Real-world Comparison of Faricimab and Aflibercept as Second-line Therapies for Neovascular Age-Related Macular Degeneration

Purpose : To compare real-world effectiveness of faricimab versus aflibercept as second-line therapies for neovascular age-related macular degeneration (nAMD). Methods : This multicenter retrospective cohort study included patients with nAMD who switched to faricimab or aflibercept as second-line anti-VEGF therapy and were followed ≥12 months. Outcomes included best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), injection intervals, and switching rates. Multivariable linear regression identified predictors of visual and anatomical change. Results : A total of 177 eyes (88 faricimab, 89 aflibercept) were analyzed. Faricimab-treated patients had worse baseline BCVA (0.60 ± 0.42 vs. 0.46 ± 0.36 logMAR; p = 0.026) and lower CMT (329 ± 121 vs. 363 ± 96 µm; p = 0.043). At final follow-up, faricimab achieved a significant BCVA gain (−0.072 ± 0.284 logMAR; p = 0.009), while aflibercept maintained stable vision ( p = 0.465). Both agents significantly reduced CMT ( p < 0.001), with a greater mean reduction observed in the aflibercept group (−89.4 vs. −56.2 µm; p = 0.016). Final BCVA and CMT were comparable. Baseline CMT predicted anatomical improvement (B = −0.510; p < 0.001) and baseline BCVA predicted visual gain (B = −0.207; p = 0.006). Conclusion : Faricimab and aflibercept demonstrated comparable real-world visual and anatomical outcomes as second-line nAMD therapies. Baseline disease severity predicted treatment response.