The Betadine Conversation and My Injection Protocol
Last updated: November 2023
Lately, I’ve been seeing numerous negative comments about the injections for the choroidal neovascularization (wet) type of macular degeneration. Many of our wonderful community members find the after-effects almost worse than the injection itself.
Most are suggesting it is probably the Betadine drops specifically that leave the eye feeling gritty, itchy, and painful. It does seem to be the problem. Some have even commented it is causing them to consider stopping the shots!
What do Betadine drops do?
PreventBlindness.org had this to say about it:
"Betadine (povidone-iodine 5%) has become the standard of care for cleansing the eye during anti-VEGF injection procedures. Though the incidence of sensitivity to povidone-iodine (PVPI) is infrequent, some patients are reporting severe and prolonged burning of the conjunctiva. They also mention the very limited options that have been tried."1
Different perspectives
I must be one of the very lucky ones, having only a very minor ache for a few hours. One of my injections was done by a doctor filling in for my wonderful retina specialist, which was a little alarming, but instead just gave me another perspective on the treatment protocol.
This new specialist used a numbing shot first, which was a new experience. In trying to compare, I think the only difference was in the minor ache afterward. Perhaps a bit less, but really not noticeable. My doctor does rinse the eye well afterward, which must be part of the reason it doesn’t bother me later.
My eye routine
My injection routine for the past three years has been:
First the eye chart, then a pressure test for glaucoma, followed by the dilation drops. Next are the OCT pictures, then the Fundus photos.
My treatment
This is what they then used for me, spread out over almost a half-hour:
- 2 x Zymar (antibiotic)
- 0.5% Alcaine (numbing drop)
- 5%. Povidone Iodine (antiseptic)
- 2%. Lidocaine (freezing gel)
A patch goes over the eye to keep it shut until the doctor removes it.
Administering the injection
After a short conversation with the doctor about what the pictures have shown, we decide how long before the next visit. The doctor uses more Lidocaine, props the eye open with a speculum, which I barely feel, and dabs a swab with iodine to the spot. Then a very slight pressure, and it’s done. He takes great care to wash it out well with a sterile saline solution.
A new routine
When I arrived for my injection yesterday, I saw no one in the waiting area had a patch on their eyes. The treatment team explained they had changed some things, which made the injection and its after-effects easier on the patients.
The new routine:
- Vigamox (antibiotic)
- 0.5% Alcaine (numbing drop)
- 5% Povidone Iodine (antiseptic)
No patch needed.
Alcaine instead of Lidocaine
Then into the treatment room, where the only difference is the doctor uses Alcaine instead of the Lidocaine gel (they described the amount as “lots”). Followed by the same saline solution.
No blurriness or aching afterward
They were right, it is easier on the patient! The injection itself felt the same. My eye was not blurry on the way home, I had none of the “goopy” gel feeling afterward, not even minor aching, and woke up this morning feeling as if I hadn’t even had the shot!
Betadine sensitivities
I hope some of this information is useful to you, or that it stirs up a conversation where we might learn of differences that could be helpful to any one of us. Especially those who are extra sensitive to the Betadine. Please let us know how you and your doctor manage your injection routine.
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