How does treat-and-extend (T&E) work for anti-VEGF in AMD?

T&E protocol: extend injection interval by 2 weeks after each visit with no activity (dry OCT, stable VA). Maximum extension 12-16 weeks for ranibizumab/bevacizumab, 16 weeks for aflibercept, 24 weeks for faricimab or brolucizumab. Shorten by 2 weeks if recurrence.

Which anti-VEGF agents are available for AMD?

Ranibizumab (Lucentis, FDA 2006), bevacizumab (Avastin, off-label), aflibercept (Eylea, FDA 2011), brolucizumab (Beovu, FDA 2019), faricimab (Vabysmo, FDA 2022, dual anti-VEGF/Ang-2). CATT trial showed bevacizumab non-inferior to ranibizumab.

What is the optimal loading phase for anti-VEGF?

Most regimens use 3 monthly loading injections (ranibizumab, bevacizumab) or 3 injections every 4 weeks for aflibercept (2mg). After loading, T&E or PRN based on OCT activity. VIEW trial showed aflibercept q8w non-inferior to ranibizumab monthly.

Anti-VEGF Injection Interval Optimization

Optimize anti-VEGF injection intervals for neovascular AMD using treat-and-extend (T&E) or pro-re-nata (PRN) protocols. Extend by 2-week intervals when OCT shows dry macula for 2 consecutive visits.

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Frequently Asked Questions

How does treat-and-extend (T&E) work for anti-VEGF in AMD?

Which anti-VEGF agents are available for AMD?

What is the optimal loading phase for anti-VEGF?