We thank Venkatesh and associates for their interest in our article and for their comments. They noted that 50% of eyes did not show resolution of fluid while receiving as-needed aflibercept injections. In our study, 87% of eyes became completely dry at some point, 50% of eyes achieved a completely dry retina following 3 consecutive every-other-month aflibercept injections, and 32% of eyes gained 1 or more lines of vision at last follow-up. Therefore, the response rate was better than mentioned by them. Also, it is important to note that the patients in our study were not treatment-naïve patients; all were previously treated with either bevacizumab or ranibizumab. In the VIEW 1–2 studies, every-other-month aflibercept treatment reduced treatment burden while maintaining noninferiority to monthly ranibizumab in treatment-naïve patients. Thus, it would be inappropriate to make direct comparisons of the treatment regimens between the 2 studies.
Interestingly, as mentioned in our article, the CATT trial demonstrated that 51.5% of the ranibizumab group and 67.4% of the bevacizumab group treated monthly had persistent fluid. While our study suggests that many of the patients may achieve retinal dryness and improved vision after switching to a regimen using aflibercept, there will still be a number of patients who do not.
We thank Venkatesh and associated for their suggestion; we agree that the decision to switch treatment regimens for patients is a clinical decision that should be based on the visual prognosis, which may be guided by baseline optical coherence tomography characteristics, such as preserved outer retinal integrity and vision at baseline; however, our results suggest that aflibercept still is effective treatment in eyes with persistent and recurrent neovascular age-related macular degeneration.