Artificial Intelligence for Predicting Treatment Response in Neovascular Age Macular Degeneration with Anti-VEGF: A Systematic Review and Meta-Analysis

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss; anti-vascular endothelial growth factor (anti-VEGF) therapy is standard care for neovascular AMD (nAMD), yet treatment response varies. We systematically reviewed and meta-analyzed artificial intelligence (AI) and machine learning (ML) models using optical coherence tomography (OCT)-derived information to predict anti-VEGF treatment response in nAMD. PubMed, Embase, Web of Science, and IEEE Xplore were searched from inception to 18 December 2025 for eligible studies reporting threshold-based performance. Two reviewers screened studies, extracted data, and assessed risk of bias using PROBAST+AI; pooled sensitivity and specificity were estimated with a bivariate random-effects model. Seven studies met inclusion criteria, and six were synthesized quantitatively. Pooled sensitivity was 0.79 (95% CI 0.68–0.87), and pooled specificity was 0.83 (95% CI 0.62–0.94), with substantial heterogeneity. Specificity tended to be higher for long-term and functional outcomes than for short-term and anatomical outcomes. Most studies had a high risk of bias, mainly due to limited external validation and incomplete reporting. OCT-based AI models may help stratify treatment response in nAMD, but prospective, multicenter validation and standardized outcome definitions are needed before routine use; current evidence shows no consistent advantage of deep learning over engineered radiomic features.