By Haley Leuallen, COA, OSC
This is the reaction we get from many of our patients when they are told they need an injection in their eye to save their vision. The thought of a needle in your eye is not a pleasant thought. Surprisingly, after their first treatment, most patients often tell the technician and doctor that the treatment was not as bad as they had anticipated. With proper education and explanation, we find patients are much more comfortable receiving the recommended treatment for their diagnosis. This article explains the step-by-step process our retinal specialist uses to perform an injection.
First, prior to the day of the injection, a fluorescein angiogram (FA) may be performed. This procedure is performed in the office where a fluorescent dye is injected into the bloodstream and detailed pictures of the back of the eye are taken. The dye highlights the blood vessels in the back of the eye so that they can be photographed by a technician. This test shows the doctor the blood circulation in the retina at the back of the eye. After the doctor reviews the testing, he will then base his treatment plan off the dilated exam findings and the results of the FA.
There are many different treatment options; injections are one of the most common used in our office today. An injection can be used to treat diagnoses such as diabetic retinopathy, wet macular degeneration, retinal vein occlusions, uveitis, inflammation, etc. There are different medications that can be injected into the eye. The most popular medications used in most retina offices today include Avastin, Lucentis, and Eylea, which are types of Anti-VEGF medications. Anti-VEGF treatments are a group of medicines which reduce new blood vessel growth or edema (swelling). They are used to treat eye conditions which cause new blood vessel growth or swelling under the macula area of your retina. Other medications commonly used are steroids such as Kenalog, Triesence, and Ozudex (sustained release steroidal implant). Steroids work by reducing inflammation, which is involved in many retinal conditions, particularly those causing macular edema. If any of these injections are ordered to treat the mentioned diagnoses, although minor steps may vary, there is a core process for ocular injections.
The day of the injection, the patient will present to the office for a dilated exam and imaging. The technician will focus on the eye that is receiving the treatment at that visit. Once the patient is dilated, the patient will be brought into an exam room where the process of the injection begins. The technician will start off by putting several numbing drops into the eye receiving treatment. While the numbing process is taking place, the technician will prepare the necessary items that must be present for the injection to take place. Once the patient is numbed with topical numbing drops and the procedure is explained, the patient is reclined in the exam chair and the physician then gives the patient an injection of two-percent lidocaine at the injection site which is used for additional numbing. The doctor will then clean around the eyelids and lashes of the injection eye with a betadine swab. The patient is instructed to avoid touching their eye or anywhere close to the sterile injection site during the procedure. The doctor will then place a sterile speculum in the eye to help keep the eye open during the injection. While the doctor is prepping the medication, the technician will put drops of betadine in the injection eye to kill any bacteria prior to injection. The physician will then administer the drug by penetrating the eyeball and pushing the medication into the jelly-like substance at the back of the eye called the vitreous. After the needle is removed, a sterile, cotton-tipped applicator is placed on the site to prevent reflux.
The technician will then instill another drop of betadine on the injection site to prevent infection. Once the injection is completed, the doctor will remove the speculum and clean around the patient’s eye with a sterile eye pad making sure that most of the betadine is wiped clean from the face.
The technician will then go over, in detail, all post procedure instructions. The patient will also be given a post-op instruction sheet to refer to once they are home. Instructions include:
- No makeup (if applicable) for three days following the injection
- No eye drops for three days following the injection except preservative free artificial tears
- Leave the betadine on the eye for 24 hours post injection
- Use clean tissues when pat drying any excess fluid
This sheet will also include things that they may experience, post-injection, that are normal and abnormal. Patients may experience post-procedural irritation; this is normal due to the betadine causing irritation. In addition, they may experience bloody discharge on a clean tissue after the procedure. The blood will subside within hours after injection. If the patient experiences extreme pain, decreasing vision, or sudden vision loss, the patient is instructed to call our office immediately.
Haley Leuallen has worked at Bond Eye Associates for the past three years and is a Certified Ophthalmic Assistant as well as has an Ophthalmic Scribe Certification. She is currently one of Roger T. Adler, MD’s retina technicians. Please call Bond Eye Associates to schedule your yearly health vision exam with confidence knowing that they have been a trusted, locally owned, medical practice for over 36 years. They are accepting new patients in both of their locations: Peoria and Pekin. Please call 309-692-2020 to schedule an appointment or visit their website at www.bondeye.com.