OBJECTIVES: To assess the real-world effectiveness and treatment patterns of ranibizumab and aflibercept over three years for neovascular age-related macular degeneration (nAMD) in the USA. METHODS: Data were extracted from a panel of medical retina practices across the USA, using a standardized electronic medical record (EMR) system. Treatment-naïve adult patients were included if they had a nAMD diagnosis, ≥1 ranibizumab or aflibercept prescription between July 2011 and March 2013, and at least three years of follow-up. Eyes were excluded if they discontinued or switched anti-VEGF during the follow-up period. The primary outcome was the mean (standard error [SE]) change in best corrected visual acuity (BCVA) letter score from baseline to Month 36, compared between ranibizumab and aflibercept using generalized estimating equations, adjusting for baseline BCVA, age and for clustering at the patient-level. Mean (±standard deviation [SD]) number of injection visits during the 36 months of follow-up was also compared. Eye was the unit of analysis. RESULTS: