [email protected]: To evaluate the nationwide implementation and clinical application of 24-hour intraocular pressure (IOP) monitoring in China.Methods: A nationwide descriptive cross-sectional study was conducted from September 2024 to March 2025. Two structured questionnaires were distributed to 467 hospitals across China (400 valid responses) and 170 patients recruited from our institution who were undergoing 24-hour IOP monitoring for the first time. Collected data included implementation rates, tonometer types, measurement protocols, examiner consistency, and patient-reported perceptions.Results: Among the 400 responding hospitals, 261 (65.3%) had implemented 24-hour IOP monitoring; however, 85.1% managed fewer than 20 patients per month. The most common measurement frequencies within a 24-hour period were 12 (37.2%), 6 (32.6%), and 7 times (27.2%), respectively. Non-contact tonometer (NCT) was the predominant device for both daytime (67.8%) and nighttime (64.6%) measurements. Among the 175 hospitals performing nocturnal measurements, only 7.4% employed supine positioning. In 65.5% of institutions, 24-hour IOP measurements for individual patients were performed by multiple nurses. Regarding patient perceptions, 95.8% considered 24-hour IOP monitoring important, yet 52.9% expressed reluctance to undergo the repeated procedure, citing hospitalization inconvenience (80%), sleep disruption (28.9%), concerns about measurement accuracy (4.4%), and cost (4.4%).Conclusion: Although over half of the surveyed hospitals had implemented 24-hour IOP monitoring, overall clinical utilization remained suboptimal, with highly heterogeneous local protocols and considerable patient reluctance toward the current inpatient-based, nurse-dependent monitoring paradigm. Standardized implementation of national guidelines, enhanced patient education, and development of patient-centric, wearable IOP monitoring technologies are essential to optimize accessibility and support glaucoma management.Keywords: glaucoma management, 24-hour intraocular pressure monitoring, nocturnal measurement, clinical implementation, nationwide survey, China