A randomized, noninferiority trial compared ranibizumab and bevacizumab for treating neovascular age-related macular degeneration (AMD). The study enrolled 1208 patients across 44 centers, randomly assigned to four groups: monthly or as-needed injections of ranibizumab or bevacizumab. The primary outcome was the mean change in visual acuity at 1 year, with a non-inferiority limit of 5 letters. Results showed that bevacizumab administered monthly was equivalent to ranibizumab monthly, with 8.0 and 8.5 letters gained, respectively. Bevacizumab as-needed was equivalent to ranibizumab as-needed, with 5.9 and 6.8 letters gained. Ranibizumab as-needed was equivalent to monthly ranibizumab, though the comparison between bevacizumab as-needed and monthly bevacizumab was inconclusive. The mean decrease in central retinal thickness was greater in the ranibizumab-monthly group (196 μm) than in other groups (152–168 μm, P=0.03). Rates of death, myocardial infarction, and stroke were similar between the two drugs. The proportion of patients with serious systemic adverse events was higher with bevacizumab (24.1%) than with ranibizumab (19.0%). At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab as-needed had effects on vision equivalent to monthly ranibizumab. Differences in serious adverse events require further study. Bevacizumab is more cost-effective than ranibizumab, but has a higher risk of serious systemic adverse events. Both drugs significantly reduced fluid in or under the retina, with ranibizumab showing better results in fluid resolution. The study found no significant differences in rates of death, arteriothrombotic events, or venous thrombotic events between the two drugs. However, bevacizumab-treated patients had a higher rate of serious systemic adverse events, primarily hospitalizations. The study highlights the equivalent efficacy of bevacizumab and ranibizumab for AMD treatment, with bevacizumab being more cost-effective but with a higher risk of adverse events. Further research is needed to clarify the risk-benefit profile of these drugs.A randomized, noninferiority trial compared ranibizumab and bevacizumab for treating neovascular age-related macular degeneration (AMD). The study enrolled 1208 patients across 44 centers, randomly assigned to four groups: monthly or as-needed injections of ranibizumab or bevacizumab. The primary outcome was the mean change in visual acuity at 1 year, with a non-inferiority limit of 5 letters. Results showed that bevacizumab administered monthly was equivalent to ranibizumab monthly, with 8.0 and 8.5 letters gained, respectively. Bevacizumab as-needed was equivalent to ranibizumab as-needed, with 5.9 and 6.8 letters gained. Ranibizumab as-needed was equivalent to monthly ranibizumab, though the comparison between bevacizumab as-needed and monthly bevacizumab was inconclusive. The mean decrease in central retinal thickness was greater in the ranibizumab-monthly group (196 μm) than in other groups (152–168 μm, P=0.03). Rates of death, myocardial infarction, and stroke were similar between the two drugs. The proportion of patients with serious systemic adverse events was higher with bevacizumab (24.1%) than with ranibizumab (19.0%). At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab as-needed had effects on vision equivalent to monthly ranibizumab. Differences in serious adverse events require further study. Bevacizumab is more cost-effective than ranibizumab, but has a higher risk of serious systemic adverse events. Both drugs significantly reduced fluid in or under the retina, with ranibizumab showing better results in fluid resolution. The study found no significant differences in rates of death, arteriothrombotic events, or venous thrombotic events between the two drugs. However, bevacizumab-treated patients had a higher rate of serious systemic adverse events, primarily hospitalizations. The study highlights the equivalent efficacy of bevacizumab and ranibizumab for AMD treatment, with bevacizumab being more cost-effective but with a higher risk of adverse events. Further research is needed to clarify the risk-benefit profile of these drugs.