Macular atrophy in neovascular age-related macular degeneration

The authors are commenting on the study entitled “Macular atrophy in neovascular age-related macular degeneration” published by Gillies et al. in Ophthalmology 2020;127(2):198-210, which analyzed the differences in the development and growth of macular atrophy over 24 months between treat-and-extend ranibizumab and aflibercept in patients with active, chronic, treatment-naïve subfoveal choroidal neovascularization secondary to neovascular age-related macular degeneration. The authors of this study concluded that no significant differences in the rate of development or growth of macular atrophy over 24 months were achieved between ranibizumab and aflibercept. However, the validation, extrapolation, and generalizability of the authors’ finding can be made only by statistical analyses including all the missing baseline potential predictive factors referred to above by us in addition to the baseline characteristics already evaluated in this study. Regardless of the anti-vascular endothelial growth factor agents chosen (e.g., ranibizumab/bevacizumab/aflibercept), and regardless of the treatment dosing paradigms used (e,g., treat-and-extend, pro re nata, fixed-interval, or escalated regimen), the efficacy of therapy depends primarily on the precociousness of the therapy after the neovascular age-related macular degeneration diagnosis.