Patient Reported Experiences and Comfort Associated with Intravitreal Injection Technique: A Cross-Sectional Survey Approach.

Purpose: To better understand patient experiences associated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection techniques.

Methods

A total of 1111 patients receiving anti-VEGF injections at 5 Retina Consultants of Texas clinic locations completed surveys about their experiences during and after injection. Responses were compared using t-test, analysis of variance, and Tukey-Kramer test.

Results

Patients rated overall discomfort with injection techniques as a mean visual analog scale score < 2 (scale 1-10, ranging from mild to worst possible). Techniques for anesthetization, lid retraction, and povidone-iodine (Betadine) application varied. Lidocaine pledgets were associated with the most discomfort (P < .05). Patient preference was significantly higher for manual lid retraction over speculum use (P = .0017). Betadine-soaked cotton tips were considered significantly more comfortable than Betadine drops, and drops more comfortable than Betadine swabs (each P < .05). Regarding side effects ever experienced after injection, subconjunctival hemorrhages were reported by 64.0% of participants (n = 702), floaters by 64.4% (n = 685), and eye irritation by 51.1% (n = 530), resolving within 2 days for 37.9% (n = 215), 51.1% (n = 334), and 48.6% (n = 254), respectively. Of returning participants, 41.1% found injections administered by physicians on the survey day more comfortable than injections administered by previous physicians. Common complaints included inadequate anesthesia and irritation from Betadine.

Conclusions

Most patients tolerate anti-VEGF injections well, with minimal side effects. Surveyed patients preferred topical gel or subconjunctival injections, manual lid retraction, and Betadine-soaked cotton tips. Future studies may consider the safety associated with each technique.