Table 4.

Benefits and issues of T&E compared with PRN from the treating ophthalmologist perspective

Benefits
Shorter consultation time per patient	• With PRN, at every injection, the patients need to be informed that their symptoms have worsened, but with T&E, such explanations can be omitted since injections are administered regardless of symptoms • If the administration method of T&E and its meaning are explained thoroughly at the first consultation, subsequent consultations are shorter since patients already understand why they are receiving injections • Scheduling does not take as long as with PRN since the treatment goal is clear with T&E
Decrease in burden of developing patient-specific treatment plans Decrease in overall psychological stress	• With a predetermined injection schedule, there is no need to accommodate the patients’ and ophthalmologists’ schedules on a per-injection basis • Since the patients’ visit and injection schedules are based on the previous injection interval, scheduling is much easier • There is no need to explain why the patients require an injection. Moreover, worsening of symptoms does not occur frequently with T&E, so the treatment process is easier to handle • The patients’ disappointed expressions are not seen when they come in for an injection that is predetermined and is not administered because the symptoms have worsened • There is less burden of explaining the treatment process since injection intervals are constant or are even extended in certain cases
Easier to set injection schedules	• Injections can be provided months in advance, which makes it easier to set the injection schedules for patients and foresee capacity
Issues
Explaining the necessity of proactive injections as prevention	• The significance of proactive injections is not easily accepted by patients who have stabilized and entered maintenance phase since the effectiveness is less tangible than at the beginning of treatment. Patients with wAMD in only one eye or who have not experienced worsening of symptoms require more time in accepting continued preventive injections • Thorough explanation of the significance of proactive injections at the initial consultation is essential in getting patients to continue with long-term treatment • Without cost-effectiveness data, explaining the necessity of proactive injections as a preventive measure is difficult
Increased financial burden	• There have been cases where patients refuse T&E due to financial reasons • Thorough explanation of the financial burden is important in order for patients to be willing to undergo long-term treatment. However, this is especially difficult for first-time patients or for patients who have not experienced recurrence or worsening of symptoms
Insufficient area designated for injections	• Even though the number of patients has increased, the clinic space to provide injections remains unchanged
Insufficient human resources	• While patient numbers have increased with better treatment results and fewer dropouts, it has been difficult to increase the staff to match the increased demand
Increased number of appointments	• The time to process scheduling appointments has increased with the increase in patients receiving injections, which has cut into consultation times

Abbreviations: PRN, pro re nata; T&E, treat-and-extend; wAMD, wet age-related macular degeneration.