Anxious About Those Eye Injections?

When I moved from the Northeastern part of the US to the Southeastern part, I had to decipher some of the words and phrases used here. One was “Better than a poke in the eye with a sharp stick.” It obviously means that no one wants a poke in the eye with something sharp. I’ve adapted the phrase for use here:

Better than a poke in the eye with a sharp needle.

I don't want an injection in my eye!

When people with AMD hear that the treatment for wet AMD is an injection in the eye, the reaction is almost universal: “No way!” The imagination runs wild with images of a large syringe with a huge needle at the end of the arm of an enormous doctor coming for the eyes.

My work with those who have wet AMD has shown, however, that it’s often the thought of the injections which is worse than the reality, but there’s often anxiety no matter how often a person has injections.

What are eye injections like?

When I asked those with wet AMD who have had or are having injections what it's like, I got a wide range of responses (paraphrasing):

• "There was no pain, no redness."
• "It was the worst experience I've ever had!"
• "There was some pressure or pain when injected, but that goes away."
• "There was some redness afterwards if the needle hits a blood vessel."
• "The eye feels [one or more of] painful, gritty, is sensitive to light, watery."

What's the point of them?

For better or worse, the anti-VEGF injections are the only treatment for wet AMD, and as such, are the only way to retain as much visual acuity as possible. Those people who choose not have them or don’t have them as needed may lose most or all of their central vision.

Eye injection experience

There’s quite a variety of reactions to the anti-VEGF injections. I have found that because there are sometimes not-so-good reactions, it’s those reactions that are the most often reported. There are, however, those who do NOT have bad experiences. We just don’t hear as much from them.

So what is going on?

Your retina specialist can make a difference

I’ve had people tell me that they had injections that were awful, but when they switched to another retina specialist (RS), there were no problems, or at least less. They attributed that to the skill of the eye specialist. I’ve also had people tell me that usually, the injections are not a problem unless the RS is in a rush.

Eye injection procedure

Proper preparation for an anti-VEGF injection is critical. The procedure involves cleaning the eye area, numbing the eye using gel or drops, and inserting an eyelid holder to keep the eyelids open.

One person told me that she usually had no problems with injections until one appointment where the RS was running late. She had been given the numbing shot, but she was put back into the waiting room. The numbing wasn't refreshed as it should have been.

Betadine reactions after eye injections

When someone’s eye burns or hurts after it’s been cleaned, that may be a reaction to the Betadine used. If that happens, you might ask the eye specialist to use another cleaning agent.

If they won’t, you might ask him/her to be sure that the eye is rinsed out thoroughly in the office. When you get home, you can rinse the eye out again. Saline eye drops work well for this.

Anxiety and macular degeneration

Have you heard the term ‘eye anxiety’? I first saw it in an article titled, ‘Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration.’ This article reports on a research study of the same name where 300 patients with wet AMD who were receiving anti-VEGF injections completed a survey to determine their levels of anxiety, depression, and post-traumatic stress.

The results showed that 56% of the patients reported they were anxious not because of fear of pain, but because they were afraid of going blind. They were also were concerned that the treatment would not be effective. This anxiety was not related to the number of injections. Clinical depression was found especially in those who were in the early stages of their treatment.¹

If you experience these feelings of depression and anxiety about the injections, you are not alone. There is help available! 

What can a retina specialist or ophthalmologist do to help?

The office of the RS is where much of the work begins to make an injection less traumatic. Here are some things we hope that they will consider:

• If the preparation has been done but there is a delay before the injection, we hope that they re-evaluate the effectiveness of the numbing drops at that time.
• It's been suggested that the staff and the doctor pay attention to the state of mind of the patient. If they feel that there’s too much anxiety before or after the injection, we hope they'll refer patients to counselors who can help.

What can our support system do to help?

For those of us who care for and support someone with wet AMD, we might:

• Take the time to make sure they are educated and reassured.
• Ask how it went and how they feel now that it’s done.
• Talk to them about professional counseling if needed. You might be able to help them find it.

How can I reduce injection anxiety?

If you have concerns and are thinking of stopping the injections despite the recommendation of the eye specialist, your concerns need to be taken seriously. You might try to:

• Talk to your RS about your concerns if the injections cause you to have side effects that you weren't expecting.
• Talk to those in your circle of friends, family, and support groups about your feelings.
• If you continue to feel depressed and anxious, please seek out professional help. Some types of insurance will cover the expense. There are also ways to get the cost reduced based on your income.

Anti-VEGF for wet macular degeneration

It is not something any of us want or look forward to, but anti-VEGF injections are one of the only treatments currently available for wet AMD. There is a lot of variability as to how individuals react to anti-VEGF injections for various reasons. We hope that with attention to the procedure and state of mind by the RS and staff and with the help of those around us, these safe and effective injections won't be so traumatic.