Comparative Effectiveness of Intravitreal Ranibizumab and Aflibercept in Neovascular Age-Related Macular Degeneration

Ranibizumab and aflibercept are established intravitreal therapies for neovascular age-related macular degeneration. Their comparative effectiveness depends on the dose, treatment regimen, baseline disease and continuity of care. Evidence was assessed from pivotal trials, direct comparisons, individualized dosing studies, observational cohorts, anatomical biomarker studies, safety analyses and switching studies. VIEW supports comparable visual efficacy of conventional aflibercept and ranibizumab regimens under trial conditions, while RIVAL provides a comparison using a shared treat-and-extend strategy. Newer high-dose aflibercept evidence addresses durability against conventional aflibercept and should not be interpreted as a direct comparison with ranibizumab. Across studies, anatomical drying, visual improvement and reduced injection burden are related but distinct outcomes. Real-world results are additionally influenced by delayed visits, treatment selection and incomplete follow-up. Switching can improve anatomy in selected eyes, but uncontrolled before–after studies cannot reliably isolate the drug effect. Regimen delivery and individualized disease monitoring are central to treatment effectiveness, and superiority claims require matched populations, dosing strategies and clinically meaningful endpoints.