Non-physician delivered intravitreal injection service: A systematic review of safety, implementation, training and patient experience.

In 30 seconds

This systematic review assessed the safety, implementation, training and patient experience of intravitreal anti-VEGF injections delivered by non-physician healthcare professionals. It included 16 studies comprising 100 150 injections, primarily from the United Kingdom and Scandinavia. All injectors received structured training under ophthalmologist supervision. Reported endophthalmitis rates were 0.015%-0.07%, comparable to physician-led benchmarks. The review also found increased clinical capacity, shorter waiting times and lower costs, alongside high patient satisfaction and acceptance. The authors conclude that this model can be safe and feasible when supported by training and robust governance.

Key findings

• Across 16 studies and 100 150 injections, reported endophthalmitis rates were 0.015%-0.07%, comparable to physician-led benchmarks.
• Implementation increased clinical capacity by 25%-85% and was associated with reduced waiting times and costs.
• Patients reported high satisfaction, confidence and acceptance of non-physician-delivered injections.
• All injectors completed structured training under an ophthalmologist's supervision.

Why it matters

Rising demand for anti-VEGF therapy can strain ophthalmic services. This review suggests that trained non-physician professionals may help expand injection capacity while maintaining low reported complication rates and positive patient experience. The findings highlight the importance of structured training and governance when considering task shifting; they do not establish that outcomes will be equivalent in every service setting.

What to keep in mind

The review qualitatively synthesized individual studies, primarily from the United Kingdom and Scandinavia; the abstract does not report a pooled comparative effect estimate.