Task shifting of intraocular injections from physicians to nurses: a randomized single-masked noninferiority study

Abstract

Purpose To test if task shifting of intraocular injections to nurses in a real‐world setting can result in similar visual function outcome with equal safety profile. Method All patients with either age‐related macular degeneration, retinal vein occlusion or diabetic macular oedema remitted to intraocular injections at a tertiary ophthalmology department in Norway between March 2015 and May 2017, were asked to participate. The participants were randomized to either nurse‐ or physician‐administered intraocular injections of anti‐vascular endothelial growth factor. The primary outcome measure was change in best‐corrected visual acuity from baseline to 1‐year follow‐up. The mean difference in the primary outcome between the groups was analysed by a noninferiority test with a margin of three letters in disfavour of the nurse group. Adverse events were recorded. Results Three hundred and forty‐two patients entered the study. Two hundred and fifty‐nine completed the 1‐year follow‐up and were included in the study sample for the analysis of the primary outcome. Nurse‐administered intraocular injections were noninferior to physician‐administered injections with 0.7 and 1.6 letters gained, respectively (95% CI of the mean difference, −2.9 to 1.0; p = 0.019, one‐sided t‐test). Two thousand and seventy‐seven injections and three ocular adverse events were recorded. Conclusion Task shifting of intraocular injections to nurses can be performed without increased risk to visual function. Such a task shift can alleviate the burden of performing intraocular injections in ophthalmology departments. To our knowledge, this is the first RCT on task shifting of a surgical procedure from physicians to nurses in a high‐income country.