Implementation of a Nurse-Delivered Intravitreal Injection Service

J DaCosta; R Hamilton; J Nago; A Mapani; E Kennedy; T Luckett; C Pavesio; D Flanagan


Eye. 2014;28(6):734-740. 

In This Article

Abstract and Introduction


Purpose. The purpose of this study was to introduce nurse-delivered intravitreal injections to increase medical retina treatment capacity.

Methods. Indemnity, clinical governance, training, planning, and implementation issues were addressed. The outcome measures were patient safety, patient experience, and clinic capacity.

Results. No serious vision-threatening complications were recorded in a consecutive series of 4000 nurse-delivered intravitreal injections. A Mann–Whitney test showed a significant increase in intravitreal injections (P=0.003) in the medical retina service after introduction of nurse-delivered intravitreal injections. The majority of patients accepted and were satisfied with a nurse-delivered intravitreal injection.

Discussion. Nurse-delivered intravitreal injections appear safe, acceptable to patients, and are an effective means to increase intravitreal injection capacity in medical retina clinics.


Anti-vascular endothelial growth factor (Anti-VEGF) treatment has revolutionised the management of neovascular age-related macular degeneration (AMD). The majority of patients attend for an intensive follow-up and injection regime at six weekly intervals in alignment with current NICE guidelines.[1]

Intravitreal ranibizumab is currently licensed only for administration by an ophthalmologist. Expansion of intravitreal injection services is necessary for conditions such as diabetic macular oedema and retinal vein occlusions.

Recent reforms to the UK medical training system have reduced the number of ophthalmologists in training. An ageing population, economic constraints, and the introduction of clinical commissioning have created an incentive to explore new methods of multidisciplinary working.

Traditional nursing work has changed considerably in recent years with the introduction of extended roles in many surgical specialties. There is a growing awareness of the positive impact of extended roles both for health professionals and for patients.