CURRENT ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPIES FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A NARRATIVE REVIEW OF AVAILABLE AGENTS AND TREATMENT STRATEGIES

Abstract

Background: Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible central vision loss in older adults. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed disease management, but the expanding range of agents and evolving dosing strategies has complicated therapeutic decision-making. Objective: To summarize the anti-VEGF agents currently available for nAMD, compare their efficacy, safety and durability, and evaluate contemporary treatment strategies used to optimize long-term visual outcomes while minimizing treatment burden. Methods: A narrative literature review was conducted using PubMed and Google Scholar. Eligible publications included landmark randomized trials, real-world studies, systematic reviews, meta-analyses, consensus statements and international clinical guidelines addressing anti-VEGF pharmacotherapy and treatment regimens in nAMD, prioritizing high-quality evidence. Key Findings: Ranibizumab, aflibercept 2 mg, brolucizumab, faricimab, aflibercept 8 mg and the recently approved ophthalmic formulation bevacizumab-vikg all preserve or improve visual acuity. Functional outcomes are broadly comparable across agents, with meaningful differences confined to durability, anatomical fluid control and safety, most notably the intraocular inflammation signal associated with brolucizumab. Treat-and-extend dosing matched fixed dosing for visual acuity while requiring fewer injections and outperformed pro re nata regimens. Faricimab and aflibercept 8 mg maintained intervals of 12 weeks or longer in most patients, and switching agents improved anatomical outcomes in insufficiently responding eyes. Conclusions: Contemporary management of nAMD centers on individualized anti-VEGF therapy guided by disease activity, treatment response and patient-specific factors. Longer-acting agents and emerging approaches are expected to further improve disease control while reducing the burden of repeated intravitreal injections.