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Neovascular age-related macular degeneration (nAMD) remains a leading cause of vision loss, with intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy imposing a substantial treatment burden for patients requiring frequent dosing [1, 2]. Recently, faricimab (FAR; Roche/Genentech) and high-dose 8 mg aflibercept (AFL-8 mg; Bayer/Regeneron) have been introduced with the aim of extending treatment durability [3, 4]. Real-world comparative data in previously treated, high-demand patients remain limited. We report outcomes from a consecutive Australian cohort evaluating the effect of switching to FAR or AFL-8 mg on injection interval, visual acuity and anatomical outcomes. We conducted a retrospective observational cohort study of patients with nAMD treated by five retina specialists at a single private practice. Ethics approval was obtained from The Royal Victorian Eye and Ear Hospital Human Research Ethics Committee (25/1615HL, 25/1645HL). All eyes had received at least three injections of a prior anti-VEGF agent and were switched due to the need for frequent injections, either to maintain a dry macula, having had a prior failed attempt at extension of interval due to recurrence in intraretinal (IRF) or subretinal fluid (SRF) or if they had persistent IRF or SRF despite monthly injections. The decision to switch to FAR or AFL-8 mg was based on the Pharmaceutical Benefits Scheme (PBS) listing of the drugs. From January 2024 until October 2024, all eligible patients who gave consent were consecutively switched to 0.05 mL 6 mg FAR. Data from each visit (until October 2025) were collected. Following the PBS listing of AFL-8 mg in October 2024, all eligible and consenting patients with inadequate response were consecutively switched to 0.07 mL AFL-8 mg. Data were collected until October 2025. Following commencement of FAR or AFL-8 mg, a treatment interval matching regimen was initiated at the interval determined on the prior anti-VEGF agent. If eyes maintained stable vision and had a dry macula on OCT following switch, an individualised treat-and-extend protocol was followed. All eyes received a minimum of three injections of FAR or AFL-8 mg post-switch (see Supporting Information for full methodology). The primary outcome was the change in mean injection interval, comparing the three injections immediately prior to the switch with the mean of the last three injections up to 12 months post-switch. Best-corrected visual acuity (BCVA; ETDRS letters) and central subfield thickness (CST) on spectral-domain OCT were collected at each visit. A total of 100 eyes of 88 patients met the inclusion criteria: 58 eyes (50 patients) switched to FAR and 42 eyes (38 patients) to AFL-8 mg. Baseline characteristics were broadly similar between groups, although the faricimab-switched cohort had a longer duration of prior treatment and longer post-switch follow-up. Mean pre-switch injection intervals were comparable (FAR 7.0 weeks vs. AFL-8 mg 7.4 weeks, p = 0.387) (Table 1). Switching to either agent resulted in a statistically significant extension of treatment intervals. Eyes switched to FAR achieved a mean interval increase of 1.2 weeks (from 7.0 to 8.2 weeks, p < 0.001), while those switched to AFL-8 mg similarly gained 1.2 weeks (from 7.4 to 8.6 weeks, p = 0.002). The proportion of eyes extended by at least 2 weeks post-switch was 29% (FAR group) and 38% (AFL-8 mg group) (Figure 1). Anatomical outcomes improved in both groups. CST decreased by a mean of 24 μm (331 to 307 μm) in the FAR cohort and 22 μm (326 to 303 μm) in the AFL-8 mg cohort (both p < 0.01). Visual outcomes differed modestly. BCVA improved by a mean of 3.2 letters (68 to 72.1 letters, p = 0.014) following switch to AFL-8 mg, whereas no significant change was observed following switch to FAR (−1.9 letters from 63.7 to 61.8, p = 0.078). Adverse events were uncommon, with two cases of mild anterior uveitis following FAR. These resolved with topical corticosteroids and reverting to the original anti-VEGF agent. No cases of retinal vasculitis were observed. One patient with longstanding hypertension in the AFL-8 mg cohort developed a central retinal vein occlusion unrelated to treatment. Our results are broadly consistent with other real-world studies evaluating agent-switching in refractory nAMD, where reported gains typically range from −0.7 to +3.7 weeks [5]. These intervals are substantially less than those observed in treatment-naïve eyes in pivotal clinical trials TENAYA and LUCERNE for FAR, and PULSAR for high-dose AFL-8 mg. The discrepancy between real-world and clinical trial findings likely reflects differences in baseline disease chronicity, treatment resistance and adherence to fixed-interval dosing protocols. The limitations of our study include the retrospective design, modest sample size and more extensive follow-up in the FAR cohort. Nevertheless, the consecutive nature of the cohort and standardised treat-and-extend approach reflect contemporary Australian practice. In summary, our findings demonstrate that in a real-world cohort of high-demand, previously treated nAMD patients, switching to either FAR or AFL-8 mg provides a similar modest but clinically meaningful extension of injection interval. This equates to around one fewer injection per year, alongside improved anatomical stability. The magnitude of benefit is smaller than that reported in clinical trials of treatment-naïve eyes, likely reflecting a subgroup with greater disease chronicity and treatment resistance [3, 4]. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request. Data S1: Supporting Information—Methodology Expanded. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.