OCT biomarkers as predictors of treatment interval in neovascular age-related macular degeneration treated with intravitreal aflibercept using a treat-and-extend regimen

Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in older adults. Treat-and-extend (T&E) regimen for anti-vascular endothelial growth factor therapy are widely used to individualize treatment, yet substantial variability exists in achievable treatment intervals, and reliable baseline predictors remain unclear. This study investigates the association between baseline optical coherence tomography (OCT) biomarkers and treatment interval in eyes with nAMD treated with intravitreal aflibercept using a T&E regimen in real-world clinical settings. This retrospective study analyzed 174 treatment-naïve eyes with nAMD of 167 patients from an initial screening of 536 eyes of 333 patients. Baseline OCT biomarkers were evaluated. Subretinal fluid, intraretinal fluid, and pigment epithelial detachments were automatically quantified using convolutional neural network-based segmentation algorithms. Correlations between OCT measurements and < q12 weeks intervals at 52 weeks were analyzed. Of the 174 eyes included, 78 (44.8%) were treated at intervals < q12 weeks at 12 months. Retinal angiomatous proliferation (RAP) (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.045 − 8.022; p = 0.041), absence of intra/subretinal hemorrhage (OR, 0.381; 95% CI, 0.165 − 0.880; p = 0.024), and longer disruption of external limiting membrane (ELM) (OR, 1.094; 95% CI, 1.018 − 1.176; p = 0.014) and ellipsoid zone (EZ) (OR, 1.066; 95% CI, 1.011 − 1.124; p = 0.018) were significantly associated with < q12 weeks interval, whereas quantitative fluid measurements were not significantly associated with dosing interval. Baseline structural OCT biomarkers were associated with treatment interval requirements in nAMD managed with a T&E regimen, suggesting their potential value for early identification of patients likely to require more intensive treatment.