The future of biomarkers in neovascular age-related macular degeneration: active disease or degenerative process?

Abstract

The introduction of intravitreal injections of anti-vascular endothelial growth factor (VEGF) has led to a new standard of care regarding the treatment of neovascular age-related macular degeneration (nAMD). Although VEGF inhibitors caused a paradigm shift in the management of these patients, the burden of frequent follow-up and direct as well as indirect costs of treatment remain a challenge for patients, healthcare systems, and societies. Initial treatment and particularly retreatment decisions still rest upon optical coherence tomography (OCT)-based biomarkers, especially the presence of subretinal fluid (SRF) and intraretinal fluid (IRF). A complete resolution of fluid is often considered a therapeutic target. However, in order to further reduce disease burden and adapt treatment frequency to the individual disease activity, this paradigm needs to be reconsidered.