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Neurodevelopmental outcomes in preterm infants with retinopathy of prematurity
Hao Tan1, Patricia Blasco2, Tamorah Lewis3
1Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, OR, USA.
Insights
Anti-VEGF treatments for retinopathy of prematurity (ROP) offer benefits but raise concerns about potential neurodevelopmental effects in premature infants. Further research is needed to understand these impacts fully.
Area of Science:
- Ophthalmology
- Neonatology
- Neurodevelopmental Science
Background:
- The introduction of anti-vascular endothelial growth factor (anti-VEGF) agents has shifted retinopathy of prematurity (ROP) treatment paradigms.
- Anti-VEGF therapies offer advantages over laser treatment, including easier administration and better visual outcomes.
- Concerns exist regarding systemic absorption of anti-VEGF agents and potential neurodevelopmental effects in infants.
Purpose of the Study:
- To review existing literature on neurodevelopmental outcomes in extremely preterm infants treated for ROP with anti-VEGF agents.
- To contextualize these outcomes considering prematurity, comorbidities, and socioeconomic factors.
- To discuss methods for assessing neurodevelopmental status in this population.
Main Methods:
- Literature review of studies on neurodevelopmental outcomes in infants treated for ROP.
- Analysis of factors influencing neurodevelopment in extremely preterm infants.
- Discussion of neurodevelopmental testing and indicators.
Main Results:
- Anti-VEGF treatment for ROP is associated with potential neurodevelopmental concerns, necessitating careful evaluation.
- Extreme prematurity itself significantly impacts neurodevelopmental outcomes.
- Systemic comorbidities and socioeconomic factors also play crucial roles.
Conclusions:
- While anti-VEGF agents are effective for ROP, their long-term neurodevelopmental effects require ongoing investigation.
- Comprehensive assessment of neurodevelopment is essential for infants treated for ROP.
- Further research should focus on mitigating risks and optimizing outcomes for these vulnerable infants.
Abstract:
Over the past decade there has been a paradigm shift in the treatment of retinopathy of prematurity (ROP) with the introduction of antivascular endothelial growth factor (anti-VEGF) treatments. Anti-VEGF agents have the advantages of being easier to administer, requiring less anesthesia, having the potential for improved peripheral vision, and producing less refractive error than laser treatment. On the other hand, it is known that intravitreal administration of anti-VEGF agents lowers VEGF levels in the blood and raises the theoretical concern of intraocular anti-VEGF causing deleterious effects in other organ systems, including the brain. As a result, there has been increased attention recently on neurodevelopmental outcomes in infants treated with anti-VEGF agents. These studies should be put into context with what is known about systemic comorbidities, socioeconomic influences, and the effects of extreme prematurity itself on neurodevelopmental outcomes. We summarize what is known about neurodevelopmental outcomes in extremely preterm infants with ROP, discuss the implications for determining the neurodevelopmental status using neurodevelopmental testing as well as other indicators, and review the existing literature relating to neurodevelopmental outcomes in babies treated for ROP.
