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The rising incidence of neovascular (wet) age-related macular degeneration (nAMD) as a cause of vision loss necessitates updated treatment paradigms and innovative therapies that reduce the burden of treatment while preserving optimal visual outcomes. A growing body of research shows that treat-and-extend approaches using approved anti–vascular endothelial growth factor agents for nAMD are feasible, achieving visual outcomes comparable to those of on-label treatment while reducing the number of injections over time. Importantly, this approach must be tailored to each individual patient, using careful analysis of optical coherence tomography (OCT) images collected at regular intervals. Recent analyses suggest that treat-and-extend approaches could be further individualized by assessing intraretinal fluid—a negative prognosticator—and subretinal fluid, which might have neutral or even positive clinical relevance. Several investigational therapies in late-stage development also have the potential to greatly reduce treatment burden if they are approved. The desired outcome of this activity is for retina specialists and other ophthalmologists to better appraise recent research on the clinical relevance of fluid on OCT and to apply the evidence to evaluate current and emerging treatment strategies and therapies.
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