Intravitreal injections related to psychosocial load in patients with retinal disease


The burden of treatment continues to have a major effect on the quality of life and psychosocial well-being of patients receiving intravitreal injections (IVI) for retinal disease.

In the results of the QUALITII survey, a 50-item survey that established treatment load scores (TBS) based on 9 items examining the load received by patients, a team of investigators reported that patients with diabetic macular edema (DME) or diabetic retinopathy (DR) reported the greatest burdens of their injection therapies.

The survey, provided to 4 retina clinics in 4 states for data presented at the 2021 American Society of Retina Specialists (ASRS) Scientific Meeting this weekend, also showed that patients’ adherence to their IVI therapy was associated with a decrease in anxiety.

Presented by Rui Wang, MD, resident physician at Penn State University, the trial aimed to quantify the areas of burden experienced by patients with retinal disease receiving repeated intravitreal injections.

“IVIs are the basic treatment for multiple retinal exudating diseases and often require an indefinite course,” they wrote. “A deep and quantitative understanding of the burden at the patient level can inform approaches to improving the patient experience that will ultimately result in optimized clinical outcomes. “

Wang and colleagues observed the 4 clinics conducting a survey with QUALITII, establishing a priori power analysis based on TBS to identify small to moderate effect sizes among different disease groups: DME / DR (n = 360) , age-related macular degeneration (AMD; n = 657) or retinal vein occlusion (RVO; n = 221). Their population included 178 other patients with unidentified retinal disease.

The average age of the patients surveyed was 70 years, with 55% of the participants being women. About 2 in 5 patients received an IVI every 4 to 5 weeks; 4 out of 5 patients received it every 4 to 8 weeks.

Almost two-thirds (65%) of patients reported adverse events from IVI at least half the time with new injections, and more than one-third (36%) reported adverse events with each injection. The most common side effects included eye pain (49%) and sensitivity to light (37%).

About half (51%) of patients with> 50 IVI reported having restrictions on their usual activities, compared with 33% of patients with P <.001>

The mean TBS of the patients was 16.1 and ranged from 1 to 48. Patients with DME / DR reported a mean score of 17.1 versus 15.5 in patients with AMD and 15.3 in patients with AMD. patients with RVO (P = .03).

Wang and colleagues concluded that a majority of patients reported problems with their IVV treatment, with an association observed between an increased treatment rate and increased restriction of usual activity.

“The TBS was highest for patients with DME / DR, which could be due to increased physical / psychosocial load, younger age, and increased out-of-pocket expenses that many diabetic patients incur,” they noted.

The study, “Results of a Multicenter Survey to Measure Treatment Burden: Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII)”, was presented at ASRS 2021.


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