Treat-and-Extend Strategies with Second-Generation Anti-VEGF in Patients with Retinal Vascular Diseases

In this segment, Dr. Harit Bhatt and Dr. Deepak Sambhara discuss the evolution of treat-and-extend (T&E) protocols for AMD and DME in the era of durable, second-generation anti-VEGF therapies. Dr. Bhatt explains his growing confidence in extending intervals more aggressively, using OCT stability as the key determinant for decision-making—favoring anatomical plateau and visual maintenance over absolute dryness. Dr. Sambhara agrees, noting that pivotal trials such as PULSAR, PHOTON, and YOSEMITE/RHINE have reshaped clinicians’ comfort with longer intervals. He also highlights insights from DRCR Retina Networks Protocol AO, which explores home OCT-guided dosing with faricimab, revealing new understandings of daily fluid dynamics and individualized response patterns. Both physicians emphasize a nuanced, patient-specific approach—accepting minimal, stable subretinal fluid in exchange for fewer visits and sustained vision. Together, they illustrate how advanced imaging and real-world confidence are redefining disease monitoring and extending treatment durability in retinal vascular disease management.