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Comparison of intravitreal injections in the United States of America and the UK based on observations of ophthalmic trainees

Poster Details

First Author: J.Morarji UK

Co Author(s):    J.B. Morarji   M.M. Michelotti   D.N. Zacks   E. Sioras   P.P. Lee   S.P. Kelly   0   0 0   0 0   0 0   0 0

Abstract Details


To compare and contrast the differences as observed by ophthalmology trainees in a UK and US hospital on intravitreal anti-VEGF delivery service and to highlight areas of innovative practice.


Novel intravitreal therapies have revolutionised the management of medical retinal conditions such as wet age-related macular degeneration and diabetic macular oedema. Such conditions affect millions of patients.Anti-VEGF therapy is now a significant health economics matter. The UK and United States have developed different processes to deliver intravitreal injections.


Liaison by ophthalmic trainees within a US tertiary hospital (University of Michigan, Kellogg Eye Centre) and within an NHS district hospital (Royal Bolton Hospital) exploring the type of anti-VEGF used, status of injector, injection technique, peri-procedural preparations, and the financial constructs.


Significant differences were found with regard to the organization of clinic and scheduling for injections, type and cost of anti-VEGF medication used, materials used in the process, and practitioners providing the injections. A photo essay highlights different injection practices. Tables comparing costs and billing are presented.


Comparative costs of injections is significantly impacted by the use of bevacizumab in the US which is significantly cheaper than ranibizumab used with NHS care. Ophthalmic nurse practitioners are increasingly performing anti-VEGF injections in the UK. Sterile techniques differ between the two services. The Invitrea injection device used at Royal Bolton differs from the speculum and caliper system used at the Kellogg Eye Centre.

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