title: Strategies for Improving Patient Comfort During Intravitreal Injections: Results from a Survey-Based Study.
abstract: BACKGROUND
  Many ocular diseases require intravitreal injections of pharmacological agents. Optimizing patients' experiences during injections is important to ensure compliance and maintenance of quality of life. The objective of this study was to identify strategies to help alleviate discomfort during intravitreal injections.
  
  
  METHODS
  A cross-sectional study surveying 128 patients during clinic visits between 2014 and 2015 in two outpatient Retina Clinics (one academic and one private). Patients receiving an intravitreal injection(s) for any retinal disorder were given a questionnaire with 10-yes/no responses for various potential strategies. Responses were stratified by sex, age (<30 years, 30-60 years, and >60 years) and total number of prior injections (0-9 injections, 10-20 injections and >20 injections).
  
  
  RESULTS
  A total of 128 patients were surveyed: 59 males, 41 females and 28 with no sex specified. Our results identified four favorable strategies as those receiving more than 50% "yes" votes. These included the presence of technician/staff during the procedure, the use of a neck pillow, a verbal warning before the injection and performing injections in both eyes on the same day. Other specific strategies were identified for females, younger patients and those with greatest experience. These included: females preferred having their hand held during injections (P = 0.001) and using a stress ball (P = 0.000) when compared to males. Stratifying by age, patients 30-60 years old preferred having their hand held (P = 0.008) and background music (P = 0.007). Stratifying by prior injections, patients with >20 prior injections preferred having their hand held (P = 0.001), using a stress ball (P = 0.021) and, if necessary, having bilateral injections performed the same day to improve comfort (P = 0.037).
  
  
  CONCLUSIONS
  Having an extra staff member present during the injection, having a neck pillow, having a verbal warning prior to injection and having both eyes injected on the same day were indicated as favorable strategies by over half of those surveyed. Further, specific strategies were identified for females, younger patients (30-60 years old) and those with greatest experience (>20 injections).
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gomez
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Dara D
authors.initials: DD
authors.lastname: Koozekanani
authors.affiliation: Medical School, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Feng
authors.affiliation: Medical School, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Holt
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Drayna
authors.affiliation: Mayo School of Medicine, Rochester, MN, USA.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Mackley
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Frederik J G M
authors.initials: FJ
authors.lastname: van Kuijk
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Beardsley
authors.affiliation: Edina Retina Consultants, Edina, MN, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Johnston
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Terry
authors.affiliation: Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA. smontezu@umn.edu.
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Montezuma
keywords: Comfort; Drug delivery; Intravitreal injection; Patient; Quality improvement; Retinal disease