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The purpose of the study was to assess the association of macular atrophy (MA) according to the activity of macular neovascularisation using optical coherence tomography (OCT) in patients with neovascular age‐related macular degeneration (nAMD). A total of 973 eyes were eligible for analysis. Only SRFL eyes had a lower risk of developing subfoveal MA and extrafoveal MA than IRFL eyes. IRFL eyes had lower visual acuity (VA) (54.5 letters) and the highest proportion of eyes with vision ≤35 letters (25%) at five years, while only SRL eyes had comparable 5‐year VA (63.7 letters) to inactive eyes (63.7 letters). Based on the study findings, the subretinal fluid protects against MA. Distinguishing the compartment of retinal fluid and understanding its relationship with MA and SF can guide the management of nAMD.
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