title: 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.
authors.affiliation: a Department of Community & Clinical Allied Health , La Trobe University , Melbourne , Australia.|b Eye Surgery Associates , Cabrini Medical Hospital , Malvern , Australia.
authors.forename: Jessica
authors.initials: J
authors.lastname: Boyle
authors.affiliation: a Department of Community & Clinical Allied Health , La Trobe University , Melbourne , Australia.|b Eye Surgery Associates , Cabrini Medical Hospital , Malvern , Australia.
authors.forename: Meri
authors.initials: M
authors.lastname: Vukicevic
authors.affiliation: a Department of Community & Clinical Allied Health , La Trobe University , Melbourne , Australia.|c Department of Ophthalmology , Royal Children's Hospital , Melbourne , Australia.
authors.forename: Konstandina
authors.initials: K
authors.lastname: Koklanis
authors.affiliation: d Department of Rehabilitation , Nutrition & Sport, La Trobe University , Melbourne , Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Itsiopoulos
authors.affiliation: e Centre for Eye Research , Royal Victorian Eye and Ear Hospital , East Melbourne , Australia.|f Department of Surgery , University of Melbourne , Melbourne , Australia.
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Rees
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D001315:Australia; D005260:Female; D006801:Humans; D058449:Intravitreal Injections / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D042442:Vascular Endothelial Growth Factors / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D042442:Vascular Endothelial Growth Factors
keywords: Age-related macular degeneration; anti-VEGF; burden; exudative maculopathies; intravitreal injection; neovascular; patient experience; treatment