Study Finds Wet AMD Poor-responders Need Different Monitoring Approach

The above images from the study show representative cases demonstrating distinct patterns of progressive structural deterioration in poor responders to anti-VEGF therapy. Macular atrophy didn’t achieve independent significance in the study. The authors explain that in advanced disease, fibrotic processes may obscure the functional impact of photoreceptor loss caused by macular atrophy. The bottom image shows progressive subretinal fibrosis characterised by organised hyperreflective subretinal material with posterior shadowing at worst visual outcome, corresponding to dense fibrotic scar visible on fundus examination. Photo: Lolli I, et al. Eye 2026. Click image to enlarge. For approximately one quarter of wet AMD patients, anti-VEGF injections have little effect. While central retinal thickness is considered a key monitoring parameter in wet AMD, it doesn’t seem to be as strongly linked to functional outcomes in this particular population. A study recently published in Eye tracked the structural changes that poor-response eyes undergo and found that these eyes require a focus on fibrotic changes over standard thickness-based monitoring.The study included 70 eyes of 70 treatment-naïve patients who received seven or more injections in their first year and had a 10-letter or greater visual decline from baseline. All patients underwent OCT imaging and visual acuity testing after completing loading dose therapy (baseline); upon a loss of 10 ETDRS letters; and at their worst visual outcome. Mean follow-up was 38.5 months.The researchers reported significant macular atrophy that progressed from 7% to 41% and then 81%. They also observed a significant increase in subretinal fibrosis. Their analysis suggested three distinct phases among poor-responders:Baseline. No independent predictors were identified.The 10-letter loss point. Three independent predictors emerged—subretinal fibrosis, hyperreflective material and intraretinal fluid.Fibrosis-dominated phase. Cicatricial changes were the only determinant of visual outcomes. These occurred despite morphometric control with conventional central retinal thickness monitoring.Central retinal thickness had no predictive value over the follow-up course and was considered inadequate for these patients. The observed reduction in central retinal thickness likely reflected neurodegenerative tissue loss rather than therapeutic success, the researchers noted.The researchers concluded that poor-responders experience “progressive structural deterioration that follows independent pathways from functional decline.” They emphasized the need for a different approach to monitoring that focuses on qualitative structural assessment focused on fibrotic changes rather than quantitative-based thickness metrics.Click here for the journal source. Lolli I, Grazia Pignataro M, Chiara Termite A, et al. The progressive journey of poor-responder neovascular AMD: tracking structural evolution and visual decline over time. Eye 2026. [Epub February 17, 2026]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.