Anxiety and pain perception using a speculum-free eyelid retraction technique for intravitreal injection

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 260; no. 6; pp. 2023 - 2028
• Main Authors: Wasser, Lauren M., Roditi, Eduardo, Weiss, Adina R., Weill, Yishay, Koslowsky, Meni, Zadok, David, Hanhart, Joel, Magal, Itay
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2022; Springer Nature B.V
• Subjects: Anxiety; Anxiety - diagnosis; Anxiety - etiology; Anxiety - prevention & control; Eyelid; Eyelids; Humans; Injection; Intravitreal Injections; Medical Ophthalmology; Medicine; Medicine & Public Health; Mood; Ophthalmology; Pain; Pain - diagnosis; Pain - etiology; Pain - prevention & control; Pain Perception; Prospective Studies; Surgical Instruments; Anxiety; Pain; Speculum; Intravitreal injection; Lid splinting eyelid retraction technique
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-021-05422-7

Purpose
This study compared pain and anxiety levels in individuals receiving intravitreal injections (IVIs) using a speculum-free injection technique, the lid splinting eyelid retraction technique, or using a speculum.
Methods
This was a prospective study of individuals receiving IVI at a single tertiary care medical center who responded to a questionnaire and visual analog scale (VAS) between December 2019 and January 2020. In one group, a speculum was used prior to injection, whereas in the other group, a speculum-free injection technique was used.
Results
A total of 108 individuals were included in this study: 54 received IVI with the speculum-free lid splinting eyelid retraction technique and 54 received IVI with a speculum. A correlation between pain and anxiety was demonstrated in the control group (
p
-value < 0.01); however, in the speculum-free group, this correlation was lower and not significant. When comparing pain and anxiety between the study groups, lower median pain (Mood’s:
Z
 = 5.378,
p
-value < 0.001) and lower anxiety (Mood’s:
Z
 = 2.108,
p
-value = 0.035) scores were demonstrated in the speculum-free group than in the control group. The distribution of pain scores was significantly different between the study groups (Kolmogorov–Smirnov:
D
 = 0.518,
p
-value < 0.001), and trending differences in anxiety between the groups were observed (Kolmogorov–Smirnov:
D
 = 0.259,
p
-value = 0.053).
Conclusion
The lid splinting eyelid retraction technique, a speculum-free technique, was associated with less anxiety and pain in patients than the use of a speculum. As IVI often involves repeated treatment, identifying modifiable factors that may relieve anxiety and pain is of utmost importance.