Wet age-related macular degeneration requires long-term anti-VEGF injections to suppress abnormal vessel growth and prevent central vision loss. Two treatment protocols dominate clinical practice: fixed monthly dosing and treat-and-extend, where injection intervals are gradually lengthened based on OCT response. The choice between them affects how many clinic visits a patient needs each year, the total injection burden, and ultimately how well vision is maintained over time.

According to Dr. Mayank Bansal, a leading retina specialist at the Best Eye Hospital in Delhi, “Treat-and-extend has become the preferred protocol for most wet AMD patients because it personalises the dosing interval to each eye’s disease activity rather than applying a fixed schedule regardless of response.”

How Do the Two Protocols Compare?

Both protocols begin with a loading phase of three monthly injections. After that, the approach diverges based on how the retina responds on OCT at each review.

Patients who cannot commit to regular OCT monitoring are better suited to fixed monthly dosing, where the schedule is predictable and adherence is easier to track. For a full overview of the injection agents used across both protocols, read our blog on eye injections.

What Determines Which Protocol Is Right?

Protocol selection is not purely clinical. Follow-up reliability, travel burden, and the agent being used all factor into the decision.

• OCT fluid at loading phase end: Patients who achieve a completely dry macula after three loading injections are strong candidates for treat-and-extend. Those with persistent fluid need close monthly monitoring before any interval extension is attempted.
• Injection agent used: Brolucizumab and Aflibercept both support treat-and-extend well, reaching maximum stable intervals of 12 and 16 weeks respectively. Ranibizumab biosimilars are more commonly run on fixed monthly schedules given their shorter duration of action.
• Patient geography and travel access: For patients travelling from abroad, treat-and-extend meaningfully reduces annual trips. Reaching a stable 12-week interval cuts visits from 13 to roughly 4 to 5 per year.
• Disease severity at presentation: Late presenters with extensive subretinal fluid or pigment epithelial detachment at baseline need longer loading before interval extension is appropriate. Rushing to extend in these eyes risks fluid recurrence and vision loss.
• Bilateral disease: When both eyes require injections, treat-and-extend allows synchronisation so both are treated on the same visit once intervals align, cutting the annual clinic burden significantly.

The protocol that preserves vision best is the one the patient can actually follow consistently over years, not just in the first few months. Pairing the right agent with a dosing schedule the patient can realistically sustain is what drives durable long-term outcomes. For AMD-specific treatment protocols and what to expect at each stage, the macular degeneration treatment page covers the full pathway.

Why Choose Dr. Mayank Bansal ?

Dr. Mayank Bansal is MD (AIIMS), FRCS (Glasgow), FACS, with a retina fellowship at UCLA. Over 15 years of vitreoretinal practice managing wet AMD across all stages, with OCT-guided treat-and-extend protocols used as standard across all injection patients. Bilateral AMD cases are synchronised to single-visit scheduling where clinically appropriate to reduce patient burden. International patients receive full coordination including accommodation support, scheduling, and structured discharge summaries for handover to their treating ophthalmologist at home.