Jay Sheth
Anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed the management of macular neovascularization and other retinal vascular disorders; however, treatment burden, variable response, and cost continue to limit real-world outcomes. This Commentary presents an evidence synthesis from a curated collection of articles, focusing on three intersecting priorities: expanding access through biosimilars with comparable efficacy and safety profiles; optimizing treatment through individualized agent selection and faricimab switching paradigms; and leveraging quantitative multimodal imaging biomarkers, including advanced en-face optical coherence tomography fluid metrics, to refine disease monitoring and retreatment decisions. Emerging structural and angiographic biomarkers, including advanced en-face optical coherence tomography metrics, offer opportunities for earlier risk stratification and personalized care. In parallel, patient-centered considerations and pragmatic treatment algorithms remain essential to enhance adherence and durability of response. Together, these themes underscore a shift toward precision-guided, accessible, and evidence-based retinal care. Prospective validation and implementation research will be critical to translate these advances into sustainable clinical practice.