Intravitreal Injections Linked to Psychosocial Burden in Retina Disease Patients

Rui Wang, MD

Treatment burden continues to be a major effect on the quality of life and psychosocial wellness of patients receiving intravitreal injections (IVI) for retinal disease.

In findings from the QUALITII survey, a 50-item survey that established treatment burden scores (TBS) based on 9 items examining patient-received burden, a team of investigators reported that patients with diabetic macular edema (DME) or diabetic retinopathy (DR) reported the greatest burdens from their injection therapies.

The survey, provided to 4 retina clinics across 4 states for the data presented at the American Society of Retina Specialists (ASRS) 2021 Scientific Meeting this weekend, also showed that patient adherence to their IVI therapy was associated with decreasing anxiety.

Presented by Rui Wang, MD, a resident physician with Penn State University, the trial sought to quantify the areas of burden experienced by patients with retina disease receiving repeated intravitreal injections.

“IVI are the mainstay treatment for multiple exudative retinal diseases and often require an indefinite course,” they wrote. “A thorough, quantitative understanding of patient-level burden may inform approaches to improving patient experiences that ultimately translate into optimized clinical outcomes.”

Wang and colleagues observed the 4 clinics conducting survey with QUALITII, establishing an a priori power analysis based on TBS to identify small-to-moderate effect sizes among differing disease groups: DME/DR (n = 360), age-related macular degeneration (AMD; n = 657), or retinal vein occlusion (RVO; n = 221). Their population included another 178 patients with an unidentified retina disease.

Mean surveyed patient age was 70 years old, with 55% of participants being female. About 2 in 5 patients received IVI every 4-5 weeks; 4 in 5 patients received it every 4-8 weeks.

Nearly two-thirds (65%) of patients reported IVI adverse events at least half the time with new injections, and more than one-third (36%) reported adverse events with every injection. The most common side effects included eye pain (49%) and light sensitivity (37%).

About half (51%) of patients with >50 IVI reported having restrictions to usual activities, versus 33% of patients with <10 injections (P <.001).

Mean patient TBS was 16.1, and ranged from 1 to 48. Patients with DME/DR reported a mean 17.1 score, versus 15.5 among patients with AMD, and 15.3 among patients with RVO (P = .03).

Wang and colleagues concluded that a majority of patients reported challenges related to their IVI treatment, with an observed association between increased rate of treatment and increased restriction on usual activity.

“The TBS was highest for patients with DME/DR which could be due to increased physical/psychosocial burden, younger age, and increased out-of-pocket cost that many diabetic patients bear,” they noted.

The study, “Results of a Multicenter Survey to Measure Treatment Burden: Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII),” was presented at ASRS 2021.