Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Abstract

The purpose of this chapter is to examine the various treatment strategies used to manage neovascular age-related macular degeneration (nAMD). The chapter will focus on the three main strategies including fixed interval dosing, as needed Pro-Re-Nata (PRN) treatment and Treat-and-Extend (TAE), with its variant the Treat-Extend-Stop (TES) protocol. We will discuss the visual results of randomized clinical trials and retrospective studies using these methodologies and compare their outcomes, the pros and cons of each treatment strategy, as well as the underlying mechanisms that may explain these differences. The results of long-term extension trials following landmark randomized clinical studies and other long-term retrospective studies will also be compared to studies using a fixed interval dosing or the TAE/ TES method. We will also focus on the visual results of the TES protocol and examine recurrence rates, proposing a definition of the recurrence of choroidal neovascularization (CNV) versus increased disease activity. These topics discussed will help optimize anti-VEGF treatment regimens for patients with nAMD over the long term.