Clinical Characteristics and Long-Term Outcomes of Eyes With Neovascular Age-Related Macular Degeneration Requiring Frequent Treatment

<b>Purpose:</b> To compare long-term visual outcomes in neovascular age-related macular degeneration (AMD) patients who received frequent vs infrequent antivascular endothelial growth factor injections. <b>Methods:</b> This retrospective case series included treatment-naïve AMD patients receiving either frequent injections (≤ 6-week intervals) or infrequent injections (≥ 10-week intervals). Best-available visual acuity (VA) and anatomic outcomes were assessed at the initial visit, 52 weeks, 104 weeks, and final visit. <b>Results:</b> A total of 151 eyes were studied over a mean follow-up of 42.6 months: 81 eyes (54%) in the frequent group and 70 eyes (46%) in the infrequent group. Baseline central foveal thickness (CFT) was higher in the frequent group (320 µm vs 265 µm; <i>P</i> = .002). Though CFT improved in both groups, it remained higher in the frequent group at 52 weeks (230 µm vs 185 µm; <i>P</i> = .004), 104 weeks (203 µm vs 173 µm; <i>P</i> = .004), and final visit (197 µm vs 165 µm; <i>P</i> = .015). The frequent group showed more subretinal and intraretinal fluid at all times. Baseline logMAR VA was 0.63 and 0.84 in the frequent and infrequent groups, respectively <i>(P</i> = .10). Visual improvement was similar between groups at 52 weeks (0.21 vs 0.22 logMAR; <i>P</i> = .916), 104 weeks (0.21 vs 0.18 logMAR; <i>P</i> = .714), and final visit (0.1 vs 0.05 logMAR; <i>P</i> = .510). Poor baseline VA (<i>P</i> < .001) and geographic atrophy (<i>P</i> = .025) were associated with worse outcomes. <b>Conclusions:</b> Over 4 years, despite higher CFT and more fluid, frequent injections showed similar visual improvement to infrequent injections. Baseline vision was the strongest predictor of final outcomes, regardless of injection frequency.