Anxiety level associated with increased perceptions of intravitreal injection pain

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A patient’s anxiety level may predict their perceived level of intravitreal injection pain, according to a study published in the journal Investigative Ophthalmology & Visual Science.

In this prospective non interventional study, 140 patients who met the study criteria and were scheduled for intravitreal anti-VEGF injections (IVA) filled out pre-procedure GAD-7 Anxiety (0-21) and Pittsburgh Sleep Quality Index (PSQI) questionnaires (0-21).

Mean (SD) anxiety score was 4.9 (5.6), PSQI, 6.3 (4.1) and IVA pain 3.69 (2.64).

Researchers found that anxiety was significantly correlated with IVA pain and that the patient’s previous night’s sleep was negatively correlated with pain whereas PSQI was positively correlated with IVA pain.

The only significant predictor of IVA pain was anxiety, with IVA pain increasing 0.11-point for every point increase on the anxiety scale.

“Anxiety screening questionnaires may help practitioners identify patients at risk for elevated pain. Future studies of modifications that target anxiety may help address pain perception in this procedure,” the authors concluded.


Mbekeani J, Wieder MS, Inker S, et al. Impact of anxiety levels and sleep patterns on perceived pain during intravitreal injections. Investig Ophthalmol Vis Sci. 2020;61(7).

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