Treat And Extend Paradigm In Management Of Neovascular Age-Related Macular Degeneration: Current Practice And Future Directions

Introduction: With neovascular age-related macular degeneration (nAMD) being a leading cause of irreversible vision loss and its implications as a major health care burden, treatment regimens that offer practicable and sustainable approaches in the real-world setting are being explored for their efficacy. The treat and extend (TREX) approach to nAMD management allows for personalization of treatment based on patient variability of response. This has been shown to provide a superior, proactive treatment model which achieves acceptable maintenance of visual acuity and anatomical disease stability.Areas covered: Aspects of a TREX treatment approach are described based on evidence from clinical trials and real-world settings. Gaps in the current understanding of how a TREX regime is enabled are also explored.Expert opinion: A TREX approach to patients with nAMD is associated with greater visual gains compared to reactive treatment regimens. It shows potential superior outcomes in community settings compared to fixed-dosing regimens which do not allow for individualization of treatment. The chronic, progressive nature of nAMD pathogenesis requires a sustainable management strategy that is able to be further refined and applied to the use of existing, new and upcoming agents being developed for control of neovascularization.