Table 6.

Issues arising from introducing T&E and their countermeasures as answered by nonacademic hospital ophthalmologists

Phase	Issues	Specific examples of issues	Countermeasures
Patient explanation phase	Explaining the necessity of proactive injections as prevention	• Since the impression of T&E is “more injections” than PRN, it is difficult to get the patient to accept the possible increased burden that comes with more injections • Cannot explain the cost-effectiveness of the injections during the maintenance phase	• Explained the efficacy/effectiveness in a more tangible way to the patient – The importance of reducing risk before symptoms worsen was explained to the patient using their OCT images – The patient was also advised that restarting treatment after symptoms have worsened has reduced effects – Although no reports have been presented at academic congresses for high-risk patients on the verge of dropping out, extending their injection interval for >3 months was considered
Operational phase	Insufficient space for injections	• Even though the number of patients has increased, the clinic space to provide injections remains unchanged	• Provided injections in outpatient treatment rooms instead of operating rooms
	Insufficient human resources	• It is difficult to increase the staff to match the increased number of patients • It takes time to manage both consultations and injections	• Designated roles within the staff – Roles were separated for consultations, which require more experienced staff, and injections, which can be administered uniformly by any of the ophthalmologists, in order to make the process more efficient – The nurses took the patient’s history prior to consultations

Abbreviations: OCT, optical coherence tomography; PRN, pro re nata; T&E, treat-and-extend.