Extended Dosing Intervals and Emerging Interventions for Retinal Diseases

PULSAR trial analysis shows aflibercept 8 mg permits extended dosing while maintaining efficacy—offering a pathway to reduced treatment burden for patients with polypoidal choroidal vasculopathy (PCV) and age-related macular degeneration (AMD).

The post hoc comparison evaluated visual-acuity outcomes and the proportion of patients achieving longer injection intervals versus the standard 2 mg regimen, emphasizing clinical endpoints rather than surrogate measures. Overall, the analysis indicates aflibercept 8 mg can sustain visual-acuity gains while enabling longer intervals for many patients.

This finding shifts expectations for anti-VEGF durability compared with prior 2 mg q8–12-week approaches: the higher-dose preparation produced comparable visual-acuity gains while permitting extended dosing intervals, supporting less-frequent injections in routine care for selected patients.

Nearly 90% of patients in the analysis tolerated 12–16-week injection intervals. Mean visual-acuity gains with the 8 mg preparation were comparable to the 2 mg dose, and the report prioritized achieved outcomes over mechanistic claims. As a post hoc analysis rather than a primary endpoint trial, these results warrant cautious interpretation; the most direct clinical impact is likely among patients with PCV, who were most affected by the interval findings.

Safety in this analysis was consistent with the 2 mg dose, with no new or unexpected signals reported. Operationally, practices will need to adjust scheduling templates to accommodate 12–16-week windows and refine monitoring cadence to detect interval-related changes early. Clinicians should continue routine vigilance for adverse events and follow established safety procedures when extending intervals.

Looking ahead, restorative approaches such as subretinal implants are emerging as complementary options for patients with advanced geographic atrophy or irreversible photoreceptor loss. These devices—still investigational in most settings—aim to restore visual function by directly stimulating retinal tissue or replacing degenerated cells and are best considered for patients with limited benefit from pharmacologic therapy while trials continue.

Key Takeaways:

• A post hoc PULSAR analysis indicates aflibercept 8 mg provides comparable visual-acuity outcomes with potential for extended 12–16-week dosing intervals in many patients.
• Safety appeared consistent with the 2 mg dose in this analysis; maintain structured safety monitoring and vigilance when extending intervals.
• Consider extended appointment intervals for eligible patients (eg, PCV and selected AMD cases receiving frequent injections) while awaiting confirmatory prospective data.