Pain related to intravitreal injections for age-related macular degeneration: A qualitative study of the perspectives of patients and practitioners.

Yiallouridou, Christina, Acton, Jennifer Heloise ORCID: https://orcid.org/0000-0002-0347-7651, Banerjee, Sanjiv, Waterman, Heather ORCID: https://orcid.org/0000-0001-7052-2734 and Wood, Ashley ORCID: https://orcid.org/0000-0002-9312-6184 2023. Pain related to intravitreal injections for age-related macular degeneration: A qualitative study of the perspectives of patients and practitioners. BMJ Open 13 , e069625. 10.1136/bmjopen-2022-069625

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Abstract

Objectives Ocular pain is a commonly reported finding in the intravitreal injection procedure, but post-injection experiences and patient adherence to treatment remain underexplored. We therefore aimed to identify key variations in the intravitreal injection procedure that may influence pain, and to gain insights into the post-injection experience and treatment adherence from the perspective of patients and practitioners. Design Qualitative semistructured interview study using reflexive thematic analysis of transcripts. Setting Hospital Eye Clinic in Wales, UK. Interviews were conducted between May and September 2019. Participants Purposive sample of patients aged ≥50 years with neovascular age-related macular degeneration and no other retinal pathology who had received at least six intravitreal injections, and practitioners including ophthalmologists, registered nurses and optometrists who performed intravitreal injections at the research site. Results Data saturation was reached with 21 interviews: 14 patients and 7 practitioners. Three main themes were identified from the analysis: fear of losing eyesight and treatment anxiety influence patient adherence to treatment, variability in pain experience during treatment, and post-injection experience and impact on patient recovery. To reassure patients feeling apprehensive about the injections, practitioners promoted safety and trust, and used techniques to manage anxiety. Key variations that may influence pain identified were application of antiseptic or anaesthetic, injecting methods and communication. During injection, patients reported a dull-aching and sharp pain, contrary to practitioners’ perspective of feeling a ‘pressure’. Patients described prolonged soreness and irritation of up to 36 hours post-injection affecting their sleep and recovery. Conclusion Establishing rapport supported patients to recognise the necessity of ongoing treatment to prevent sight loss; however, inadequate pain management led to undesirable outcomes. Practitioners should use pain assessment tools during and immediately after injection and provide ongoing consistent information to help patients manage pain at home.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Healthcare Sciences Optometry and Vision Sciences
Publisher:	BMJ Publishing Group
Funders:	Abbeyfield Research Foundation
Date of First Compliant Deposit:	7 August 2023
Date of Acceptance:	1 August 2023
Last Modified:	22 Aug 2023 11:09
URI:	https://orca.cardiff.ac.uk/id/eprint/161507

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