Intravitreal injections are a routine part of our clinic days at Orange County Retina Medical Group. Each day, we see between 50 and 60 patients, about 30 of which are for injections, making efficiency crucial. Compassion, however, is also important because it is common for patients to feel overwhelmed by the continued demands of retinal care. Finding the right balance between the 2 priorities has shaped how we have evolved our pre-injection protocol and helped us reduce bottlenecks, alleviate stress, and maintain clinic productivity.
I play a central role in preparing patients for their intravitreal injections and making sure they receive effective and consistent care. From walking them through what to expect while they are in our clinic to ensuring that they are receiving the correct treatment on the correct day, I see firsthand how intravitreal injections can cause anxiety, even among patients who have received them before.
A Standard Approach to Patient Communication
Although new patients undergo a more thorough workup and receive a detailed explanation of every step of the injection process, even returning patients need a reminder of what to expect. Many of our patients receive multiple types of injections for different retinal conditions, and sometimes these injections are on different days.
Clarity and consistency are key to avoiding patient confusion and reducing their fears. Regardless of how familiar a patient is with our process, we always let them know what is going into their eyes before we begin. That communication fosters trust. We’ve found patients have a better experience in our clinic if they are not subjected to any surprises.
Reducing Procedural Complexity
In addition to avoiding surprises, we have found that reducing the complexity of our pre-injection protocol has also led to improved patient experience. Until recently, several steps were required before any injection. We used multiple numbing agents, including proparacaine drops, lidocaine-soaked pledgets, and Akten gel. We then applied a separate 5% betadine drop for sterilization. This process, although thorough, took about 30 minutes per patient. For an injection that lasts just a few seconds, that duration of preparation placed a lot of strain on our schedule—and our patients.
The complexity also added to patient apprehension, especially for those new to injections. Seeing multiple bottles of drops lined up often was intimidating. Older patients or those with physical limitations such as difficulty tilting their head or neck often found it uncomfortable to remain in position long enough for every step to be completed properly.
We recently adopted a more streamlined approach that still allows us to follow a protocol that includes the essential components including ocular disinfection and anesthesia and ensures safety and efficacy while also considering patient comfort and needs. In the process, we have cut our pre-injection time nearly in half. Instead of using multiple agents, now we use a combination drop (povidone-iodine 1.25% and proparacaine 0.5%; Povicaine, ImprimisRx) that both numbs and sterilizes the eye.
In our practice, use of a single-drop solution has significantly improved both efficiency and patient comfort. Fewer drops mean less time explaining our protocol to patients, less time patients are left waiting between applications, and less movement and positioning for patients with mobility issues. The entire prep process now takes about 15 minutes instead of 30 minutes. Additionally, by reducing the number of times we touch the eye, we’ve maximized sterility and reduced the risk of abrasions and injection-related infections.
Importantly, patients have noticed the difference. Most comment they have clear vision immediately after the injection, and they are more comfortable both during and after the injection. For patients who used to report irritation and/or a burning sensation from the separate betadine application, the discomfort is virtually gone. We have also seen that patients no longer leave the clinic with residual irritation or confusion, so they are more confident in our care.
Respecting Surgeon Preferences
Not all of our physicians follow the same protocol. Some, for example, still prefer a separate betadine swab before the injection. For those surgeons, the ophthalmic technicians perform a rinse post-injection using balanced salt solution to reduce irritation and help prevent ocular discomfort.
Although the rinse is no longer mandatory, it may help some patients feel more comfortable leaving the clinic because there is no lingering discomfort—even though we reassured them that temporary burning was normal.
Unexpected Benefits
One unexpected benefit of the simplified pre-injection protocol is its impact on post-injection diagnostic imaging. Sometimes after the injection, our retinal surgeon might notice something new that wasn’t present during the last visit—especially for patients who return every few months. Prior to this, multiple ocular gels and sterilizers left a film over the eye that could interfere with imaging, even after rinsing with a balanced salt solution. Now there are fewer residues, allowing us to capture clearer images immediately after the procedure.
Spotting a new concern during a routine exam and getting quality imaging immediately without having the patient come back another day is key. It saves time and ensures faster, more accurate decision-making.
Conclusion
A good protocol is not just about maintaining safety and sterility. It is also about achieving a predictable, comfortable, and efficient experience for both patients and staff. Small changes, like consolidating drops or adjusting to patient needs, can have a big impact. Compassion is key.
Simplifying our pre-injection process has helped us improve the patient experience. We've found that when patients feel confident and at ease with the pre-injection process, many are more likely to stay on track with their treatment plan. For technicians, a smoother workflow and reduced pre-procedural complexity better equips us to focus on what matters most: Helping our patients see their best.
By rethinking and refining how we approach intravitreal injections, we have not only saved time—we have built patient trust. OP
