In the fight against neovascular age-related macular degeneration (AMD), there are three heavyweights in the arena: ranibizumab, aflibercept, and bevacizumab. Although bevacizumab is commonly used off-label, ranibizumab and aflibercept are both indicated for the treatment of neovascular AMD. But which to choose?

It’s known that all three are roughly similar in terms of efficacy and safety – aflibercept’s approval was based on the Phase III VIEW trials which found that it was non-inferior to ranibizumab (1),(2), and the CATT trial showed comparable outcomes with both ranibizumab and bevacizumab (3). But we also know that the real-world outcomes of patients receiving ranibizumab for the treatment of neovascular AMD don’t match those in the clinical trials (4). So across all of the “heavyweights,” is there a best choice amongst them in the real world?