Abstract
Purpose
To assess feelings, preoperative anxiety, and need for information in patients undergoing intravitreal injections (IVI).
Methods
An observational cross-sectional study was conducted in our tertiary university care center between December 2017 and December 2018. Consecutive patients undergoing IVI were included. A paper survey was completed before and after IVI to assess patient experience. Preoperative anxiety and need for information were assessed using the Amsterdam Preoperative Anxiety Information Scale (APAIS) score.
Results
Hundred patients with a median age of 76.5 years (42–95, SD = 10.1) were included. Median best-corrected visual acuity (BCVA) in both eyes was 0.4 logMAR. Main IVI indications were wet age-related macular degeneration (n = 58), diabetic macular edema (n = 19), and venous occlusion (n = 16). The IVI most unpleasant steps were as follows: using an eyelid retractor, needle entry, changing of physician from one IVI to another, the pre-IVI waiting time, and the high number of IVI required for disease control. Preoperative anxiety (APAIS score ≥ 11) was correlated in the multivariate analysis with the need for information (p = 0.004), changing of ophthalmologist between different IVI sessions (p = 0.006), and pain expected before the IVI (p = 0.010). The need for information (APAIS score ≥ 5) was only associated with the preoperative anxiety in the multivariate analysis (p = 0.001).
Conclusion
Preoperative anxiety and need for information are common in patients undergoing IVI even after many IVI. Being injected by different practitioners was strongly correlated with preoperative anxiety and should be avoided as much as possible. Better educational and information programs are needed.
Similar content being viewed by others
References
Coleman HR, Chan C-C, Ferris FL et al (2008) Age-related macular degeneration. Lancet Lond Engl 372(9652):1835–1845
Osaadon P, Fagan XJ, Lifshitz T et al (2014) A review of anti-VEGF agents for proliferative diabetic retinopathy. Eye Lond Engl 28(5):510–520
Jiang Y, Mieler WF (2017) Update on the use of anti-VEGF Intravitreal therapies for retinal vein occlusions. Asia-Pac J Ophthalmol Phila Pa 6(6):546–553
Gillies MC, Campain A, Barthelmes D et al (2015) Long-term outcomes of treatment of neovascular age-related macular degeneration: data from an observational study. Ophthalmology. 122(9):1837–1845
Sloan FA, Hanrahan BW (2014) The effects of technological advances on outcomes for elderly persons with exudative age-related macular degeneration. JAMA Ophthalmol 132(4):456–463
Scott IU, VanVeldhuisen PC, Ip MS et al (2017) Effect of bevacizumab vs aflibercept on visual acuity among patients with macular edema due to central retinal vein occlusion: the SCORE2 randomized clinical trial. JAMA. 317(20):2072–2087
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Maguire MG, Martin DF et al (2016) Five-year outcomes with anti-vascular endothelial growth factor treatment of neovascular age-related macular degeneration: the comparison of age-related macular degeneration treatments trials. Ophthalmology. 123(8):1751–1761
Eter N, Mohr A, Wachtlin J et al (2017) Dexamethasone intravitreal implant in retinal vein occlusion: real-life data from a prospective, multicenter clinical trial. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 255(1):77–87
Boyer DS, Yoon YH, Belfort R et al (2014) Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 121(10):1904–1914
Mitchell J, Bradley C (2006) Quality of life in age-related macular degeneration: a review of the literature. Health Qual Life Outcomes 21 4:97
Berdeaux GH, Nordmann J-P, Colin E et al (2005) Vision-related quality of life in patients suffering from age-related macular degeneration. Am J Ophthalmol 139(2):271–279
Aroney C, Fraser-Bell S, Lamoureux EL et al (2016) Vision-related quality of life outcomes in the BEVORDEX study: a clinical trial comparing Ozurdex sustained release dexamethasone intravitreal implant and bevacizumab treatment for diabetic macular edema. Invest Ophthalmol Vis Sci 57(13):5541–5546
Sivaprasad S, Oyetunde S (2016) Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion. Clin Ophthalmol Auckl NZ 10:939–946
Dawson SR, Mallen CD, Gouldstone MB et al (2014) The prevalence of anxiety and depression in people with age-related macular degeneration: a systematic review of observational study data. BMC Ophthalmol 14:78
Nijkamp MD, Kenens CA, Dijker AJM et al (2004) Determinants of surgery related anxiety in cataract patients. Br J Ophthalmol 88(10):1310–1314
Senra H, Balaskas K, Mahmoodi N et al (2017) Experience of anti-VEGF treatment and clinical levels of depression and anxiety in patients with wet age-related macular degeneration. Am J Ophthalmol 177:213–224
Boyle J, Vukicevic M, Koklanis K et al (2015) Experiences of patients undergoing anti-VEGF treatment for neovascular age-related macular degeneration: a systematic review. Psychol Health Med 20(3):296–310
Senra H, Ali Z, Balaskas K et al (2016) Psychological impact of anti-VEGF treatments for wet macular degeneration-a review. Graefes Arch Clin Exp Ophthalmol Albrecht Von Graefes Arch Klin Exp Ophthalmol 254(10):1873–1880
Moerman N, van Dam FS, Muller MJ et al (1996) The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 82(3):445–451
Maurice-Szamburski A, Loundou A, Capdevila X et al (2013) Validation of the French version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health Qual Life Outcomes 11:166
Gayadine-Harricham Y, Amzallag T (2017) Prevalence and causes of pain after cataract surgery: comparison of 1st and 2nd eyes. J Fr Ophtalmol 40(6):505–511
Wattier J-M, Barreau O, Devos P et al (2011) Measure of preoperative anxiety and need for information with six issues. Ann Fr Anesth Reanim 30(7–8):533–537
Wang J-K, Huang T-L, Su P-Y et al (2015) An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema. Eye Sci 30(4):176–183
Segal O, Segal-Trivitz Y, Nemet AY et al (2016) Anxiety levels and perceived pain intensity during intravitreal injections. Acta Ophthalmol 94(2):203–204
Tailor R, Beasley R, Yang Y et al (2011) Evaluation of patients’ experiences at different stages of the intravitreal injection procedure - what can be improved? Clin Ophthalmol Auckl NZ 5:1499–1502
Rifkin L, Schaal S (2012) Factors affecting patients’ pain intensity during in office intravitreal injection procedure. Retina Phila Pa 32(4):696–700
Chua PYS, Mitrut I, Armbrecht A-M et al (2009) Evaluating patient discomfort, anxiety, and fear before and after ranibizumab intravitreous injection for wet age-related macular degeneration. Arch Ophthalmol Chic Ill 1960 127(7):939–940
Roth DB, Scott IU, Gulati N et al (2006) Patient perceptions of discomfort and changes in vision and functional status associated with intravitreal triamcinolone injection. Am J Ophthalmol 142(3):492–494
Berth H, Petrowski K, Balck F (2007) The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version. Psycho-Soc Med 4:Doc01
Finger RP, Fenwick E, Hirneiss CW et al (2013) Visual impairment as a function of visual acuity in both eyes and its impact on patient reported preferences. PLoS One 8(12):e81042
Finger RP, Guymer RH, Gillies MC et al (2014) The impact of anti-vascular endothelial growth factor treatment on quality of life in neovascular age-related macular degeneration. Ophthalmology. 121(6):1246–1251
Lee WJ, Cho HY, Kim DH et al (2013) Depression of late age-related macular degeneration patients in Korea. Asia-Pac J Ophthalmol Phila Pa 2(1):23–27
Casten R, Rovner BW, Leiby BE et al (2010) Depression despite anti-vascular endothelial growth factor treatment of age-related macular degeneration. Arch Ophthalmol Chic Ill 1960 128(4):506–508
Henriksen K, Adhami S (2010) Patient experience of intravitreal injections in AMD. Int J Ophthalmic Pract 1:68–72
Thetford C, Hodge S, Harding S et al (2013) Living with age-related macular degeneration treatment: patient experiences of being treated with ranibizumab (Lucentis)® intravitreal injections. Br J Vis Impair 31:89–101
Moisseiev E, Regenbogen M, Rabinovitch T et al (2014) Evaluation of pain during intravitreal Ozurdex injections vs. intravitreal bevacizumab injections. Eye Lond Engl 28(8):980–985
Rodriguez-Osorio CA, Dominguez-Cherit G (2008) Medical decision making: paternalism versus patient-centered (autonomous) care. Curr Opin Crit Care 14(6):708–713
Feng A, O’Neill J, Holt M et al (2016) Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations. Clin Ophthalmol Auckl NZ 10:1505–1511
Moisseiev E, Regenbogen M, Bartfeld Y et al (2014) Evaluation of pain in intravitreal bevacizumab injections. Curr Eye Res 37(9):813–817
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Baillif, Stephanie has received research grants from Allergan, Bayer, Novartis, and Horus Pharma. The other authors have no affiliation with any organization or entity with any financial interest.
Ethical approval
The study conduct was approved by the Commission Nationale Informatique et Libertés (CNIL Number: 2004024 v 0) and was performed in accordance with the ethical standards outlined by the 1964 Helsinki Declaration and its latter amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Martel, A., Nahon-Esteve, S., Martini, K. et al. Feelings, preoperative anxiety, and need for information in patients undergoing intravitreal injections. Graefes Arch Clin Exp Ophthalmol 258, 1395–1403 (2020). https://doi.org/10.1007/s00417-020-04699-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-020-04699-4