IMPORTANCE To assess the impact of injection frequency on visual outcomes in patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal aflibercept. BACKGROUND The UK licence for treatment of nAMD with aflibercept is based on the VIEW protocol. We tested the hypothesis that patients receiving fewer than the eight recommended injections in the first year would experience worse visual outcomes. DESIGN Retrospective, single-centre observational study. PARTICIPANTS There were 42 eyes from 42 patients included. METHODS Fight Retinal Blindness! software was used to record real-world outcomes of all treatment-naïve eyes receiving aflibercept for at least 1 year. MAIN OUTCOME MEASURES Visual acuity (VA) at 1 year in eyes which received the recommended eight injections versus those receiving seven or fewer injections. RESULTS There were 21 eyes (50%) that received the recommended eight aflibercept injections in the first year of treatment, whilst 14 eyes received seven injections, five received six injections and two received only five injections, with median VA change +7.0, +5.0, -4.0 and -6.5 LogMAR letters, respectively. Those eyes receiving seven or fewer injections had worse baseline vision. The main reasons for patients being undertreated were insufficient clinic capacity and non-attendance due to illness. CONCLUSIONS AND RELEVANCE Patients in the real-world receiving aflibercept for nAMD at fixed intervals as per UK licence could achieve similar visual improvement at 1 year compared with phase III clinical trials. Undertreated patients had worse visual outcomes. Measures need to be introduced to increase clinic capacity and closely follow non-attenders to improve future outcomes.