Anxiety and pain perception using a speculum-free eyelid retraction technique for intravitreal injection

Lauren M. Wasser, Eduardo Roditi, Adina R. Weiss, Yishay Weill, Meni Koslowsky, David Zadok, Joel Hanhart, Itay Magal

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: This study compared pain and anxiety levels in individuals receiving intravitreal injections (IVIs) using a speculum-free injection technique, the lid splinting eyelid retraction technique, or using a speculum. Methods: This was a prospective study of individuals receiving IVI at a single tertiary care medical center who responded to a questionnaire and visual analog scale (VAS) between December 2019 and January 2020. In one group, a speculum was used prior to injection, whereas in the other group, a speculum-free injection technique was used. Results: A total of 108 individuals were included in this study: 54 received IVI with the speculum-free lid splinting eyelid retraction technique and 54 received IVI with a speculum. A correlation between pain and anxiety was demonstrated in the control group (p-value < 0.01); however, in the speculum-free group, this correlation was lower and not significant. When comparing pain and anxiety between the study groups, lower median pain (Mood’s: Z = 5.378, p-value < 0.001) and lower anxiety (Mood’s: Z = 2.108, p-value = 0.035) scores were demonstrated in the speculum-free group than in the control group. The distribution of pain scores was significantly different between the study groups (Kolmogorov–Smirnov: D = 0.518, p-value < 0.001), and trending differences in anxiety between the groups were observed (Kolmogorov–Smirnov: D = 0.259, p-value = 0.053). Conclusion: The lid splinting eyelid retraction technique, a speculum-free technique, was associated with less anxiety and pain in patients than the use of a speculum. As IVI often involves repeated treatment, identifying modifiable factors that may relieve anxiety and pain is of utmost importance.[Figure not available: see fulltext.].

Original languageEnglish
Pages (from-to)2023-2028
Number of pages6
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number6
StatePublished - Jun 2022

Bibliographical note

Funding Information:
The authors acknowledge the work of Sondra Turjeman, PhD, for her expert statistical analysis.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


  • Anxiety
  • Intravitreal injection
  • Lid splinting eyelid retraction technique
  • Pain
  • Speculum


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