Training and practice are key to learning retinal injection techniques

In-person and virtual trainings, coupled with the support of local product representatives, are the best ways to ensure retina specialists are set up for success. (Image Credit: Adobe Stock/Parilov)

As ophthalmologists and retina specialists, we know ocular injections are indispensable because they allow us to administer innovative medications and to manage a variety of retinal conditions. The frequency of intravitreal and suprachoroidal injections has significantly increased since the approval and availability of new, effective treatments for patients with common conditions such as age-related macular degeneration, uveitic macular edema, diabetic retinopathy, and retinal vein occlusion.

However, these new devices and injectors are not always intuitive. They require both instruction and hands-on experience to properly understand and perform these procedures. It is crucial to master the techniques involved to ensure patient safety and reduce the risk of complications.

I have traveled around the United States training fellow physicians on the intricacies of eye injections, and I have helped them administer different ocular therapies to patients. In this article, I will discuss insights I have gleaned from my experiences.

Seeing is believing

It is no surprise that many ophthalmologists are visual learners. As a professional trainer, I instruct others by demonstrating how I give an injection. For example, I have trained retina specialists in the novel technique of injecting into the suprachoroidal space (SCS).

In-person training allows physicians to experience equipment in a safe environment, which is important to learning. In-person training also allows a trained physician to both demonstrate proper technique and give guidance relevant to what they are observing from the trainee. However, in-person training is not always available or feasible, so for those instances, I recommend live virtual training as a secondary option.

Both types of training provide an opportunity for open discussion among colleagues, where trainers with firsthand experience can provide insights into different scenarios we’ve encountered. For example, a trainer may discuss what a failed injection looks like and what to do in such cases.

Other materials, including video presentations, real patient injection videos, animations, and training kits can be beneficial. I recommend, especially for new products, that physicians connect with their local product representatives, who often provide training kits. These can include examples of the appropriate depth and location of where the needle should be for each technique.

Make performing the procedure on a live patient a priority

It is important to remember that with each new technology comes a learning curve. When working with new products, don’t be discouraged if an unexpected issue or scenario arises. Although the model eye provided in training kits is not always indicative of what you will see during a real patient injection, practicing with one is critical to familiarize yourself with the nuances of a technique or delivery system. I recommend performing an actual injection in clinic shortly after being trained to ensure appropriate medication delivery and better outcomes.

Retrain on your schedule

Although most specialists I’ve trained do well with a single training session, physicians should retrain whenever necessary. Call your trainer if you have questions or contact your local product representative if you would like additional training kits. If you are attending a medical meeting, visit the company’s exhibit booth to interact with a product’s injectors, ask any questions you have, and gain hands-on experience. The representatives may be able to give you a few pointers on handling and working with their medical product.

Since the COVID-19 pandemic, many academic meetings and skill-transfer sessions have become virtual. This is one of the greatest advantages we’ve gained since 2020 because it allows us to learn at our own speed. Virtual trainings are often recorded and may be accessed at any time, providing the flexibility to view these instructive materials when and where we prefer.

Overall, I’ve found that a combination of in-person and virtual training, coupled with the support of local product representatives, is the best way to ensure retina specialists are set up for success.

Conclusion

All ocular injection techniques and drug devices have nuances that require training, regardless of how often a retina specialist may perform a certain procedure. With many new therapies on the horizon, now is the best time to brush up or learn different delivery approaches for eye injections. As an experienced trainer, I recommend live training, both virtual and in person, from a qualified trainer to master the techniques involved, ensure patient safety, reduce the risk of complications, and potentially improve patient outcomes. •

Peter Y. chang, MD, FACS

E: pchang@mersi.com

Chang is copresident and a partner at Massachusetts Eye Research and Surgery Institution (MERSI) in Waltham. He is fellowship-trained in uveitis and vitreoretinal surgery. His clinical interests center on uveitis and its complications, as well as various ocular inflammatory diseases.

Financial disclosures

Alimera Sciences (consultant)

Bausch + Lomb (consultant, XIPERE trainer)

EyePoint Pharmaceuticals (speaker, consultant)

Mallinckrodt Pharmaceuticals (speaker, consultant)

Ocugen (consultant)

X4 Pharmaceuticals (consultant)