Intravitreal Injections Come With High Patient Burden, Barriers to Care

Patients with protective face masks in waiting room of medical clinic
Patients with protective face masks in waiting room of medical clinic
Despite satisfaction with their visual outcomes, patients find intravitreal injections burdensome and an interruption to everyday activities, findings presented at the ASRS 2022 meeting show.

Despite their high adherence rates and treatment satisfaction, most patients who undergo intravitreal injections face significant barriers and treatment burdens, according to a survey of patients and caregivers presented at the American Society of Retina Specialists 2022 meeting, held July 13-16 in New York.

Whether receiving the injections of anti–vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME), patients and caregivers reported issues including work absenteeism, long recovery periods (of up to 2 days), and impairment to daily activities associated with the injections. 

“More durable therapies with longer treatment intervals and fewer clinic visits could potentially alleviate the treatment burden,” according to the researchers.

The study included survey responses from 193 respondents: 98 patients with nAMD (mean age 80±8 years), 67 patients with DME (65±11 years), 19 caregivers for patients with nAMD, and 9 caregivers for patients with DME. Both patient groups had been living with their disorder and undergoing treatment for at least a year. 

The survey focused partly on barriers to care that patients faced. It found that nearly half of the patients with nAMD faced at least 1 barrier that prevented them from attending scheduled injections, as did two-thirds of the patients with DME. Most of the barriers were related to  the pain and discomfort associated with the injection itself, or the patient belief that treatments were not beneficial, according to the research data. Other perceived barriers included the COVID-19 pandemic and financial reasons. Clinical and appointment factors, including a lack of appointment reminders or limited access to transportation, were also reported.

Regarding transportation, more than a quarter of the patients had to travel for an hour or longer to treatments, and 16% reported having to wait for at least an hour in the waiting room before being seen, the study findings show. The treatments themselves interrupted patients’ days as well, as nearly half reported some level of impairment during recovery, which took a full day or more for approximately 21% of patients. When asked about daily activities, (such as cooking, leisure, or social events) 31% reported experiencing interruptions due to the injections.  

Caregivers also reported that the time spent traveling to and from appointments, and the extra needs the patients’ recovery period placed on them, led to interruptions in their own lives.

The study also recorded patients’ treatment adherence and vision-related satisfaction, which were high, the researchers note. Only 12% of participants with DME and 3% of those with nAMD reported missing 1 injection or more. The treatment satisfaction among both groups was moderately high, the survey data shows.


Holekamp N, Sheth V, Adam M, et al. Patient and caregiver experience with anti-vegf intravitreal injections to treat neovascular age-related macular degeneration and diabetic macular edema in the US. Poster presented at: The 40th annual meeting of the American Society of Retina Specialists; June 13-16, 2022; New York, NY. Poster 107.