When consenting a patient for intravitreal injection, the natural number to reach for is the risk per injection, because that is what is about to happen. For retinal detachment that is about 1 in 8,675, which sounds — and is — very small.
But a patient with neovascular macular degeneration or diabetic macular oedema is not consenting to one injection. They are beginning a course that may run for years. The per-eye figure, about 1 in 1,250, is the one that describes what they are actually agreeing to, and the authors note even that understates it, since the contributing studies averaged under fourteen injections per eye.
The same logic applies to endophthalmitis and to any per-procedure risk in a repeated treatment. Quote the cumulative figure, say plainly that it accumulates with each injection, and record that you did. It is a more honest conversation and it takes no longer.
- Per-injection risk understates what a long-term patient is accepting
- Detachment: about 1 in 8,675 per injection, about 1 in 1,250 per eye
- The same applies to endophthalmitis and other per-procedure risks
- Say the risk accumulates, and document that you said so
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