Age-Related Macular Degeneration and Anti-VEGF Therapy: A Systematic Review

Neovascular age-related macular degeneration (nAMD) is one of the leading causes of severe central vision loss in older adults. Anti-vascular endothelial growth factor (anti-VEGF) therapy represents the cornerstone of nAMD management. Contemporary research focuses on improving treatment durability, reducing injection burden, and evaluating the safety of novel agents and treatment regimens. Methods: A systematic narrative review of the literature was conducted using the PubMed/MEDLINE database. Phase 3 randomized clinical trials, extension studies, post hoc analyses, systematic reviews, meta-analyses, and real-world evidence studies related to nAMD treatment were analyzed. Only publications addressing long-acting anti-VEGF therapies, alternative dosing regimens, and real-world effectiveness and safety outcomes were included [1–26]. Results: Clinical trials demonstrated that modern anti-VEGF therapies enable extension of treatment intervals up to 16 weeks while maintaining non-inferior functional and anatomical efficacy compared with standard monthly regimens [1,3]. The use of higher-dose VEGF inhibitors (aflibercept 8 mg) further improved treatment durability, including in specific nAMD subtypes such as polypoidal choroidal vasculopathy (PCV) [2,4]. Real-world studies confirmed treatment effectiveness in both treatment-naïve and previously treated patients, including those with insufficient response to prior therapies, showing reduced disease activity and treatment burden [6–17]. Safety analyses indicated that some agents, particularly brolucizumab, are associated with a risk of intraocular inflammation, necessitating careful patient selection and close monitoring [18–26]. Conclusions: Modern anti-VEGF treatment strategies allow further individualization of nAMD therapy by increasing durability and reducing injection frequency. Treatment selection should consider clinical efficacy, safety profile, and patient-specific needs.