Background <p>To evaluate the outcome of treat and extend (T&amp;E) for neovascular age related macular degeneration (nAMD) at 12, 18 and 24 months and the impact of clinical characteristics on treatment success defined as extension of treatment interval to ≥12 weeks and functional improvement or stability.</p> Methods <p>Visual and anatomical outcomes evaluated by optical coherence tomography (OCT) and extension of treatment interval to ≥12 weeks were analyzed retrospectively. Clinical factors effective on extension of the treatment interval and visual outcome were evaluated.</p> Results <p>There were 138 eyes with at least 18 months of follow-up. Patients exhibited a significant improvement in visual acuity and reduction in central subfield thickness (CST), subretinal fluid (SRF), intraretinal fluid (IRF) and pigment epithelial detachment (PED) at both the 12^th and 18^th months. There was recurrence of IRF and a reduction in gain of visual acuity at 24 months. In 15.2%, 36.2% and 40.6% of eyes, the treatment interval could be extended to ≥12-weeks at 12, 18 and 24 months. Presence of a large PED was found as the only independent variable effecting extension of treatment interval to 12 weeks at 18 months. Baseline BCVA of &gt;20/100 and no IRF at baseline were identified as independent predictive factors for better visual acuity at 18 months.</p> Conclusion <p>Presence of IRF and a visual acuity of ≤20/100 at baseline were found to be negative predictors for visual prognosis, while large PED was a negative predictive factor for less frequent treatment, but it did not affect visual outcome. Treatment interval should be extended cautiously in patients with baseline intraretinal fluid and visual acuity of ≤20/100 in order to balance decreasing the burden of treatment by longer treatment intervals with improvement of visual gain.</p>