June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Non-pharmacological clinical interventions to reduce pain and anxiety during intravitreal injection procedures
Author Affiliations & Notes
  • Peter D Cackett
    Princess Alexandra Eye Pavilion, Edinburgh, Edinburgh, United Kingdom
  • Jean Ngee Yap
    Princess Alexandra Eye Pavilion, Edinburgh, Edinburgh, United Kingdom
  • Juanlyn Ang
    Princess Alexandra Eye Pavilion, Edinburgh, Edinburgh, United Kingdom
  • Peng Yong Sim
    Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Shyamanga Borooah
    University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Peter Cackett Novartis, Code R (Recipient), Bayer, Code R (Recipient), Roche, Code R (Recipient), Allergan, Code R (Recipient); Jean Yap None; Juanlyn Ang None; Peng Sim None; Shyamanga Borooah None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 2189. doi:
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      Peter D Cackett, Jean Ngee Yap, Juanlyn Ang, Peng Yong Sim, Shyamanga Borooah; Non-pharmacological clinical interventions to reduce pain and anxiety during intravitreal injection procedures. Invest. Ophthalmol. Vis. Sci. 2023;64(8):2189.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Intravitreal injection (IVT) is the most commonly performed procedure in Ophthalmology and is used in the management of many medical retina conditions including age-related macular degeneration, vein occlusions and diabetic macular oedema. IVT-associated pain and anxiety is frequently reported despite analgesia, and this can potentially reduce compliance with treatment. In this prospective study, we wanted to assess the impact of non-pharmacological clinical interventions on IVT-related pain and anxiety. These included the use of patients’ choice of music, explanation of the procedure, chatting during the procedure, hand-holding, or a combination of all four interventions.

Methods : Consecutive patients receiving IVTs at the Princess Alexandra Eye Pavilion, Edinburgh over a 5-week period were enrolled. Patients with or without the non-pharmacological clinical intervention were interviewed. The interview comprised a 10-item questionnaire, which included anxiety and pain intensity scores. Anxiety score of 0 represented calm and 10 represented very anxious. Pain intensity score was recorded using the 0 to 10 numeric pain rating scale. Ethical approval was obtained from the local health board (NHS Lothian) quality improvement and audit committee.

Results : A total of 313 patients participated. There was a significantly lower mean pain score in the intervention group (1.18 ± 1.58) compared to the non-intervention group (1.86 ± 2.05) (P<0.01). There was also a lower mean anxiety score in the intervention group (2.75 ± 2.97) compared to the non-intervention group (3.20 ± 3.12), although this was not statistically significant (P=0.21). Older age, male gender and increased number of previous IVTs were associated with decreased odds of higher anxiety.

Conclusions : When patients are given the choice, non-pharmacological interventions appear to have a positive impact on IVT-associated pain but not anxiety. Age, male gender and number of previous IVTs appear to influence IVT-associated anxiety. We would recommend offering patients all of these interventions to improve both patient satisfaction and also compliance with IVT treatment.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.


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