OSN Europe: Survey highlights heavy burden, high level of emotional distress related to intravitreal injections

A survey carried out across three countries in Europe among patients with diabetic macular edema or retinal vein occlusion found that the impact of intravitreal injections in terms of anxiety is high and adds up to the stress and burden of multiple appointments, long waiting times, expenses and need for carers.

“The most desired improvement suggested by patients was to have fewer injections to achieve the same visual result,” Sobha Sivaprasad, MD, first author of the study, said.

One hundred thirty-one patients from Germany, the United Kingdom and Italy completed a questionnaire; 86 patients (66%) had DME, and 45 (34%) had RVO.

Practical impact

One set of questions investigated the practical impact of intravitreal injection treatment on patients and carers.

“We looked at the number of appointments and the time spent on average for each appointment by patients and carers. We found that the total appointment burden was 13.5 hours for RVO patients and 20 hours for DME patients every 6 months. On average, each intravitreal injection took 4.5 hours including travel time,” Sivaprasad said.

More than half of the patients who are still working had to take at least 1 day off work. Seventy-one percent of the patients needed assistance from carers at the time of injection, and for carers, this involved a time investment of 6.3 hours on average per injection.

“Since 50% of carers work, in 60% of the cases they had to take time off to help the patients,” Sivaprasad said.

Patients with diabetes have a more complex schedule of multiple visits that involve not only the retina specialist and general ophthalmologist, but also the general practitioner and diabetologist, plus the cardiologist and neurologist in some cases. “This amounts on average to 19 appointments per patient every 6 months, a considerable burden which makes attendance difficult,” Sivaprasad said.

Emotional distress

Three-quarters of patients reported anxiety in connection with intravitreal injections, and 54% reported feeling anxious for at least 2 days before the treatment. Patients defined anxiety as not being able to relax and take their mind off the thought of the injection. One in four patients (26%) said their sleep was affected, and 10% developed physical symptoms, such as headache and nausea.

“We asked patients what sort of improvement they desired, and 42% said they want fewer injections and 22% said they want fewer appointments to get the same results. Fourteen percent of responders said they would like to wait less time before the procedure, and 7% would like to have the treatment carried out closer to their home or to have free transportation. Some expressed the need to have their hand held by a nurse while having the injection and 3% to have more time with the doctor,” Sivaprasad said.

Click here to read the full publication exclusive, The Global Notebook, published in Ocular Surgery News Europe Edition, October 2015.