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Abstract

Intravitreal injections are essential for managing retinal diseases such as age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO). Despite their clinical efficacy, high costs and limited reimbursement may restrict patient access, particularly in middle-income countries like Albania. A cross-sectional survey was conducted from March to June 2025 in four tertiary ophthalmology centers in Albania. Structured questionnaires were administered to 112 patients who had received at least one intravitreal injection and 32 ophthalmologists who routinely provide these treatments. Data on demographics, clinical characteristics, affordability, access, and reimbursement experiences were collected and analyzed using descriptive statistics, chi-square tests, and thematic content analysis for qualitative responses. The majority of patients (59%) reported that intravitreal injections were unaffordable, and 44% had delayed or skipped treatment due to cost. Rural patients were significantly more likely to experience financial barriers than urban patients (p < 0.05). Ophthalmologists reported that most patients struggle with treatment costs and identified reimbursement limitations as a significant challenge. Both groups highlighted inconsistent drug availability and logistical barriers as obstacles to timely care. Qualitative analysis revealed concerns about high out-of-pocket expenses, the need for policy reform, and the importance of affordable alternatives such as bevacizumab. High costs, limited reimbursement, and geographic disparities constrain access to intravitreal injections in Albania. Policy measures to expand coverage, streamline procurement, and decentralize services are urgently needed to ensure equitable access to vision-saving therapies.‎

Keywords: Intravitreal injections, Albania, Anti-VEGF, Health policy, Ophthalmology, Retinal diseases

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