Subjective and objective measures of the patient experience before, during, and after intravitreal anti–vascular endothelial growth factor injections

Abstract

Purpose: To assess patient experience of intravitreal injections using vital-signs, visual-experience, pain-rating and emotional response during intravitreal anti-VEGF injections. Methods: A prospective observational study of patient experience of intravitreal anti-VEGF injections done following metrics were collected pre-injection, during injection, and post-injection: pain assessment using visual analog score, fear-response rating, visual-experience questionnaire, and vital-signs. Results: A total of one-hundred-and-seventy-four patients undergoing intravitreal anti-VEGF injections for retinal pathologies were included in the study. Mean age was 58.8 ± 10.4 years in <5 injection group ( n = 133) and 59.02 ± 9.0 years in ≥5 injection group ( n = 41) ( P = 0.90).During injection, 90.2% of patients in <5 injection group reported moderate or severe pain compared to 78% of patients in ≥5 injection group. In pre and post-injection phases, mild-to-moderate pain was reported in both groups ( P = <0.001). Ninety-two (52.9%) patients reported having a mild frightening experience. There was no statistical significance in patients assessment of fear with respect to age, sex, or number of injections. The Systolic Blood Pressure (SBP) during and following injection ((SBP 171.7 ± 21.1,150.8 ± 16.2) procedures was significantly higher in cases with <5 injections when comparing to cases with >5 injections (SBP 159.7 ± 26.4, 143.2 ± 17.0) ( P = 0.003), ( P = 0.011). DBP, heart rate, pulse rate measurements were similar among patients in all phases of the study. Conclusion: We report a large sample size with comprehensive assessments of the patient experience. Higher pain ratings in the <5 injection group, the increase in the SBP in the pre-and during injection phases, and the overall rating of mild-to-moderate fear during the procedure.

Treatment contentment and preference of patients undergoing intravitreal anti-VEGF therapy

“…In their report, concerns about treatment effectiveness were a main source of anxiety, comparable to our findings, that the majority of our patients are afraid of unfavourable results of the examination regarding disease activity. Mekala et al reported similar results about fear, but a higher number of patients feeling pain during and after the IVI than in our study [9]. In line with our results, pain was not associated with the time period since onset of treatment.…”

“…Most studies focus on morphological and functional outcome parameters and do not include the perception of patients on the treatment strategy so that evidence on this complex topic is limited. Less is known about patient's experience undergoing anti-VEGF therapy [6][7][8][9].…”