Background/Objectives <p>This study aimed to evaluate the long-term (7 years) outcome of visual acuity in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents following the observe-and-plan regimen.</p> Subjects/Methods <p>A total of 195 eyes from 181 patients with nAMD (mean age 79.5 ± 6.9 years), with a mean follow-up duration of 66 ± 37 months, treated with intravitreal anti-VEGF (ranibizumab or aflibercept) were included in this retrospective study. The principles of the observe-and-plan regimen were followed, with follow-up exceeding 3 years in real-life settings. Data collected included visual acuity (VA), number of injections and visits, central retinal thickness, and any complications over 7 years from baseline.</p> Results <p>The mean baseline VA was 63 ± 17 Early Treatment of Diabetic Retinopathy Study letters (Snellen equivalent 20/63), improving to 73 ± 14 at year 1. The initial visual gain was slightly reduced with a final mean VA of 70 ± 18 letters (Snellen equivalent 20/40) at year 7. The mean central macular thickness decreased significantly from 375 ± 129 at baseline to 276 ± 75 at year 1 and to 279 ± 87 at year 7. The mean annual number of injections decreased from 8.7 ± 3.2 in year 1 to 6.7 ± 3.7 in year 2 and to 5.5 ± 2.8 in year 7. The mean annual number of visits remained constant throughout, with 4.1 ± 1.3 visits in year 1 and 4.7 ± 1.7 in year 7.</p> Conclusions <p>The observe-and-plan regimen was very efficient for treating nAMD in real-life settings, reducing the clinical burden on the medical system and patients, with excellent functional and structural long-term results.</p>