Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration

Abstract

Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.

A Collaborative Retrospective Study on the Efficacy and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema

“…In addition, current anti-VEGF treatments require frequent injections and monitoring, causing a significant burden on patients and health care systems, with a financial impact and reduction in patient quality of life. 11 Laser photocoagulation may prevent visual acuity loss in certain groups of patients; however, it typically cannot restore or improve visual acuity and is inferior to anti-VEGF treatments. 12 Corticosteroids inhibit leukocytosis and expression of prostaglandins and proinflammatory cytokines, enhance the barrier function of vascular tight junctions, and reduce VEGF levels.…”

A qualitative exploration of the experience and quality of life of patients, and their family carers, admitted to a specialist eye hospital with microbial keratitis

“…Our sample patients were prepared to tolerate substantial pain and privations in silence to retain hope of saving their sight. Similarly, patients requiring intra-vitreal injections for age related macular degeneration reported experiencing financial and travel burdens and treatment related anxiety but were willing to accept this in order to preserve their precious sight (22). Facing the prospect of impaired vision or further sight reduction, our patients were highly anxious and experienced high levels of concern which were not always disclosed to staff.…”

Optimizing Anti-VEGF Treatment Outcomes for Patients with Neovascular Age-Related Macular Degeneration

“…The condition is associated with increased risks of cognitive dysfunction, depression, and falls and related injuries, along with requirements for extensive and costly caregiving services. [4][5][6][7][8] Loss of central vision in AMD affects patients' abilities to drive, read, write, recognize faces, and participate in social activities.…”

“…Patients generally understand the severe implications of inadequate AMD treatment and many initially express fears of having injections in the eye, anticipating pain or discomfort. 8 In addition, due to age-related challenges, many patients have difficulty arranging and traveling to appointments for treatment and monitoring. In a survey of 75 patients with nAMD (mean age = 79 years), the reported mean time per visit was 11.7 hours, accounting for appointment preparation, travel, waiting time, treatment time, and post-appointment recovery.…”