Introduction <p>The evolution of treatment patterns in neovascular age-related macular degeneration (nAMD) warrants investigation into the impact of patients’ adherence to anti-vascular endothelial growth factor (VEGF) treatment on visual outcomes. This retrospective, non-randomized, non-comparative study aimed to investigate real-world adherence to anti-VEGF treatment.</p> Methods <p>Patient (eyes) (≥ 50 years) with a diagnosis of nAMD who had a first injection of aflibercept or ranibizumab between January 2016 and December 2018 and 12 months of follow-up were included. Visual acuity (VA; logMAR letters) and duration of injection intervals were recorded. Adherence was defined as &lt; 20% of visits deviating from the schedule by ≥ 14 days.</p> Results <p>Overall, 133 patient eyes were included: 129 adherent, and four non-adherent. Mean (standard deviation) baseline VA was 57.0 (23.6) and 53.8 (35.3) letters in adherent and non-adherent patient eyes, respectively. Mean change in VA by month 12 was higher in adherent (6.3 letters) than non-adherent patient eyes (− 11 letters). Compared with the previous visit, adherent visits were associated with a mean increase in VA of 0.67 letters and non-adherent visits with a decrease of 2.30 letters.</p> Conclusions <p>These results emphasize the importance of adherence to appropriate dosing regimens to optimize visual outcomes in patients with nAMD.</p>