•To evaluate the activation rate of quiescent type 1 macular neovascularization (MNV)

•To identify OCTA–derived predictors of conversion to exudative disease.

•A retrospective longitudinal cohort study

•Inclusion Criteria: Eyes with treatment-naïve quiescent MNV associated with AMD or polypoidal choroidal vasculopathy.

•Structural OCT and OCTA parameters were analysed at baseline and during follow-up.

•Activation Definition: Development of intraretinal or subretinal fluid or haemorrhage requiring anti-VEGF therapy.

•Follow up period: 35.9 months

•17 out of 50 eyes progressed to exudative disease

•Neovascular area enlargement and increased branching complexity was seen in 29%, hypointense halo formation in 47.1% and increasing pigment epithelial detachment dimensions were seen in 23.5% of activated eyes.

•OCTA-derived vascular remodelling features are strong predictors of activation in quiescent type 1 MNV.

•Incorporating these biomarkers into clinical surveillance protocols may improve risk stratification and enable earlier detection of conversion.