The clinical significance and prognostic implications of residual subretinal fluid (SRF) in patients being treated for wet age-related macular degeneration (AMD) were the subjects of a debate at the recent AAO 2026 Annual Meeting. The role of fluorescein angiography (FA) in wet AMD was also debated at the meeting.

Following these presentations, featured expert Rishi P. Singh, MD, FASRS, was interviewed by Conference Reporter Editor-in-Chief Tom Iarocci, MD. Clinical perspectives from Dr Singh on these findings are presented here.

At AAO 2026, there was a debate between Anat Loewenstein, MD, and Avni Patel Finn, MD, on whether wet AMD can tolerate SRF. Dr Loewenstein argued that wet AMD tolerates SRF, while Dr Finn argued that it does not. Dr Loewenstein cited data from the CATT and HARBOR trials showing that eyes with residual SRF can still do quite well. You do not need to dry the retina completely, and you get a good visual outcome at 1 or 2 year(s). Other randomized studies, such as the FLUID and TOLERANT trials, have also supported the finding that residual SRF can be tolerated and does not affect final visual outcomes. Dr Finn’s counterpoint was that some of these studies were very narrow in their patient selection, in that they included only patients with residual SRF under 200 μm. However, the clearing of residual SRF does have a functional benefit, as the HARBOR trial also showed.

Just to break it down from my perspective, I think we have learned that if you look at the artificial intelligence data, which are really the true value or quantification of the fluid, all fluid matters, whether it is residual SRF, intraretinal fluid, or subretinal pigment epithelial fluid. We saw this demonstrated in the artificial intelligence–based post hoc analysis of the HAWK and HARRIER trials.

We do not tolerate any of these fluid compartments routinely. They all have negative prognostic value for visual outcomes, and I think that tolerating some of these fluid levels may contribute to macular atrophy. There are some studies that I have coauthored in which we looked at large fluid fluctuations in patients with wet AMD and ultimately found that overtreating these individuals really helps reduce these fluid fluctuations compared with undertreating them.

Now, if you see persistent fluid, sometimes that is not undertreatment, but rather the wrong diagnosis. So, it is important to make sure that this is not a masquerade syndrome mimicking wet AMD and to determine whether the fluid persistence is active or passive. Ask yourself: Do the findings suggest active disease, or is this just retinal degeneration or retinal pigment epithelial dysfunction, which might not be active? I think that FA is usually the best option in this case for figuring out the differences. Treatment frequency also matters, and tightening the frequency to every 4 weeks can tell you whether you are using the right drug regimen in these patients. The truth is that even high-frequency treatment and treatment delivered through a port delivery system do not lead to macular atrophy in these patient populations.

Also at AAO 2026, there was a debate between John T. Thompson, MD, and Jennifer Irene Lim, MD, on the role of FA in the management of AMD. Dr Thompson argued that FA is still essential when managing AMD, including wet AMD, and Dr Lim argued that it is not essential. Dr Thompson showed that FA has sensitivity and specificity issues compared with optical coherence tomography (OCT) angiography, which matches my experience as well. However, OCT angiography is not 100% sensitive or specific either. Dr Lim also emphasized the risk of dyes and obtaining intravenous access with FA.

Ultimately, I believe that both FA and OCT angiography have a role to play in the management of AMD. Therefore, I think that it is important to have both tools at our disposal, depending on the clinical scenario.