Episode Transcript
Interviewer: For many patients dealing with age-related macular degeneration, there's a very effective treatment available that's been shown to slow or stop vision loss. However, the medication is administered through a process called intravitreal injection. In other words, an injection with a needle into the eye.
Dr. Monika Fleckenstein is a Professor of at the Moran Eye Center. She's a retina specialist and has performed this procedure many times in her practice. And we wanted to find out, Dr. Fleckenstein, how do you talk a patient through this procedure if they're really anxious about getting an injection in their eye?
Managing Patient Anxiety for Intravitreal Injection Procedures
Dr. Fleckenstein: First of all, it's really important that we explain to our patients that these injections are really necessary to prevent further decrease in their vision, and these medications work very well, so it would be just sad not to treat this condition.
And of course, the idea to have a needle in their eye, I can absolutely understand that this is so scary, but we are able to take away this fear a little bit from our patients.
So first of all, it's a very fast procedure. We numb the eye, so patients do not really feel pain. It's more of a pressure when our patients report to us what they feel. Then we talk our patients through the procedure.
We also hold hands. We can also hold the head if a patient feels more comfortable if we stabilize the head a little bit because every patient is asking, "What if I move? And what if I try to close my eye?" So we actually also help to open the eye. This can be done with fingers or also with small clamps that we put into the eye. But this is all not painful because we use numbing drops.
And my experience is also that patients feel much safer if we can tell them, "We have something in your eye. You can try to blink, but actually, it'll prevent you from blinking, and you intervene with the procedure." So they should not be scared of blinking or something that they could cause any damage.
So we have means to open the eye, and also to stabilize the head. And then, again, usually the procedure is so fast. After the first injection patients tell me, "That's it? It's over? This is all?" And usually then for the next injections, patients are much more calm.
Again, I have several patients who are scared before each injection, and I can understand this. Most of our patients are just fine. For the patients who have more pain, we can use more numbing drops. We can also use numbing underneath a certain layer in the eye so that it's even less painful if they experienced pain during the injections before. Again, most of our patients are just fine with these injections.
How Safe Are Intravitreal Injection Procedures for Age-Related Macular Degeneration?
Interviewer: And it's safe as well?
Dr. Fleckenstein: It's one of the most performed procedures in medicine. It is very safe. However, of course, any procedure may have complications, and this is also something we explain to our patients in detail. Not to fear them, but to tell them what to do if they experience symptoms of complications.
Interviewer: So what you're saying is if they experience complications, you know how to deal with it, but they need to know that a complication is happening. Is that a fair assessment?
Dr. Fleckenstein: Yeah. So what I explain to my patient is there are immediate things, that you may injure some structures in the eye, which is very seldom. But of course, it may happen that the lens, for example, is injured. But this is usually something you would realize right away, and these things can usually be solved.
The most feared complication is an inflammation or infection in the eye. And this occurs in 1 of 3,000 injections. And most important if patients develop symptoms, I always explain in detail what these symptoms are, so that patients do not hesitate to contact us and to come in.
Typically, on the day of the injection, it's completely normal for the eye to be itchy, and they have foreign body sensations in the evening because we used disinfectant for the surface of the eye, and this irritates the surface of the eye. But the next day, everything should be just fine.
But if symptoms like pain, worsening in vision, a pinkish eye, or anything like this develop typically two, three, four, five, six, or seven days after the injection, and the day after the injection everything is fine, then they should be alert. This could be a sign that there is an infection in their eye.
We provide our patients with an exact plan of what to do if they experience such symptoms. They are provided with a phone number where they can reach someone at the eye hospital, at the Moran Eye Center 24/7. They can be seen 24/7, and if there's indeed such a complication as an infection in the eye, the patient needs to get treatment, which is antibiotics into the eye or even surgery. But this may prevent a bad cause of these infections.
Expected Improvement for Patients After Intravitreal Injections for Age-Related Macular Degeneration
Interviewer: And then tell me what kind of improvement a patient can expect when they get this type of treatment.
Dr. Fleckenstein: We know from studies that the majority of patients will experience a delay or a stabilization of their disease. So our primary goal is to stabilize their vision so that it does not get worse.
Usually, patients with wet AMD come in and tell you, "I experienced a decrease in vision within the last weeks or months." And to prevent further decrease in vision, this is our primary goal and aim of the treatment.
Then about 30% of patients can even regain vision. And so it's really a wonderful treatment, and quite a few of our patients realize a wonderful improvement in their vision after the first, second, and third injection. We know the sooner this disease is treated, the sooner the wet form is treated, the better the outcome. So this is why it's so important to be seen as soon as possible if you develop such symptoms.
Interviewer: And how often does a patient need to get the injections?
Dr. Fleckenstein: It depends on the medication that has been used, but the medication that is usually used for the first injections needs to be put into the eyes every four weeks in the beginning, and then usually the ophthalmologist will adjust the treatment to the individual response of a patient.
So if we see that a patient or an eye nicely responded to treatment, we will try to extend the intervals between injections. We will also have patients who need injections every four weeks, but then we also have patients who may, after several months, even be able to be without injections.
This is more seldom, and this is what I explain to my patients. It's a lifelong treatment, so it's taken a little bit like hypertension treatment. So you will need regular treatment lifelong, but the result is, in most situations, the vision can be stabilized.
Interviewer: Yes, you don't continue to lose your vision. That's a pretty fantastic payoff.
Dr. Fleckenstein: Yes.
Interviewer: Do you have any tips for somebody that is getting the injections on things they can do to help prepare themselves mentally for something like this, or while they're in the office something that they can do that would help make it a nicer procedure?
Dr. Fleckenstein: So first of all, it's a difference in Germany. I'm from Germany. So, in Germany, patients would always come with someone to give them a ride, to support them. Here in the U.S., I often see that patients come on their own. So I feel that particularly for the first injections, it's nice to have someone around to drive, but also to be there and to be in the room so that they're not alone. So I think this is helpful.
Again, I think if you really think about this particular wet stage of the disease untreated, it will really lead to you losing your central vision. And these treatments are working so well, and these treatments are for more than 15 years in the hands of ophthalmologists. We are all very much experienced in providing this care. The teams are very experienced.
Also, something to calm down a little bit. I think the idea to have a needle in the eye . . . I usually say to my patients, and sometimes I hope it helps them as well, I tell them, "I can absolutely understand that you are scared. I would be scared as well. I like to provide this injection, to do this procedure, but the idea that I would need to undergo it . . ." So I can really understand the fear.
But again, it's fast, usually, it's safe, we have not a lot of complications, and it's proven that it helps. So we can prevent vision loss. We can prevent blindness with these injections.