Beyond clinical efficacy: Measuring the life impact of repeated Anti-VEGF Injections in Indian patients

PURPOSE: To evaluate the psychosocial and economic burden associated with repeated intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in Indian patients. METHODS: This cross-sectional study included adults with age-related macular degeneration (AMD) or diabetic macular edema who had received ≥3 anti-VEGF injections at a tertiary eye care hospital between January 2022 and January 2025. A 25-item questionnaire, adapted from the QUALITII tool, assessed discomfort, anxiety, inconvenience, time loss, and satisfaction. A nine-item Intravitreal Injection Burden Score (range: 9-54) was developed. Internal consistency was assessed with Cronbach's alpha. RESULTS: One hundred patients were included (mean age 58.05 ± 12.77 years; 53% male). Treatment burden was multidimensional, involving procedural discomfort, anxiety, time burden, and caregiver dependence. Injection-related discomfort and anxiety were commonly reported, with 65% experiencing predominantly mild discomfort. Treatment visits imposed a considerable time burden, with most patients spending 4-8 hours per visit and 85% requiring caregiver assistance. Activity restriction and postinjection analgesic use were noted in 24% and 26% of patients, respectively. The mean Intravitreal Injection Burden Score was 19.28 ± 6.3 (range 9-36), with moderate internal consistency (Cronbach's α = 0.67). CONCLUSION: While anti-VEGF therapy remains the standard of care for exudative retinal diseases, repeated injections impose significant psychosocial and economic burdens in Indian patients. Patient-centered care and supportive frameworks play a crucial role in improving adherence and health outcomes.