The authors report on a retrospective study of neovascular age-related macular degeneration (AMD) patients treated with a variable ranibizumab dosing regimen over a period of four years (from January 2007 to December 2011). A total of 600 treatment naïve eyes of 555 patients aged 50 years or older, vision of 0.05 or better and foveal involvement were included in the study. Upon diagnosis, three 0.5mg ranibizmuab intravitreal injections were administered at intervals four weeks apart. The third injection was followed by a clinical examination one month later. If there was activity from the neovascular AMD, intravitreal ranibizumab was administered one at a time. If there was no further activity, follow-up was scheduled four to six weeks later, and then extended to eight to 12 weeks. Patients were discontinued from treatment if there was no AMD activity after six to seven months of observation, or if there was a lack of treatment response or if vision remained persistently <0.05. As expected, the mean vision improved from 0.24 at baseline to 0.18 at four years. Overall, 408 eyes of 381 (around two thirds) patients had treatment discontinued, mainly due to poor vision (169 eyes; 28.2%) followed by inactivity (120 eyes; 20.0%). Of the 120 eyes with discontinued treatment due to disease inactivity, only 20 (16.7%) were referred back due to disease activity, by which time vision had decreased significantly from 0.38 to 0.15. A total of 7,584 injections were given, with the mean number of injections being 5.5 per year. The ocular complication rate was low at 0.2%, with serious complications occurring in only three eyes – one rhegmatogenous retinal detachment and two infective endophthalmitis. In terms of the fellow eye, one third needed treatment during the four year period. This study reaffirms the successful outcomes of ranibizumab injections for neovascular AMD in an as-required model that resembles what happens clinically in most hospitals.