This article was originally published in a sponsored newsletter.
Anti-complement injections represent an interesting new territory in retina care. Typically, patients who receive intravitreal injections for wet AMD and diabetic macular edema notice some improvement in their vision or diagnostic photos. However, it is likely that vision in geographic atrophy (GA) patients will still worsen over time despite treatment. How do we motivate patients to initiate therapy and keep coming back to the clinic? What are the key pearls to have in conversations with patients?
First, it is important to take time during the initial encounter to explain the risks and benefits of treatment to patients. These conversations can be long and nuanced, so set aside extra time in your schedule for GA evaluations. Do not hesitate to give patients reading materials and have them return for another visit to continue the discussion. It is also critical to remind patients that these injections are not the same as wet AMD injections, so they should not compare their experience to a friend who has had significant visual benefit from their wet AMD injections. Including family members is important as well; otherwise, there can be a lot of confusion regarding the goal of injections.
Second, make the injection experience as comfortable as possible. Avoid dilation if possible and consider quicker, “treatment-only” visits. Take the time to apply extra numbing agents and remind patients that they may experience a black-out of vision or a brow ache after the injection due to the higher volume of medication administrated. Consider using an ointment or other lubricating agent after injections to avoid post-injection discomfort. Patients can have a lot of anxiety around injections, so making the experience as pleasant as possible can help motivate patients to return for treatment.
Lastly, and perhaps most importantly, validate patient concerns. Our GA patients are frustrated because they cannot read, drive, or watch TV like they used to. It can be difficult to be dependent on family members for appointments and other everyday activities. The injections can be uncomfortable. And remember that these patients may also have other medical conditions that are frustrating to manage. Take a few extra seconds to ask your patients how they are functioning at home. Validating their limitations and concerns is important to remind them that they are not alone and that you are working as a team to optimize their vision.
