Retina World Congress 2026: Can vibration reduce pain during intravitreal injections?

Intravitreal injections are among the most frequently performed procedures in ophthalmology, yet patient discomfort and anxiety remain common concerns, particularly in those requiring long-term treatment for chronic retinal disease. Supraorbital vibration, applied as an adjunct to topical anesthesia, is emerging as a simple, non-invasive technique that may reduce pain perception during these procedures.

In this Q&A conversation with the Eye Care Network, Victor M. Villegas, MD—program director of the Department of Ophthalmology at the University of Puerto Rico in San Juan, and voluntary faculty at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine—discussed the technique, the evidence behind it, and its practical application in a high-volume retina practice at the Retina World Congress 2026, held May 14 to 17 in Fort Lauderdale, Florida.

Note: Transcript edited for clarity and length.

What is the neurophysiologic basis for using supraorbital vibration as an adjunct to topical anesthesia during intravitreal injections, and how does it modulate pain perception?

Victor M. Villegas, MD: The primary mechanism is grounded in the gate control theory of pain. High-frequency vibrational stimuli activate large-diameter A-beta mechanoreceptive fibers in the supraorbital region, which in turn inhibit the transmission of nociceptive signals carried by smaller A-delta and C fibers at the level of the spinal cord and trigeminal pathways. By applying vibration immediately prior to and during the injection, we effectively “close the gate,” reducing the perception of pain. This is particularly relevant in periocular procedures, where sensory innervation is dense and patients often experience heightened anticipatory anxiety.

How does supraorbital vibration compare with other adjunctive strategies—such as subconjunctival anesthesia or cooling techniques—in terms of pain control, patient preference, and procedural efficiency?

Villegas: Supraorbital vibration offers several advantages. Unlike subconjunctival anesthesia, it is non-invasive and avoids additional needle-related discomfort, subconjunctival hemorrhage, and increased procedural time. Compared [with] cooling techniques such as topical ice, vibration is easier to standardize, faster to apply, and does not introduce variability related to temperature or tissue tolerance. In our study, 94% of patients preferred vibrational anesthesia, and 82% reported reduced pain. From a workflow perspective, it adds only a few seconds to the procedure and can be seamlessly integrated without disrupting efficiency, making it particularly attractive for high-volume retina practices.

In your study, did you observe variability in response among different patient populations, such as those with prior injection experience, heightened anxiety, or chronic retinal disease?

Villegas: [Although] our study was not specifically powered to stratify outcomes across subgroups, we did observe that patients with prior intravitreal injection experience frequently reported a noticeable improvement when vibration was introduced. Among the subset of patients who had undergone injections both with and without vibration, 82% indicated a better overall experience with vibration. Additionally, anecdotal observations suggest that patients with higher levels of anxiety or pediatric patients may derive particular benefit, likely due to both the sensory distraction and modulation of nociceptive signaling. These findings highlight an important area for future prospective, stratified analysis.

What are the potential barriers to adopting this technique in high-volume retina practices, and how might clinicians balance improved patient comfort with procedural efficiency?

Villegas: The main barriers are logistical rather than clinical. These include access to the device, training staff to apply it consistently, and integrating it into an already streamlined workflow. However, in our experience, these challenges are minimal. We currently employ this technique for all patients in a high-volume ocular oncology and retina practice. The technique requires only brief application (2–3 seconds), can be performed by ancillary staff, and does not significantly extend chair time. Importantly, improving patient comfort may enhance adherence to long-term treatment regimens, which is critical in chronic retinal diseases. With minimal investment and workflow adjustment, practices can achieve meaningful gains in patient satisfaction without sacrificing efficiency.

Victor M. Villegas, MD

E: victor.villegas@upr.edu

Villegas specializes in Ocular Oncology and Retina and serves as Program Director, Department of Ophthalmology, University of Puerto Rico in San Juan, Puerto Rico, and as Voluntary Faculty, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine in Miami, Florida. Villegas has no conflicts of interest to disclose.