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October 13, 2025
2 min read
Key takeaways:
- The average number of annual injections decreased from 8.7 in year 1 to 4.7 in year 7.
- The regimen could reduce clinical burden while maintaining “very good” long-term visual outcomes.
In a real-life setting, an observe-and-plan regimen for anti-VEGF injections in neovascular age-related macular degeneration reduced the clinical burden while improving visual acuity over the long term.
“The observe-and-plan regimen was developed to provide individually adjusted treatment frequency with anti-VEGF while reducing the clinical burden of monitoring visits. It is based on the concept that adequate future treatment intervals can be adequately predicted after the initial loading dose,” Mohamed Sherif, of University Eye Hospital Jules-Gonin, Switzerland, and colleagues wrote in Eye. “However, the absence of monitoring visits during these injection series poses a risk of unrecognized recurrence, potentially leading to vision loss.”
Sherif and colleagues retrospectively analyzed 195 eyes of 181 patients with neovascular AMD who were treated with Lucentis (ranibizumab, Genentech) or Eylea (aflibercept, Regeneron) under the observe-and-plan regimen for an average of 66 months. The primary outcome was the change in visual acuity over 7 years.
With anti-VEGF treatment, average visual acuity increased from 63 ± 17 letters at baseline to 73 ± 14 letters at year 1. By year 7, the initial benefit had decreased slightly to 70 ± 18 letters.
The average number of anti-VEGF injections per year decreased over the course of the study, from 8.7 in year 1 to 6.7 in year 2 and 5.5 in year 7. Visits were consistent, averaging 4.1 per year in year 1 and 4.7 per year in year 7.
“The major advantage of the [observe-and-plan] regimen lies in the rapid determination of the optimal treatment interval (after loading dose), followed by a series of injections according to the individualized treatment need, thereby allowing a significantly reduced number of monitoring visits while maintaining the required treatment frequency for each patient,” Sherif and colleagues wrote. “Hence, the number of visits was significantly lower than the number of injections.”
The average central macular thickness decreased significantly from 375 ± 129 µm at baseline to 276 ± 75 µm at year 1 and 279 ± 87 µm at year 7.
“The [observe-and-plan] regimen applied in real-life settings proved to be both efficient and resource-sparing in treating [neovascular] AMD, allowing for very good long-term VA outcomes while reducing the clinical burden on the medical system and patients,” the researchers wrote. “The number of injections required may be further reduced by the use of longer-acting anti-VEGF agents. However, this will also have to be demonstrated using real-life long-term studies.”
Perspective
This study evaluated the long-term effectiveness of the observe-and-plan (OAP) regimen for neovascular age-related macular degeneration over 7 years, excluding confounding retinal conditions and limiting treatment to ranibizumab or aflibercept. Findings showed sustained visual acuity gains, significant reductions in central retinal thickness and fewer injections, with patients requiring only about four monitoring visits annually.
This is clinically meaningful and relevant for optometrists working in comanagement or referral settings. OAP demonstrates that structured, proactive care can improve functional and anatomical outcomes while reducing patient and clinic burden. It provides a practical option for patients and clinics managing capacity constraints by balancing efficacy and efficiency.
However, caution is needed. The study relied on a high-sensitivity OCT device not available everywhere and had a 45% dropout rate. As a retrospective, single-center study, it did not separate outcomes by anti-VEGF agent (or analysis of switching) or compare directly with treat-and-extend or as-needed regimens. These limitations may bias the results and affect generalizability. Nevertheless, the results support OAP as a practical alternative for patients who can reliably adhere. A prospective, multicenter study would help clarify which patient groups benefit most and validate OAP role alongside other regimens in long-term neovascular AMD management.
Bismark Owusu-Afriyie, OD, MS, FAAO
Disclosures: Owusu-Afriyie reports no relevant financial disclosures.
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