Psychosocial determinants of anti-VEGF treatment adherence in AMD patients: optimization of one-stop intravitreal injection service model

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 vs. 6.47 vs. 6.01 h, 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 (57.83 vs. 86.92 vs. 111.75 μm, P < 0.05). Multifactorial analysis showed that residential distance >38 km, 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.