ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Psychosocial Determinants of Anti-VEGF Treatment Adherence in AMD Patients: Optimization of One-Stop Intravitreal Injection Service Model
Xi Zhang 1
Bingjie Cui 1
Yingyue Liu 2
Xiangning Ji 1
Xiaoyu Tian 1
Siqing Hou 1
Lidong Yang 1
Junshu Yang 3
1. Cangzhou Central Hospital, Cangzhou, China
2. Cangzhou Eye Hospital, Cangzhou, China
3. Hebei Medical University, Shijiazhuang, China
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Abstract
Objective: To investigate modifiable psychosocial determinants of anti-VEGF treatment adherence in patients with neovascular age-related macular degeneration (nAMD) and evaluate the optimization effects of a one-stop intravitreal injection service model. Methods: This historical control mixed-methods study included patients receiving anti-VEGF treatment at Cangzhou Regional Ophthalmology Center from August 2022 to October 2024. Patients were divided into three groups based on service models: traditional multiple-visit group (historical control, n=165), one-stop standard group (n=161), and one-stop AI-enhanced group (n=162). The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological status, and geographic information systems analyzed spatial accessibility impacts. Primary outcome measures included 12-month retention rate, early discontinuation rate (within 6 months), and appointment adherence rate. In-depth semi-structured interviews were conducted with patients from the one-stop standard and AI-enhanced groups, using thematic analysis to identify key influencing factors. Logistic regression analysis was used to analyze adherence predictors. Results: Compared to the historical control group, the one-stop standard and AI-enhanced groups showed significantly reduced clinic-to-injection time (23.87 hours vs 6.47 hours vs 6.01 hours, P<0.05), significantly improved 12-month retention rates (52.12% vs 73.29% vs 85.80%, P<0.05), and significantly reduced early discontinuation rates (29.09% vs 17.39% vs 9.88%, P<0.05). Regarding clinical outcomes, patients in the AI-enhanced group showed more significant best-corrected visual acuity (BCVA) improvement (logMAR change: -0.08 vs -0.12 vs -0.17, P<0.05) and more pronounced central retinal thickness reduction (57.83μm vs 86.92μm vs 111.75μm, P<0.05). Multifactorial analysis showed that residential distance >38km, baseline high anxiety levels, and baseline depressive symptoms were independent risk factors for treatment discontinuation. AI-enhanced intervention significantly reduced early discontinuation risk (P<0.05). Qualitative analysis identified five main themes: treatment anxiety, service experience, expectation management, social support, and service improvement needs. Safety event incidence rates showed no significant differences between groups (P>0.05). Conclusion: The one-stop intravitreal injection service model significantly improved treatment adherence in nAMD patients, with AI-enhanced intervention further optimizing outcomes. Baseline anxiety and depression levels, along with geographic distance, are important modifiable determinants of treatment adherence. Personalized service models integrating psychosocial interventions provide new insights for precision management of chronic eye diseases.
Summary
Keywords
Anti-VEGF treatment, artificial intelligence, neovascular age-related macular degeneration, One-Stop Service, Psychosocial factors, Treatment Adherence
Received
13 November 2025
Accepted
26 January 2026
Copyright
© 2026 Zhang, Cui, Liu, Ji, Tian, Hou, Yang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xi Zhang
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