Abstract: Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in the elderly population. Although anti-vascular endothelial growth factor (anti-VEGF) therapy has become the first-line treatment for nAMD, patient responses vary considerably. This article systematically reviews the value of OCT and OCTA imaging biomarkers in predicting anti-VEGF treatment response in nAMD. The presence of intraretinal fluid (IRF), subretinal hyperreflective material (SHRM), pigment epithelial detachment (PED), outer retinal tubulation (ORT), larger macular neovascularization (MNV) area, higher fractal dimension (FD), and higher lacunarity are associated with poor treatment response and worse visual prognosis, whereas the presence of baseline subretinal fluid (SRF) is associated with favorable visual outcomes. In addition, qualitative morphological features of MNV, including vascular loops and peripheral anastomotic arches, help assess lesion activity and predict treatment resistance. Identification of these biomarkers and their predictive value may facilitate early recognition of hyporesponders or non-responders, enable adjustment of treatment regimens, and prevent further vision loss.

Key words: Neovascular age-related macular degeneration, Optical coherence tomography, Optical coherence tomography angiography, Biomarker