New Treatments for Neovascular AMD: What Is Changing

New treatments for neovascular AMD have one main goal, which is to keep the macula dry with fewer injections.

Monthly injections of ranibizumab and bevacizumab proved that vision can be saved, but they left patients with a heavy burden of visits (see anti-VEGF therapy).

The newest drugs and devices stretch the interval, and some approaches aim to replace repeated injections altogether.

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Why New Treatments for Neovascular AMD Are Needed

Real-world results are often worse than trial results, because patients miss visits and clinics delay treatment.

Many eyes also keep fluid despite frequent injections, and atrophy and fibrosis slowly erode vision over the years.

The ideal treatment would be more durable, safer for the retina, and easier to deliver.

New Treatments for Neovascular AMD: Bispecific Antibodies

Faricimab blocks both VEGF-A and angiopoietin-2, two pathways that drive leakage and instability of new vessels.

In the TENAYA and LUCERNE trials, faricimab gave vision gains similar to aflibercept 2 milligrams, with many patients treated every 12 or 16 weeks after loading doses (see the references).

This makes it an option for patients who struggle with frequent visits.

Higher-Dose Aflibercept

Aflibercept 8 milligrams uses the same molecule at a higher dose to extend durability.

In the PULSAR trial, clinicians could also maintain most patients at 12 or 16 week intervals with similar vision to the standard dose (see high-dose aflibercept).

New Treatments for Neovascular AMD: Biosimilars and Cost

Biosimilar versions of ranibizumab and aflibercept have reached the market, so they widen access by lowering cost.

Studies show equivalent efficacy and safety to the originators, and they are changing how health systems buy drugs.

Long-Acting Delivery

• The port delivery system with ranibizumab is a refillable implant that cuts injections to about twice a year, with higher surgical risk (see port delivery system with ranibizumab)
• Sustained-release tyrosine kinase inhibitor inserts are in advanced trials, and aim for dosing every six months
• Treat-and-extend regimens allow individualized intervals with any drug

New Treatments for Neovascular AMD: Gene Therapy

Gene therapy for AMD aims to make the eye produce its own anti-VEGF protein after a single procedure.

Several programs use subretinal, suprachoroidal, or intravitreal delivery, and early trials show reduced injection need, though long-term safety and durability are still being studied.

Complement and Atrophy

Complement inhibitors for geographic atrophy do not treat wet disease, but they matter for patients whose eyes progress to atrophy after years of injections (see geographic atrophy treatment).

New Treatments for Neovascular AMD: Choosing Among Options

• Patients who attend well and respond to a drug can stay on it, with an extended interval
• Patients with a high burden of visits may benefit from a longer-acting drug
• Those with persistent fluid may change to a different drug class
• Cost, access, and local approval often decide the choice

What to Tell Patients

Explain that the treatments are improving, and that the first step is still to start therapy early and attend regularly.

Reassure them that a switch of drug is possible, and that researchers are testing new options.

Practical Example

A 78-year-old woman has wet AMD in one eye, and has received treatment for two years with monthly visits.

Her retina is dry on a four-week interval but fluid returns when the doctor extends the interval to six weeks.

She lives two hours from the clinic.

After a discussion, the doctor switches her treatment to faricimab.

The doctor extends the interval step by step to twelve weeks with OCT checks at each visit.

This kind of individual plan, based on response and burden, is also where the new drugs help most.

Safety and Monitoring

• Clinicians have reported intraocular inflammation with some new agents, so patients should report pain, redness, or reduced vision at once (see brolucizumab)
• Retinal vasculitis and occlusion need urgent assessment
• Pressure checks and routine examination remain part of each visit

Introduce new drugs with clear records of efficacy and adverse events in the clinic.

Questions Patients Ask

Patients often ask whether a new drug is better.

The honest answer is that most new drugs are as effective as older ones for vision.

Their main advantage is a longer interval, which suits some patients more than others.

Looking Ahead

Researchers are testing combinations that act on several pathways at once, oral drugs that reach the retina, and gene therapies delivered once.

A realistic expectation is that treatments will become less frequent and more personalized over the next decade, while early detection stays the key to good vision.

Patients should be told that the goal is lasting vision, and that regular review remains part of care even when injections are spaced out.

For the latest studies, see the PubMed results for new treatments for neovascular AMD.

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References

1. Heier JS, Khanani AM, Quezada Ruiz C, et al. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet. 2022;399:729-740.
2. Lanzetta P, Korobelnik JF, Heier JS, et al. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet. 2024;403:1141-1152.
3. Holekamp NM, Campochiaro PA, Chang MA, et al. Archway randomized phase 3 trial of the port delivery system with ranibizumab for neovascular age-related macular degeneration. Ophthalmology. 2022;129:295-307.
4. American Academy of Ophthalmology. Basic and Clinical Science Course, Section 12: Retina and Vitreous. AAO; current edition.