Table 7.

Issues arising from introducing T&E and their countermeasures as answered by clinic 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	• Explained the efficacy/effectiveness in a more tangible way to the patient – To patients who were concerned with the financial burden, OCT images of before and after treatment were shown during the initial consultation, so that they could understand the effectiveness of the injections – While the actual number of injections may not differ compared with PRN, it was explained to the patients that the number of visits are fewer with T&E, which can decrease their time and financial burden – Tried to keep patients motivated by discussing the possibility of a cure from IPS research in the future and telling them that they may not have to continue the injections forever
	Handling concerns of financial burden from long-term treatment	• It is difficult to get patients who have never experienced relapse or worsening of symptoms to understand • Without cost-effectiveness data, explaining the necessity of the financial burden is difficult	• Prioritized patients who were referred from other hospitals and understood T&E – Patients who have been treated at university hospitals have already received a thorough explanation of T&E and have a better understanding of the treatment as the ophthalmologists tend to be AMD specialists at these hospitals. These patients were prioritized because they tended to be more accepting of the treatment regimen

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