Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3-5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61-86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1-3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRf only in treat & extend anti-VeGf regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRf might be an indicator of a more benign form of nAMD. The introduction of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD) has improved visual acuity and quality of life for millions of patients worldwide 1. In the era of anti-VEGF, the long-term maintenance of visual acuity is now challenged less by fibrovascular, and more by atrophic scars 2. Incidence and growth of macular atrophy are strongly dependent on CNV activity and resulting anti-VEGF therapy 2. CNV activity and the need for retreatment are mostly defined by the presence of macular fluid, i.e. intra-retinal fluid (IRF), sub-retinal fluid (SRF), and, less prominently, sub-pigment epithelium fluid 3. While many studies have shown a robust association of IRF with worsening visual acuity and increasing rates of macular atrophy 4-6 , subretinal fluid presence has paradoxically been shown to correlate with better visual acuity as compared to a completely dry macula, especially if located sub-foveally 7,8. The reasons for the documented beneficial effects of sub-retinal fluid on visual acuity are largely unclear. The most common hypothesis concludes that SRF presence reduces the risk of vision-threatening macular atrophy 9. Therefore, new modified treat & extend regimen tolerating SRF are currently being investigated 10. However,