{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T11:03:49Z","timestamp":1772017429690,"version":"3.50.1"},"reference-count":45,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: The management of neovascular age-related macular degeneration (nAMD) is constrained by diminishing therapeutic options for retina specialists and their patients when the disease reaches its end stages. Methods: Clinical insights emerge from two case narratives in which patients benefitted from discontinuation of anti-VEGF therapy. Results: Long-term management of nAMD with intravitreal injections of agents targeting vascular endothelial growth factor (VEGF) is crucial for slowing progression of the disease and is generally well-tolerated. However, vision often declines as the disease progresses over time, even with treatment. This article presents strategies for aligning therapeutic goals with their expected visual outcome when an eye has reached end-stage disease. It addresses considerations for how and when to stop treatment when vision becomes limited, taking into consideration the visual status of the fellow eye and incorporating input from low vision specialists who can better assess best-corrected visual acuity (BCVA) and optimize the visual function of patients. We also acknowledge the potential benefits of switching either the dose or the agent that targets VEGF to alter the long-term visual outcome of treatment. Finally, we discuss the importance of taking into consideration related manifestations of the disease, such as macular scarring, geographic atrophy, or other retinal or optic nerve diseases which may limit vision and thus the utility of continued nAMD treatment. Conclusions: Building a strong patient\u2013physician relationship is essential for navigating the shared decision-making process of when to stop treatment for nAMD.<\/jats:p>","DOI":"10.3390\/jpm15100487","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T07:17:52Z","timestamp":1760512672000},"page":"487","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating the Decision to Discontinue Intravitreal Injection Therapy in End-Stage Neovascular Age-Related Macular Degeneration"],"prefix":"10.3390","volume":"15","author":[{"given":"Justin","family":"Bennie","sequence":"first","affiliation":[{"name":"Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA"},{"name":"Division of Ophthalmology, Department of Surgery, UMass Chan\u2014Lahey School of Medicine, 31 Burlington Mall Rd, Burlington, MA 01805, USA"},{"name":"Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5504-812X","authenticated-orcid":false,"given":"David J.","family":"Ramsey","sequence":"additional","affiliation":[{"name":"Division of Ophthalmology, Department of Surgery, UMass Chan\u2014Lahey School of Medicine, 31 Burlington Mall Rd, Burlington, MA 01805, USA"},{"name":"Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA"},{"name":"Biomedical Sciences and Disease, New England College of Optometry, 424 Beacon St, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"9.e12","DOI":"10.1016\/j.ajo.2013.08.010","article-title":"Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: An evidence-based systematic review","volume":"157","author":"Wong","year":"2014","journal-title":"Am. 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