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Age-related macular degeneration (AMD) is a leading cause of severe, irreversible vision impairment in developed countries (Friedman et al., 2004; Klein et al., 1992). Although an estimated 80% of patients with AMD have the non-neovascular form, the neovascular form is responsible for almost 90% of severe visual loss (visual acuity 20/200 or worse) resulting from AMD (Ferris et al., 1984). There was no effective treatment for most of the neovascular AMD lesions till 2004. By this time, the role of vascular endothelial growth factor (VEGF) in neovascular AMD became obvious and anti-VEGF agents emerged for this purpose. Pegaptanib sodium intravitreal injection (Macugen; [OSI] Eyetech, New York, NY, 2004), ranibizumab intravitreal injection (Lucentis, Genentech, Inc., South San Francisco, CA, 2006) were the FDA approved treatments for AMD. The first report of intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) administration for neovascular AMD was published in 2005 (Rosenfeld et al., 2005). By early 2006, off-label intravitreal bevacizumab was used by many retina specialists as a first-line therapy for neovascular AMD because of the low cost of this drug. Wholesale prices of the medications range from $1950 per dose for ranibizumab and $995 per dose for pegaptanib, to approximately $50 per dose for bevacizumab (Champan & Beckey, 2006; Web, 2008).

Re-Treatment Strategies for Neovascular AMD: When to Treat? When to Stop?