Long-term outcomes of switching to aflibercept for treatment-resistant neovacular age-related macular degeneration

The authors are commenting on the study entitled “Long-term outcomes of switching to aflibercept for treatment-resistant neovascular age-related macular degeneration” published by Spooner et al. in Acta Ophthalmologica 2019;97(5):e706-e7012. The conclusion of this study was that aflibercept was an effective alternative therapy for treatment-resistant active, chronic neovascular age-related macular degeneration. 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.