The strength of the study is the large number of specialists (741) who have responded to the questionnaire. It is interesting to note that practices like wearing gloves, the use of masks, and eye speculum are more or less universal practices and are similar to those of developed countries.[1,2] It further emphasizes that ophthalmologists in India are conscious of sterile practices. Some of the practices like the use of prophylactic antibiotics and post‑treatment antibiotics are also similar to what is followed in the US and UK.[1,2] The survey surprisingly does not mention the use of topical povidone-iodine before the injection which I feel is a universal practice. It would have been interesting if the survey had looked into certain important aspects regarding the injection techniques viz.
(a) Size of needle used
(b) Displacement of the conjunctiva at the time of injection
(c) Quadrant used for performing the injection
(d) Paracentesis at the end of the procedure
(e) Is checking the peripheral retina a routine practice before the injection
(f) Does the ophthalmologists check for retinal perfusion at the end of the procedure
(g) Is pupillary dilatation a routine practice priorto the injection
(h) Bilateral simultaneous injection – is it a practice in our country as it is very common in the UK and nearly 40% of the respondents in the US perform bilateral injection.[3] (i) What is the average time gap when both eyes need treatment?
(j) When do ophthalmologists examine the patient after the injection procedure?

The survey has looked into the injection practices for the use of bevacizumab (Avastin). This is a very important contribution. Despite the recommendations of AIOS–VRSI guidelines,[4] there are still a sizeable number of ophthalmologists who are following the multiple puncture technique. It is also disheartening to note that 1/5th of the respondents are storing the open vials and loaded syringes for up to one month in the refrigerator. In a developing country like ours, bevacizumab will continue to be an important anti‑VEGF agent in Vitreo Retina practice and although aliquoting techniques are difficult we need to be careful to prevent post‑injection endophthalmitis. In a recent report from our centre where we evaluated 3806 injections of bevacizumab with proper aliquoting technique, the incidence of endophthalmitis was only 0.08%.[5]

With an increasing number of ophthalmologists practising intravitreal injection, it is necessary for AIOS and VRSI to continuously update ophthalmologists about safe and clean practices. It will also be useful for the AIOS to bring out a video on safe practices in administering intravitreal injections as part of the CME series in collaboration with VRSI