Intravitreal injection treatment (IVT) is the most commonly performed ophthalmic procedure [1]. Evidence now shows that nurse-led IVT achieves comparable safety, visual outcomes and complication rates as consultant-lead care [1,2,3]. However, patient satisfaction of IVT by non-ophthalmologists, an increasingly common practice [4], has been poorly studied. This is concerning, given the importance of patient satisfaction in assessing the quality of medical care and determining levels of treatment viability, therapeutic compliance and malpractice litigation. Our aim was to compare patient satisfaction of nurse-led vs consultant-led IVT.

Patients attending the macular treatment clinic at Central Middlesex Hospital were invited to take part in the study. A total of 61 patients agreed to participate and were subsequently consented and randomised to receive IVT treatment by either the trained clinical nurse (n = 34) or by the consultant (n = 27)—the ‘gold standard’. A modified, validated patient questionnaire (PSQ-18), see Fig. 1, was used to determine six aspects of patient satisfaction. Responses to each item were given a 5-point scale ranging from strongly agree (5 points) to strongly disagree (0 points). A painscale, ranging from 0 (no pain) to 10 (maximum pain) points, was also used to determine comfort levels during treatment. χ2-test of independence was performed to evaluate differences between the two groups.

Fig. 1
figure 1

Modified PSQ-18 patient questionnaire. The questions below are about how you feel about the care you receive when you have your eye injection. Please read each one carefully. How strongly do you AGREE or DISAGREE with each of the following statements? (Circle one number on each line)

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We found that most patients, 85%, had no preference for receiving nurse-led or consultant-led IVT, with only 15% of patients objecting to nurse-led IVT. The patients surveyed heralded from a diverse range of backgrounds: 43% Caucasian, 39% Asian, 13% African and 5% other. All the patients had attended the macular treatment clinic at least once previously, with over half (57%) attending for more than 1 year, and 36% attending for multiple visits.

The responses of the patient survey (n = 61) showed no significant difference between the nurse and consultant across all six domains of patient satisfaction when receiving IVT. This included: general satisfaction (4.71 vs 4.65, p = 0.90), technical quality (4.90 vs 4.97, p = 0.30), interpersonal manner (4.97 vs 5.00, p = 0.60), information and communication (4.91 vs 4.93, p = 0.70), time spent with the consultant or nurse (4.09 vs 4.28, p = 0.70) and staff competence (4.97 vs 5.00, p = 0.10). There was also no significant difference in patient pain scores between nurse and consultant IVT (0.6 vs 0.4, p = 0.40). Please see Table 1 for a results summary. No complications or complaints were recorded during the study period.

Table 1 Mean patient satisfaction scores (n = 61)
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In conclusion, patient satisfaction of nurse- vs consultant-led IVT is equivalent. Nurse injectors are key players in providing IVT services and ultimately preventing visual loss and blindness. However, The Royal College of Ophthalmologists (RCO) advice remains that IVT: ‘should be provided by an ophthalmic surgeon experienced with this procedure and with the management of IVT related complications or by a trainee under supervision of such an ophthalmologist’ [5]. The Royal College of Ophthalmologists guidelines should be updated to reflect the value of advanced nurse practitioners and specialist nurses in also delivering a golden-standard of care.