Aflibercept 8 mg treat-and-extend pathway for the treatment of neovascular age-related macular degeneration: guidance from a UK expert panel

Why this matters for people at risk of sight loss

Age-related macular degeneration is a leading cause of sight loss in older adults, and many people need frequent eye injections to protect their central vision. These regular trips to hospital are time consuming, stressful and costly for patients, families and the health service. This article describes how a higher dose of an existing drug, aflibercept 8 mg, could allow safer, longer gaps between injections, and presents a step-by-step treatment pathway agreed by UK eye specialists to help clinics use it consistently and efficiently.

The growing strain on eye clinics

Across the UK, eye clinics are struggling to keep up with the rising number of patients who need injections for wet age-related macular degeneration. Many people do not receive their first injection or early course of treatment within the recommended time, and some are lost to follow-up. This reflects staff shortages, limited clinic space and a growing, older population. At the same time, the number of injections given each year continues to climb sharply. Reducing how often injections are needed, without sacrificing vision, has therefore become a key goal for both doctors and health planners.

A longer lasting version of a familiar drug

Aflibercept has been used for years to treat this form of macular disease. The new 8 mg version contains more of the same active ingredient in each injection and is designed to last longer in the eye. In a large clinical trial called PULSAR, people who had never been treated before received either the standard 2 mg dose every 8 weeks or the 8 mg dose as rarely as every 12 or 16 weeks after an initial course of three monthly injections. At one year and almost two years, vision gains and eye scan results with the higher dose were at least as good as with the standard dose, and many patients on 8 mg were able to keep injections 12 weeks or more apart while maintaining control of disease activity.

A stepwise plan to stretch or shorten visit intervals

The expert panel used these trial results, together with UK guidance, to design a practical treat-and-extend plan for clinics. Everyone starting aflibercept 8 mg receives three monthly loading injections. After this, the next visit is usually 8 weeks later, though in carefully chosen patients with very quiet disease, this gap may be stretched up to 16 weeks. At each decision point, doctors use a vision test and a detailed eye scan to judge whether to extend, keep or shorten the gap before the next injection. If the macula is dry or stably controlled, the interval can be cautiously lengthened, up to a maximum of 24 weeks, with advice to consider extra monitoring when gaps become very long. If new fluid, bleeding or clear vision loss appears, the interval is cut back, sometimes as far as every 8 weeks or temporarily returning to monthly doses.

Guidance for switching, both eyes, and stopping

The pathway also explains when patients might move onto aflibercept 8 mg from other drugs and when they might return to an alternative. People whose disease is not well controlled despite very frequent injections, or who struggle to cope with short intervals, may benefit from switching and then slowly extending their schedule. The panel offers advice on treating both eyes at the same visit to reduce travel, on taking special care in people with glaucoma or very advanced eye damage, and on how to align injection dates when both eyes need different intervals. They caution that stopping treatment entirely carries a real risk that the disease will flare again and vision may not fully recover, so any decision to stop should follow careful discussion and ongoing checks where possible.

What this could mean for patients and services

To a person living with macular disease, the main message is that a higher dose of a familiar medicine may allow fewer injections over time while still protecting sight, provided careful monitoring continues. For eye clinics, the proposed pathway aims to give a clear, flexible framework that fits around the varying pressures across the National Health Service. While long term real world data are still building, early studies suggest that aflibercept 8 mg can extend treatment intervals for many people without adding new safety concerns. Used thoughtfully, this approach could ease crowded waiting rooms, reduce travel and worry for patients and their carers, and help protect vision with a more manageable schedule of care.

Citation: Gale, R., Awad, M.H., Bailey, C. et al. Aflibercept 8 mg treat-and-extend pathway for the treatment of neovascular age-related macular degeneration: guidance from a UK expert panel. Eye 40, 959–965 (2026). https://doi.org/10.1038/s41433-025-04180-8

Keywords: neovascular age-related macular degeneration, aflibercept 8 mg, treat and extend, intravitreal injections, retina clinic burden