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

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.