MyVisionTest News Archive
Jul 17, 2009
Fear and loathing associated with Lucentis therapy
A prospective survey of patients undergoing Lucentis (ranibizumab) intravitreal injection finds that the procedure was less painful than anticipated.
Lucentis intravitreous injection has emerged as a common treatment for wet age-related macular degeneration (AMD). Despite the therapeutic benefits of Lucentis, repeated injections are required as often as every 4 weeks. Despite the excellent safety profile of Lucentis and Avastin intravitreal injection, adverse events, including endophthalmitis do occur. This study investigated the pain, anxiety, and discomfort that patients undergoing Lucentis therapy experience.
Methods and results
From February 23, 2008, to June 5, 2008, 100 consecutive patients receiving the intravitreal Lucentis were recruited into this prospective survey. A validated questionnaire that covered the levels of discomfort, anxiety, and fear was administered to all of the patients 1 hour before the intravitreal injection procedure at the preassessment clinic. The postoperative questionnaire was administered by telephone 2 weeks later by the same investigator.
Of the 100 patients, the male to female ratio was 1:3. The mean age was 79 years. Sixty-six patients (66%) had previous experience with the intravitreal injection procedure. Overall, there was a mean improvement of 0.05 logMAR unit of visual acuity at 4 weeks.
The anticipated discomfort was significantly higher than the actual discomfort (P < .001). Fifty-one patients (51%) reported that intravitreal injection was less uncomfortable than anticipated, 34 patients (34%) felt the same discomfort as expected, and 16 patients (16%) experienced more discomfort than expected. During the intravitreal injection procedure, 62 patients (62%) did not experience any discomfort and 38 patients (38%) felt mild discomfort. Twenty-four hours after the procedure, 70 patients (70%) reported that they did not feel any discomfort at all and 30 patients (30%) felt mild discomfort. Fifty-three patients (53%) reported that intravitreal injection was a less fearful experience than they expected. Those who had previously received intravitreal Lucentis reported no change in fear or anxiety compared with their previous procedure. Overall, 93 patients (93%) were neither anxious nor fearful after the first injection.
Discussion
This prospective clinical study showed that intravitreal injection was less painful than anticipated (P < .001). Patients were also less fearful and anxious after the first injection (P < .001). These findings were consistent with the previous report by Roth et al on triamcinolone intravitreal injection. These issues should be addressed in pre-injection counseling and consent to reassure and inform individuals prior to the procedure. Reducing anxiety and concerns about anticipated injection-related discomfort or pain is likely to improve the patient experience and compliance with repeated procedures.
WHAT IT MEANS TO YOU: When discussing anti-VEGF therapy with treatment naive patients, it is not unusual to have patients recoil at the notion of having a medication injected directly into the eye. Although it is rare to have a patient not consent to the procedure, they may do so reluctantly, and with considerable anxiety. This study provides some valuable data that provides an empirical basis for telling patients that "it's not as bad as you think".
Read more...
Arch Ophthalmol. 2009 Jul;127(7):939-40
Tags: drug delivery, Lucentis
A prospective survey of patients undergoing Lucentis (ranibizumab) intravitreal injection finds that the procedure was less painful than anticipated.Lucentis intravitreous injection has emerged as a common treatment for wet age-related macular degeneration (AMD). Despite the therapeutic benefits of Lucentis, repeated injections are required as often as every 4 weeks. Despite the excellent safety profile of Lucentis and Avastin intravitreal injection, adverse events, including endophthalmitis do occur. This study investigated the pain, anxiety, and discomfort that patients undergoing Lucentis therapy experience.
From February 23, 2008, to June 5, 2008, 100 consecutive patients receiving the intravitreal Lucentis were recruited into this prospective survey. A validated questionnaire that covered the levels of discomfort, anxiety, and fear was administered to all of the patients 1 hour before the intravitreal injection procedure at the preassessment clinic. The postoperative questionnaire was administered by telephone 2 weeks later by the same investigator.
Of the 100 patients, the male to female ratio was 1:3. The mean age was 79 years. Sixty-six patients (66%) had previous experience with the intravitreal injection procedure. Overall, there was a mean improvement of 0.05 logMAR unit of visual acuity at 4 weeks.
The anticipated discomfort was significantly higher than the actual discomfort (P < .001). Fifty-one patients (51%) reported that intravitreal injection was less uncomfortable than anticipated, 34 patients (34%) felt the same discomfort as expected, and 16 patients (16%) experienced more discomfort than expected. During the intravitreal injection procedure, 62 patients (62%) did not experience any discomfort and 38 patients (38%) felt mild discomfort. Twenty-four hours after the procedure, 70 patients (70%) reported that they did not feel any discomfort at all and 30 patients (30%) felt mild discomfort. Fifty-three patients (53%) reported that intravitreal injection was a less fearful experience than they expected. Those who had previously received intravitreal Lucentis reported no change in fear or anxiety compared with their previous procedure. Overall, 93 patients (93%) were neither anxious nor fearful after the first injection.
Discussion
This prospective clinical study showed that intravitreal injection was less painful than anticipated (P < .001). Patients were also less fearful and anxious after the first injection (P < .001). These findings were consistent with the previous report by Roth et al on triamcinolone intravitreal injection. These issues should be addressed in pre-injection counseling and consent to reassure and inform individuals prior to the procedure. Reducing anxiety and concerns about anticipated injection-related discomfort or pain is likely to improve the patient experience and compliance with repeated procedures.
WHAT IT MEANS TO YOU: When discussing anti-VEGF therapy with treatment naive patients, it is not unusual to have patients recoil at the notion of having a medication injected directly into the eye. Although it is rare to have a patient not consent to the procedure, they may do so reluctantly, and with considerable anxiety. This study provides some valuable data that provides an empirical basis for telling patients that "it's not as bad as you think".
Read more...
Arch Ophthalmol. 2009 Jul;127(7):939-40
