Frequent office visits
The key to effective PRN treatment is frequent office visits to assess the patient’s condition.
Visits every four to six weeks particularly can be helpful in practice settings where an anti-VEGF injection can be given on the spot as needed. Problems begin to arise when patients must schedule a separate return visit for an injection.
A study published in Acta Ophthalmologica in 2015 found that patients who routinely were administered injections on the same day as the need-to-treat was identified gained 5.8 letters over the first three months. Before same-day injections became the norm, patients were injected on average two weeks after the need-to-inject was identified and they gained only 1.5 letters after the same 90-day period.
An unexpected repeat visit for treatment is a bother for patients, Dr. Larsen noted.
Taxis and public transportation may make it possible for patients to come back in a few days or weeks in urban areas, but it is problematic in rural areas where patients may have to rely on family members or friends for transportation to and from medical visits.
“Even when family and friends offer to assist, patients may shy away because they see it as an imposition,” he added. “When that happens, we see that people cannot come to the doctor every month, so they end up going every three months and treatment suffers.”