Age-related macular degeneration: Anti-VEGF therapy and preservation of autonomy in older adults

Abstract

Age-related macular degeneration (AMD) is a major threat to central vision in later life, and neovascular AMD can rapidly compromise reading, face recognition, mobility, driving, medication management, and other activities that support independent living. This narrative review examines how intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy contributes to preservation of functional autonomy in older adults, while accounting for treatment burden, adherence, bilateral disease, multimorbidity, and caregiver dependence. A literature search conducted in 2026 used PubMed/MEDLINE and the American Academy of Ophthalmology Preferred Practice Pattern as the principal sources, prioritizing pivotal trials, contemporary randomized studies, systematic reviews, guidelines, and patient-reported outcome research. Ranibizumab, bevacizumab, aflibercept, faricimab, and newer high-dose aflibercept strategies provide strong evidence for visual stabilization or improvement in neovascular AMD, with increasingly durable regimens reducing injection frequency for many patients. However, autonomy is not determined by visual acuity alone. Daily function, driving, falls, emotional health, treatment logistics, and caregiver time are clinically relevant and may diverge from ana tomic outcomes. Anti-VEGF therapy is therefore best understood as a vision-preserving platform whose functional value depends on timely treatment, sustained adherence, individualized dosing, bilateral visual status, and integration of geriatric and low-vision support.