Strategies for Improving Patient Comfort During Intravitreal Injections: Results from a Survey-Based Study

Abstract

IntroductionMany ocular diseases require intravitreal injections of pharmacological agents. Optimizing patients’ experiences during injections is important to ensure compliance and maintenance of quality of life. The objective of this study was to identify strategies to help alleviate discomfort during intravitreal injections.MethodsA cross-sectional study surveying 128 patients during clinic visits between 2014 and 2015 in two outpatient Retina Clinics (one academic and one private). Patients receiving an intravitreal injection(s) for any retinal disorder were given a questionnaire with 10-yes/no responses for various potential strategies. Responses were stratified by sex, age (<30 years, 30–60 years, and >60 years) and total number of prior injections (0–9 injections, 10–20 injections and >20 injections).ResultsA total of 128 patients were surveyed: 59 males, 41 females and 28 with no sex specified. Our results identified four favorable strategies as those receiving more than 50% “yes” votes. These included the presence of technician/staff during the procedure, the use of a neck pillow, a verbal warning before the injection and performing injections in both eyes on the same day. Other specific strategies were identified for females, younger patients and those with greatest experience. These included: females preferred having their hand held during injections (P = 0.001) and using a stress ball (P = 0.000) when compared to males. Stratifying by age, patients 30–60 years old preferred having their hand held (P = 0.008) and background music (P = 0.007). Stratifying by prior injections, patients with >20 prior injections preferred having their hand held (P = 0.001), using a stress ball (P = 0.021) and, if necessary, having bilateral injections performed the same day to improve comfort (P = 0.037).ConclusionsHaving an extra staff member present during the injection, having a neck pillow, having a verbal warning prior to injection and having both eyes injected on the same day were indicated as favorable strategies by over half of those surveyed. Further, specific strategies were identified for females, younger patients (30–60 years old) and those with greatest experience (>20 injections).

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“…These are intended to eliminate any residual or prevent the reoccurrence of subretinal fluid. Regardless of the approach, patients affected with wet AMD find themselves having to endure an indefinite number of repeated intravitreal injections of anti-VEGF drugs, along with their associated risk factors, including the development of endopthalmitis and reduced patient compliance 50, 51, 52, 53, 54…”

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“…Patients receiving an IVI for the first time should be allocated more time to learn about the injection and monitored for unexpected reactions. Gomez et al studied patient comfort during IVIs and found that favorable strategies were the presence of an extra staff member during the injection, the use of a neck pillow, and the provision of a verbal warning prior to the IVI [34]. When bilateral IVIs were necessary, the majority of the patients preferred to have them performed on the same day [34].…”

“…Gomez et al studied patient comfort during IVIs and found that favorable strategies were the presence of an extra staff member during the injection, the use of a neck pillow, and the provision of a verbal warning prior to the IVI [34]. When bilateral IVIs were necessary, the majority of the patients preferred to have them performed on the same day [34]. In addition, patients between 30 and 60 years of age preferred to have their hand held during the IVI and to have background music playing during the injection [34].…”

“…When bilateral IVIs were necessary, the majority of the patients preferred to have them performed on the same day [34]. In addition, patients between 30 and 60 years of age preferred to have their hand held during the IVI and to have background music playing during the injection [34]. Music is played in operating theaters in many surgical specialties.…”

“…Same-day bilateral injections have been debated due to concerns regarding an increased risk of local and systemic complications [54]. However, from the patient's point of view, treatment of bilateral disease on different days may increase the perceived burden of treatment [34]. Studies have investigated the safety profile of same-day bilateral injections and found that rates of endophthalmitis and systemic vascular events were comparable to those for unilateral injections [54].…”