Macular atrophy incidence and progression in eyes with neovascular age-related macular degeneration treated with vascular endothelial growth factor inhibitors using a treat-and-extend or a pro re nata regimen. four year results of the manex study

The authors are commenting on the study entitled: “Macular atrophy incidence and progression in eyes with neovascular age-related macular degeneration treated with vascular endothelial growth factor inhibitors using a treat-and-extend or a pro re nata regimen. Four-year results of the Manex study” by Spooner et al. in Ophthalmology 2020;127(12):1663-1673, compared the incidence and progression of macular atrophy in eyes with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents using either a treat-and-extend or a pro re nata regimen over 4 years in a real-world setting. The authors concluded that treat-and-extend may be the preferred treatment regimen because it allows for better functional outcomes with no increased risk for macular atrophy. We believe that the validation, extrapolation, and generalizability of these findings can be made only by regression analyses including all the missing data referred to above by us in addition to the baseline characteristics already assessed in this study, serving to identify the key drivers influencing the incidence and progression of macular atrophy in eyes with neovascular age-related macular degeneration treated with anti-vascular endothelial growth injections using treat-and-extend and pro re nata approaches.