Recommendations of the treat-and-extend regimen for neovascular age-related macular degeneration: 2020 updates

Anti-vascular endothelial growth factor (anti-VEGF) treatment is the gold standard of care for neovascular age-related macular degeneration (nAMD). To strike a balance between treatment burden and vision improvement, a treat-and-extend (T&E) regimen is the preferred approach to administer anti-VEGF treatment. To facilitate implementation of the T&E regimen for nAMD in Hong Kong, a panel of retinal experts, with the support of Bayer Healthcare, held an online meeting on 15 September 2020 to discuss the latest published evidence and clinical experiences regarding the suitability and safety of anti-VEGF agents in the T&E regimen, patient selection, retreatment criteria, considerations for treatment discontinuation, and barriers to implementing the T&E regimen. Compared with the 2019 recommendations, this 2020 version contains several major updates including differentiation of fluid compartments in retreatment criteria, additional considerations for patient selection, streamlined criteria for treatment cessation, and applicability of the T&E regimen in patients with polypoidal choroidal vasculopathy (PCV). These updated recommendations are expected to facilitate implementation of the T&E regimen for nAMD including PCV in Hong Kong, with the aims of improving patient visual acuity, lowering treatment burden, and facilitating service capacity planning over the long term.