Abstract: Refractory neovascular age-related macular degeneration (nAMD) is defined when intravitreal anti-vascular endothelial growth factor injection therapy results in poor response. Treatment of refractory patients determines the success or failure of treatment for nAMD. In this article, we present the definition and mechanism of refractory nAMD, and address various possible therapeutic approaches that can overcome refractoriness, such as switching drugs, increasing injection dosage or frequency, and combination therapy with photodynamic therapy or intravitreal steroid injection.