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

Abstract

The global demand for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy continues to rise, straining ophthalmic capacity worldwide. Task shifting from physicians to trained non-physician healthcare professionals has emerged as a potential strategy to expand service delivery. This systematic review summarizes current evidence on the safety, implementation, training and patient experiences associated with non-physician-delivered intravitreal injection services. We systematically searched 13 scientific literature databases for studies of anti-VEGF injections performed by non-physicians. Data were extracted on safety outcomes, implementation, training, supervision and patient-reported experience. Results from individual studies were qualitatively reviewed according to these four organizational themes. Sixteen studies comprising 100 150 injections were included, primarily from the United Kingdom and Scandinavia. All injectors completed structured training under an ophthalmologist's supervision. Complication rates were very low, including 0.015%-0.07% for endophthalmitis which were comparable to physician-led benchmarks. Implementation of non-physician-delivered intravitreal injection services increased clinical capacity by 25%-85%, reduced waiting times and costs, and maintained safety and efficiency. Patients reported high satisfaction, confidence and acceptance of non-physician-delivered injections. Non-physician-delivered intravitreal injection services are safe, feasible and well accepted when supported by structured training and robust governance frameworks. This task-shifting model offers a scalable solution to meet growing global demand for anti-VEGF therapy. Standardized international training and certification frameworks may further enhance safety and sustainability.