What happens when patients with neovascular age-related macular degeneration (nAMD) show suboptimal response to faricimab (Vabysmo, Genentech/Roche) and are switched to high-dose aflibercept (Eylea HD, Regeneron)? Ben Young, MD, moderates a discussion with Pheobe Mellen, MD, and Jordan Deaner, MD, exploring real-world outcomes from a retrospective study of 135 eyes. The group dives into the implications for clinical practice and tries to parse apparently conflicting data regarding anatomic changes. Drs. Mellen and Deaner reflect on their own approaches to treating recalcitrant cases and debate what this paper means for the future of anti-VEGF therapy.