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Real-World Visual Outcomes of Laser and Anti-VEGF Treatments for Retinopathy of Prematurity
Bradley S Gundlach1, Artemiy Kokhanov2, Marie Altendahl2
1From the Department of Ophthalmology (B.S.G., S.Y.S., S.F., J.D., S.P., M.K., I.T.), University of California Los Angeles, Los Angeles, California, USA.
Insights
Anti-vascular endothelial growth factor (anti-VEGF) therapy shows improved visual outcomes in retinopathy of prematurity (ROP) compared to laser treatment. This is especially true for posterior ROP, reducing amblyopia and other adverse effects.
Area of Science:
- Ophthalmology
- Neonatal Care
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Early screening and timely treatment are crucial for preventing severe visual impairment in premature infants.
- Understanding the long-term visual outcomes of different ROP treatments is essential for optimizing patient care.
Purpose of the Study:
- To characterize and compare the visual outcomes in premature infants screened for retinopathy of prematurity (ROP).
- To evaluate the efficacy of anti-vascular endothelial growth factor (anti-VEGF) therapy versus laser therapy in managing ROP.
- To identify risk factors associated with adverse visual outcomes in treated ROP patients.
Main Methods:
- A retrospective, interventional case series included 175 infants (350 eyes) undergoing ROP screening and follow-up at UCLA Medical Centers.
- Data collected included birth characteristics, ROP severity, and treatment type (anti-VEGF or laser therapy).
- Adverse visual outcomes such as myopia, strabismus, amblyopia, macular dragging, and optic atrophy were analyzed.
Main Results:
- Anti-VEGF therapy was associated with a decreased incidence of amblyopia compared to laser treatment (aOR=0.6-0.86, P < .0001).
- No significant differences were found in optic atrophy, strabismus, or myopia rates between the treatment groups.
- Infants receiving laser therapy showed higher rates of severe myopia, amblyopia, and optic atrophy than those not treated.
Conclusions:
- Anti-VEGF therapy offers advantages over primary laser treatment for ROP, particularly for posterior segment disease.
- These findings support the use of anti-VEGF agents in managing ROP to improve visual prognoses.
- Further research can explore long-term visual development and potential complications associated with both treatment modalities.
Purpose:
To characterize visual outcomes in children screened for retinopathy of prematurity (ROP).
Design:
Retrospective, interventional case series.
Methods:
Patients who received ROP screening examinations at UCLA Medical Centers and were followed with outpatient eye examinations at Stein Eye Institute and/or Doheny Eye Institute (Los Angeles, California) were included. Data were collected on birth characteristics, worst type of ROP, and ROP treatment. Adverse visual outcomes included myopia, strabismus, amblyopia, macular dragging, and optic atrophy. Snellen visual acuity was reported for children 4 years and older.
Results:
A total of 175 infants (350 eyes) were included for analysis (mean gestational age = 28.2 weeks and birth weight = 1059 g) from a screening population of 539 infants (1078 eyes, 32.4% follow-up) over a 9-year period. Fifteen eyes received primary anti-vascular endothelial growth factor (anti-VEGF) therapy, whereas 59 eyes received primary laser therapy. Primary anti-VEGF therapy, as compared with primary laser treatment, was associated with a decreased incidence of amblyopia (adjusted odds ratio [aOR] = 0.6-0.86, P < .0001) after controlling for gestational age and birth weight. The rates of optic atrophy (P = .79), strabismus (P = .98), and myopia (P = .93) were not different between anti-VEGF and laser treatment groups. Infants receiving anti-VEGF therapy had more posterior disease than laser-treated infants (P = .041). Infants receiving laser therapy were more likely to have severe myopia (aOR = 1.02-1.3, P = .023), amblyopia (aOR = 1.12-1.61, P = .002), and optic atrophy (aOR = 1.01-1.32, P = .045) than infants not treated.
Conclusion:
These findings add to the advantages of anti-VEGF treatment compared with primary laser treatment, particularly in posterior ROP.
