OCT as a Dynamic Biomarker in Retinal Disease Management: Evidence, Decision Strategies, and Clinical Guidance for...

To describe how optical coherence tomography (OCT) is used in retinal disease management to aid in decision-making, including whether to treat or observe, extend or shorten dosing intervals, switch therapy, and plan or assess surgical care.

Pivotal randomized clinical trials and designs in neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) were reviewed to characterize how OCT is used within evidence-based retreatment and monitoring strategies, including newer faricimab and aflibercept 8 mg trial programs. These decision strategies were translated into scenario-based clinical guidance for real-world decision-point use.

Where randomized evidence is limited, particularly for selected surgical retina decision points, guidance reflects the authors' expert opinion as informed by available literature and common retina practice. OCT is used in trial protocols as an anatomic biomarker for nAMD, DME, and RVO to assess disease activity, treatment response and recurrence, and to determine individualized follow-up and retreatment intervals. OCT was often obtained at protocol visits during active therapy phases and at key reassessment points. When new symptoms, suspected recurrence, incomplete response, diagnostic uncertainty, or high-risk features are present, shorter assessment intervals may be appropriate.

OCT-guided, decision-linked monitoring is supported by contemporary randomized clinical trials as integral to the management of nAMD, DME, and RVO, while recognizing that OCT frequency is generally not randomized as an isolated variable. The risk of avoidable vision loss can be reduced with scenario-based retina clinical guidance that emphasizes OCT at clinical decision points, improving patient safety and enhancing individualized care.