Cooling Anesthesia Highlighted in Retina Today

리센스메디컬 2020-10-14 191

Cooling anesthesia is an alternative, rapid, nonpharmacologic form of anesthesia that may have differentiating characteristics that make it attractive to patients and physicians alike for IVT injection, the ones that improve the patient experience and decrease toxicity to the ocular surface.


At A Glance

·         Emerging data suggest that cooling anesthesia is a rapid, nonpharmacologic approach to anesthesia that can be safely and effectively used for intravitreal injection.

·         A clinical trial, COOL-2, demonstrated the safety and efficacy of cooling anesthesia over the course of six injections.

·         Of patients in the study who received cooling anesthesia at -15° C for 10 seconds, 80% preferred that method to their previous form of anesthesia, subconjunctival lidocaine.


Intravitreal (IVT) injection is the most common procedure performed by retina specialists, with estimates of more than 6 million injections performed in the United States annually.

Despite the safety and efficacy of IVT injections, patients can experience significant anxiety and discomfort while undergoing a procedure. Current methods of anesthesia for IVT injection include the application of topical anesthetic drops, a pledget soaked with lidocaine, topical lidocaine gel, and subconjunctival lidocaine injection. All of these methods have benefits and tradeoffs in terms of patient comfort and time of onset of anesthesia, and there is no consensus choice for anesthetic use in IVT injections. Considerations for anesthesia for retina specialists include the efficiency of the procedure, the comfort of the patient, and the best utilization of resources and costs. An alternative method of anesthesia that is fast, tol­erable to patients, and has minimal adverse events could help to improve both the patient experience and the workflow of retinal physicians.

Recent publications have suggested that cooling the surface of the eye, in lieu of pharmacologic agents, might provide effective anesthesia for IVT injections. A clinical study with a prototype cooling device demonstrated that, as measured by a visual analog scale (VAS), cooling anesthesia was well tolerated and that pain with cooling anesthesia was not significantly differ­ent from pain with lidocaine gel use. Recently, results of a longitudinal study with a clinical-grade device manufactured by RecensMedical were presented at the 2020 ASRS Meeting. The COOL-2 trial (NCT03956797), sponsored by RecensMedical, was an open-label longitudinal study assessing the safety of cooling anesthesia over a series of six injections. Interestingly, more than 80% of patients who received cooling anes­thesia at -15° C for 10 seconds pre­ferred that over their previous form of anesthesia. (All patients had previ­ously received subconjunctival lido­caine as anesthesia.)

These studies demonstrate the proof of concept and safety of using cooling anesthesia for IVT injections. The rapid, nonpharmacologic nature of this anesthesia may improve the patient experience, decrease toxicity to the ocular surface, and facilitate a more rapid workflow and improved time and space efficiency for retina specialists.

Cooling anesthesia is an alternative, rapid, nonpharmacologic form of anes­thesia that may have differentiating characteristics that make it attractive to patients and physicians alike for IVT injections. We look forward to the emergence of additional data on cool­ing anesthesia and its potential for the safety and comfort of our patients in the future.


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