Abstract
Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in older adults. Treat-and-extend (T&E) regimen for anti-vascular endothelial growth factor therapy are widely used to individualize treatment, yet substantial variability exists in achievable treatment intervals, and reliable baseline predictors remain unclear. This study investigates the association between baseline optical coherence tomography (OCT) biomarkers and treatment interval in eyes with nAMD treated with intravitreal aflibercept using a T&E regimen in real-world clinical settings. This retrospective study analyzed 174 treatment-naïve eyes with nAMD of 167 patients from an initial screening of 536 eyes of 333 patients. Baseline OCT biomarkers were evaluated. Subretinal fluid, intraretinal fluid, and pigment epithelial detachments were automatically quantified using convolutional neural network-based segmentation algorithms. Correlations between OCT measurements and < q12 weeks intervals at 52 weeks were analyzed. Of the 174 eyes included, 78 (44.8%) were treated at intervals < q12 weeks at 12 months. Retinal angiomatous proliferation (RAP) (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.045 − 8.022; p = 0.041), absence of intra/subretinal hemorrhage (OR, 0.381; 95% CI, 0.165 − 0.880; p = 0.024), and longer disruption of external limiting membrane (ELM) (OR, 1.094; 95% CI, 1.018 − 1.176; p = 0.014) and ellipsoid zone (EZ) (OR, 1.066; 95% CI, 1.011 − 1.124; p = 0.018) were significantly associated with < q12 weeks interval, whereas quantitative fluid measurements were not significantly associated with dosing interval. Baseline structural OCT biomarkers were associated with treatment interval requirements in nAMD managed with a T&E regimen, suggesting their potential value for early identification of patients likely to require more intensive treatment.
Data availability
The data are not available for public access because of patient privacy concerns but are available from the corresponding author on reasonable request.
Code availability
The custom code used for retinal layer segmentation and retinal fluid segmentation in this study is not publicly available but may be obtained from the corresponding author upon reasonable request, subject to institutional and ethical approvals.
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Funding
This study was supported by the research grant with an investigator-initiated trial supported by Bayer (0620215600), and the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (Information and Communication Technology, NRF-2021R1F1A1045417). The sponsor or funding organization had no role in the design or conduct of this research.
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J.H.L. acquired and analyzed the data, drafted the initial manuscript, and revised the manuscript. S-Y.L., B.J., Y-G.K. acquired and analyzed the data. C.K.Y., U.C.P., K.H.P. conceptualized and designed the study, collected data, and critically reviewed the manuscript. E.K.L. conceptualized and designed the study, coordinated and supervised data collection, analyzed the data, critically reviewed the manuscript, and revised the manuscript. All authors read and approved the final manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Seoul National University Hospital (IRB 2109-124-1257) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was waived because of the retrospective design of the study and the use of deidentified patient information.
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Lee, J., Lee, SY., Jang, B. et al. OCT biomarkers as predictors of treatment interval in neovascular age-related macular degeneration treated with intravitreal aflibercept using a treat-and-extend regimen. Sci Rep (2026). https://doi.org/10.1038/s41598-026-36751-4
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DOI: https://doi.org/10.1038/s41598-026-36751-4
