Outcomes of an Intravitreal Injection Clinic

Atchison, Elizabeth A.; Omar, Ahmed F.; Iezzi, Raymond; Barkmeier, Andrew J.; Bakri, Sophie J.

doi:10.1097/iae.0000000000001372

Cited by 13 publications

(6 citation statements)

References 25 publications

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“…Key potential confounding variables measured, adjusted statistically? Quality rating (good/fair/poor) Atchison [ 46 ] Yes Yes Unclear Yes No Yes Yes No No Yes Unclear No Poor Boulanger-Scemama [ 13 ] Yes Yes Yes Yes No Yes Yes Yes No Yes No Yes Good Curtis [ 47 ] Yes Yes Yes Yes No Yes Yes Yes No Yes No Yes Fair Droege [ 14 ] Yes Yes Unclear Yes No Yes Yes Yes No Yes No Yes Good Ehlken [ 17 ] Yes Yes Unclear Yes Yes Yes Yes Yes No Yes Yes Yes Good Gillies [ 49 ] Yes Yes Unclear Yes Yes Yes Yes No No Unclear Unclear No Fair ...…”

Section: Resultsmentioning

confidence: 99%

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Systematic review: non-adherence and non-persistence in intravitreal treatment

Ehlken

Ziemssen

Eter

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose Intravitreal injection of VEGF inhibitors has become the standard of care for different macular diseases within the last years resulting in improved visual outcomes. Under real-life conditions, however, the necessity for frequent retreatments and reexaminations poses a burden for patients and treatment centers. Non-adherence and non-persistence to intravitreal treatment may lead to inferior clinical outcomes, and knowledge of contributing factors is crucial to improve adherence. This systematic review analyzes current literature for potential factors involved in non-adherence and non-persistence. Methods A systematic search was conducted in PubMed and Embase including three different aspects of intravitreal injection therapy: (1) diseases with intravitreal injections as treatment, (2) intravitreal injection, and (3) aspects of therapy adherence or therapy persistence. Data from identified quantitative studies were further extracted and grouped according to WHO criteria (condition, socio-economy, therapy, patient, and health system). The methodological quality of identified studies was graded. Identified qualitative studies (i.e., interviews) were descriptively analyzed and their findings narratively reported. Results Twenty-four publications were included. In 16 of those publications, a quantitative data analysis was conducted, analyzing factors associated with non-adherence. Worse visual acuity at baseline and unfavorable development of visual acuity, higher age, and greater distance to the treatment center were associated with non-adherence, while there was inconsistent evidence for an association of comorbidity. In qualitative studies, high follow-up/treatment burden, fear and anxiety, disappointed patient expectations, and lack of motivation to continue treatment were reported as reasons for non-persistence. Conclusions Knowledge of potential barriers in IVT treatment may improve adherence and potentially clinical results. Improvements can be achieved particularly in the healthcare complex (organizational improvements) and the “patient” complex by establishing realistic expectations. Recurrent education of the patient may be necessary.

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Section: Resultsmentioning

confidence: 99%

“…No study confirmed adverse events as attributable to NA in statistical analysis. However, in patient interviews, occurrence and fear of adverse events were repeatedly reported by non-adherent [ 16 , 46 , 51 , 55 , 56 ] and exposed patients [ 2 , 14 , 20 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic review: non-adherence and non-persistence in intravitreal treatment

Ehlken

Ziemssen

Eter

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…Additionally, the IVT anti-VEGF injections are currently the most effective treatment used for wet AMD since the IVT route not only maintains high concentrations of drug in the vitreous humor through repeated injections given every month or two, but also delivers the drug directly to the site of action in the posterior segment of the eye [ 36 , 75 , 77 ]. Nonetheless, IVT injections are highly invasive and present several risks such as infections, cataracts, retinal toxicity from injected agents, retinal detachment, vascular occlusion, intraocular inflammation, and vitreous haemorrhage resulting in inconvenience to patients [ 9 , 78 ]. Furthermore, the IVT route has been reported to exacerbate the systemic side effects of anti-VEGF agents leading to life threatening systemic cardiovascular as well as cerebrovascular side effects including myocardial infarctions, transient ischemic attacks, deep vein thrombosis, pulmonary embolisms and thrombophlebitis as illustrated in Figure 3 C [ 10 ].…”

Section: Posterior Segment Eye Diseases: a Global Health Crisismentioning

confidence: 99%

Posterior Segment Ophthalmic Drug Delivery: Role of Muco-Adhesion with a Special Focus on Chitosan

et al. 2021

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Posterior segment eye diseases (PSEDs) including age macular degeneration (AMD) and diabetic retinopathy (DR) are amongst the major causes of irreversible blindness worldwide. Due to the numerous barriers encountered, highly invasive intravitreal (IVT) injections represent the primary route to deliver drugs to the posterior eye tissues. Thus, the potential of a more patient friendly topical route has been widely investigated. Mucoadhesive formulations can decrease precorneal clearance while prolonging precorneal residence. Thus, they are expected to enhance the chances of adherence to corneal and conjunctival surfaces and as such, enable increased delivery to the posterior eye segment. Among the mucoadhesive polymers available, chitosan is the most widely explored due to its outstanding mucoadhesive characteristics. In this review, the major PSEDs, their treatments, barriers to topical delivery, and routes of topical drug absorption to the posterior eye are presented. To enable the successful design of mucoadhesive ophthalmic drug delivery systems (DDSs), an overview of mucoadhesion, its theory, characterization, and considerations for ocular mucoadhesion is given. Furthermore, chitosan-based DDs that have been explored to promote topical drug delivery to the posterior eye segment are reviewed. Finally, challenges of successful preclinical to clinical translation of these DDSs for posterior eye drug delivery are discussed.

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“…The second protocol, injection series, is described by the Mayo Clinic. 14,15 For patients in the injection series group, a same-day exams with OCT testing determines a set number of injection-only visits that take place over a cycle. After that cycle, a new evaluation and OCT determine parameters for the next cycle.…”

Section: Treatment Protocolsmentioning

confidence: 99%

“…We further assumed the Abbreviation: OCT, optical coherence tomography. a Annual rates were calculated from Atchison et al 15 assuming steady enrollment over the 4-year study period.…”

Section: Treatment Protocolsmentioning

confidence: 99%

Office Examinations–Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy

Emerson

Thompson

et al. 2020

Journal of VitreoRetinal Diseases

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Purpose: In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD). Methods: An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed. Treatment parameters were estimated using US population statistics, published literature, and Centers for Medicare & Medicaid Services, provider utilization data. Costs and benefits were compared for the 4 treatment scenarios. Results: Although yearly examinations and optical coherence tomography costs were higher for injection series, T&E, and as-needed protocols compared with automatic treatment, our model predicts reduced yearly injection and travel costs for those same treatment scenarios also, saving $2.9 billion (injection series), $7.2 billion (T&E), and $6.1 billion (as-needed) annually for the US population. Same-day injections accounted for 21%, 8%, and 9% of the savings, respectively, because of reduced travel burden. Furthermore, early detection of wAMD in the fellow eye during office examinations allows for a 1.8, 2.1, and 2.5 quality-adjusted life-year benefit, respectively. Conclusions: Office examinations–directed antivascular endothelial growth factor therapy for wAMD reduces travel and treatment expenses and improves screening of the fellow eye, resulting in robust cost savings and quality-adjusted life-year benefit for the US population.

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Outcomes of an Intravitreal Injection Clinic

Abstract: An injection-only clinic may provide a reasonable approach to streamline retina practices to ensure that patients receive timely injections.

Cited by 13 publications

References 25 publications

Systematic review: non-adherence and non-persistence in intravitreal treatment

Systematic review: non-adherence and non-persistence in intravitreal treatment

Posterior Segment Ophthalmic Drug Delivery: Role of Muco-Adhesion with a Special Focus on Chitosan

Office Examinations–Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy

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