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Educating to improve patients’ compliance to intravitreal injection therapy

Exudative Age Related Macular Degeneration (AMD) is an irreversible condition that occurs when new blood vessels grow from beneath the macula, the most critical part of the retina; our central vision. It is one of the leading causes of blindness in people aged 50 and above.


Before Anti–vascular endothelial growth factor (anti-VEGF) drugs were available, laser was used to treat exudative AMD, but outcomes were not favourable for patients. With the advent of anti-VEGF injections into the eye (intravitreal or IVT injection), we are able to preserve vision and maintain stability of their condition. IVT injections are a quick and effective way of administering drugs to treat eye conditions with minimal pain and side effects.

Patients need to return regularly (sometimes every 1-3 months) for subsequent injections of the anti-VEGF drugs under a "treat and extend" regime in which the intervals between jabs are extended depending on their responses to the treatment. Failure to comply typically results in poor or suboptimal response. Our doctors noticed that patients often did not understand their condition well and had poor knowledge about the importance of repeat injections. This in turn may lead to poor patient compliance, follow-up and eventual visual outcome.

In light of this, SNEC is exploring ways to improve awareness of the effectiveness of IVT injections, and to make it easier for patients to adhere to the treatment regime.

An initiative to try to improve patients and caregivers’ knowledge regarding IVT injections (ie. indications, treatment course and risks) was developed with support from EYE Academic Clinical Program (ACP).

  • A validated questionnaire on IVT injections was conceptualized and used to assess a baseline level of understanding in our patient population, with the existing educational materials.
  • Various step-wise interventions were developed, aimed at improving the level of patient / caregiver knowledge.
  • To test the effectiveness of each step of the intervention, the patient questionnaire is introduced before and after the intervention to the patients / caregivers.
  • The difference between the pre- and post-intervention scores as well as the time taken to counsel the patient by the treating doctor was recorded.
  • To assess the longer term effect of this intervention, patients will be tracked for a 12-month period to assess their rate of adherence to the IVT injections treatment.

One of the interventions involved training a dedicated retina nurse counsellor specifically for the purposes of administering the patient counselling sessions. The team also explored and developed other interesting efforts – a digital interactive platform (IVT4Me) for our patients and caregivers to improve their overall understanding. The material for the digital interactive platform was adapted from existing hardcopy educational materials.

Through the use of such interactive methods, we hope to be able to better inform our patients and their caregivers of their condition and treatment options and hence improving treatment compliance and outcomes!

Copyrights from SNEC and Novartis:

Contributed by:


  Clin Assoc Prof Anna Tan Cheng Sim
  Senior Consultant, Medical Retina, SNEC
  Clinical Director, SNEC Retina Clinic @ DMC



  Dr Shaun Sebastian Sim Khung Peng
  Consultant, Medical Retina, SNEC


Review from our nurse educators:

Hi, Becky & Melissa, how long have you been an AMD nurse counsellor?

We have been a nurse counsellor since 2020.

Why is it so important to have this counselling service?

It is important to have this counselling service as it helps patient to gain knowledge and understand more about their condition. It also gives the patient opportunities to learn. By educating them they will also understand the importance of following their appointments.

What has your experience been? Is it difficult to talk to patients about this topic? What are the most common misconceptions they have?

The difficulties we faced are that often we find it difficult to recruit patients due to the time constraint. Patients are mostly very willing to listen and learn about their condition so sharing information with them is not an issue. However, they always think and assume that it is a one-time procedure and expect their vision to improve eventually, which is something that we have to educate them on. 

Tell us about this new IVT4Me tool? How do patients respond to it? How do you think it can be changed/improved in the future?

We have been using this new IVT4Me tool since early this year 2022. Patients are receptive of this as there are images for them to click and learn. However, most patients are elderly due to the aging population so most of them are not very tech savvy. They would very much prefer face to face explanation or the brochures. Perhaps the use of audio to explain to the elderly patients would be much more efficient. We will continue to explore new ways to interact better with our patients.

Contributed by:



  Melissa  Soh Li En
  Staff Nurse, Nursing OPD – DMC

  Becky Pollyanne Chia
  Senior Staff Nurse II, Nursing OPD - DMC  


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