Patient Perspectives on Intravitreal Injection Burden: A QUALITII Study in a Portuguese Center

Abstract

INTRODUCTION: Intravitreal injections (IVIs) have transformed medical practice in ophthalmology for many retinal conditions with countless patients requiring continuing treatment. Patient adherence plays a pivotal role, influenced by their experiences and treatment challenges. Identifying sources of patient burden is vital for improving retinal disease management. This study uses the Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII) to assess the multifaceted burden of repeated IVIs within a single center.
METHODS: The validated QUALITII survey was translated and adapted to Portuguese. It was distributed to patients receiving IVIs at Centro Hospital de Leiria in Portugal. The Treatment Burden Score (TBS) was calculated to provide an overall assessment of patients’ perspectives.
RESULTS: The 168 patients of our study were aged 75.9 ± 1.1 years on average and had been receiving IVIs for 3.0 ± 0.2 years (60.7% had undergone over 10 IVIs), most frequently every 4/5 weeks. TBS averaged 24.8 ± 0.9 (n=123, scale 1–54), higher in females, anxious patients, and those requiring assistance. Satisfaction rated at 4.5 ± 0.1 (scale 0–6), positively correlated with treatment duration and perceived vision preservation, but was lower for patients receiving injections every month. Peak anxiety levels averaged 3.1 ± 0.2 (scale 0–6), higher in women and anxious patients while correlated negatively with age and positively with treatment duration. To cope with the treatment, 7.7% used anxiolytics. IVIs’ discomfort averaged 3.1 ± 0.2 (scale 0–6), and was also higher in females and anxious individuals, with 12.1% considering discontinuation. It did not affect overall satisfaction but led 13.2% to use oral pain-relief medication resulting in a higher TBS. Half of the patients reported limitations after injection for approximately 9.1 ± 1.0 hours, which also correlated with TBS. Time consumption was rated 3.2 ± 0.2 (scale 0–6) with 79.4% requiring assistance.
CONCLUSION: The burden experienced by patients under IVIs is complex with TBS offering valuable insights. Females, anxious patients, and those requiring assistance faced a higher burden. Longer treatment durations and perceived vision preservation were associated with increased satisfaction but anxiety, discomfort and post-IVI restrictions were prevalent. Addressing these issues can enhance the IVIs experience and adherence, ultimately improving patient quality of life.